Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0017 - Plan Administrator

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Plan Administrator is a rating organization for workers' compensation insurance
			 in Oregon that is designated as the plan administrator by the Director. The
			 National Council on Compensation Inc. is designated as the Plan Administrator.
			 The Plan Administrator shall continue to serve from the effective date of the
			 Plan unless the Plan Administrator resigns. The Plan Administrator must give
			 advance written notice of its resignation to the Director at least one year in
			 advance of the effective date of resignation.
(2) The Plan Administrator has the following
			 duties and responsibilities in addition to any others set forth in the Plan and
			 the organizing principles:
(a) Determining
			 the methodology and formula for making assignments to servicing carriers
			 pursuant to OAR 836-043-0060  and securing the necessary information in order to
			 make the assignments;
(b)
			 Developing and implementing assigned risk operating rules and forms approved by
			 the Director to the extent necessary to carry out the purposes of the
			 Plan;
(c) Processing assigned risk
			 applications pursuant to OAR 836-043-0041;
(d) Establishing written Assigned Carrier
			 Performance Standards for servicing carriers, subject to approval by the
			 Insurance Commissioner, including, but not limited to:
(A) Verification of ongoing Plan eligibility
			 of the employer;
(B) Issuance of
			 policies and endorsements;
(C)
			 Filings with administrative agencies;
(D) Maintenance of premiums on policies,
			 consistent with manual rules, rates, rating plans, and
			 classifications;
(E) Completion and
			 billing of final audits;
(F)
			 Collection of premium;
(G) Claim
			 services, including investigation, disability management and medical cost
			 control;
(H) Loss control services
			 and safety information to encourage employers to make safety a part of their
			 business;
(I) Payment of producer
			 fees;
(J) Issuance of renewal
			 proposals and non-renewal notices;
(K) Assurance of insured and insurer
			 compliance with all terms and conditions of the policy contract;
(L) Resolution of complaints and response to
			 insured and insurance producer inquiries; and
(M) Reporting financial and statistical
			 data;
(e) Monitoring
			 servicing carrier performance and enforcing Assigned Carrier Performance
			 Standards and incentives;
(f)
			 Administering the dispute resolution mechanism as provided in OAR
			 836-043-0070;
(g) Developing and
			 implementing assigned risk operating rules and forms to the extent necessary to
			 carry out the purposes of the Plan;
(h) Informing the Insurance Commissioner of
			 any insurer that is not participating in this Plan;
(i) Monitoring the performance and operation
			 of the Plan and initiating amendments thereto as appropriate;
(j) Determining the expenses for operation of
			 the Plan, including but not limited to the Plan Administrator's fees or legal
			 expenses associated with Plan matters, and assess each insurer participating in
			 the Plan for those expenses on an equitable basis as determined by the Plan
			 Administrator and approved by the Director; and
(k) Developing and administering a take-out
			 credit program as provided in OAR 836-043-0076.