Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0170 - Premium Audit Hearings

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 This rule establishes the procedure for an insured to request a hearing to
			 dispute the results of an audit, as described in a final premium audit billing
			 issued by an insurer to the insured, pursuant to ORS
			 737.318(3)(d)
			 and 737.505(4) to
			 (5). If an insured wants to request a
			 hearing, then the insured must send a written request for a hearing to the
			 Insurance Division. The Insurance Division must receive the request not later
			 than the 60th day after the insured received the final premium audit billing.
			 For the purpose of determining the date of receipt of a final premium audit
			 billing sent to the insured by mail when the receipt date is unknown to the
			 insured, the date of receipt shall be presumed to be three days after the
			 postmark date, or three days after the date of mailing, if the postmark is
			 illegible or unavailable.
(2) If
			 the Insurance Division timely receives the insured's request for a hearing, the
			 Insurance Division will send or make available to the insured a petition form.
			 In the petition, the insured must explain why it believes the billing is
			 incorrect and describe the actions the insured wants the director to take to
			 correct the matter. The petition, along with a complete copy of the final
			 premium audit billing, must be received by the Insurance Division not later
			 than the 60th day after the date the Insurance Division received the insured's
			 request for a hearing.
(3) For the
			 purposes of computing time periods specified in sections (1) and (2) of this
			 rule, ORS 174.120 and 174.125shall
			 govern.
(4) If the Insurance
			 Division determines that the insured is entitled to a hearing, the Insurance
			 Division shall notify the insured and the insurer, and also the bureau if the
			 statements in the petition of the insured address the use of the bureau rating
			 system, that the insured is entitled to a hearing and the Insurance Division
			 has requested the Office of Administrative Hearings to schedule and, if
			 necessary, conduct a hearing. The Insurance Division shall forward the
			 insured's request for a hearing and petition to the insurer, and, if helpful to
			 decide the matter, the bureau.
(5)
			 An insured may request the director to stay the collection effort of an insurer
			 on a final premium audit billing during the pendency of an insured's request
			 for a hearing, pursuant to ORS
			 737.505(5). The
			 application must allege and show good cause as required in ORS
			 737.505 by providing an
			 explanation of the alleged errors for which the insured is requesting relief.
			 The stay must apply only to the disputed amount. The director shall not decide
			 whether to grant or deny the insured's request for a stay until after the
			 Insurance Division has timely received the insured's request for a hearing and
			 completed petition and determined that the insured is entitled to a hearing.
			 The director may delegate to the Office of Administrative Hearings the
			 authority to grant or deny the insured's request for a stay.
(6) Subject to the exception provided in
			 section (7) of this rule, for purposes of ORS
			 737.318(3)(d)
			 and 737.505(4) to
			 (5), OAR 836-043-0110  and this rule, the
			 final premium audit billing of an insured is the first document issued by the
			 insurer to the insured after the insurer's initial or revised audit of the
			 insured that contains all of the elements specified in this section. Failure by
			 the insurer to include any of the elements renders the billing incomplete as a
			 final premium audit billing for purposes of ORS
			 737.318 and
			 737.505 and renders the debt
			 uncollectible until all elements are included. An invoice issued by an insurer
			 based on a payroll report without having performed an audit is not considered a
			 final premium audit billing. The elements are as follows:
(a) The results of the audit;
(b) If the final premium audit billing is
			 based on an initial audit, the amount of the difference between the estimated
			 standard premium reported by the insured for the entire policy period and the
			 final standard premium calculated after the policy period is over, pursuant to
			 the audit;
(c) If the final premium
			 audit billing is based on a revised audit, the amount of the difference between
			 the final standard premium calculated after the policy period is over, pursuant
			 to the initial audit, and the final standard premium, calculated pursuant to
			 the revised audit;
(d) If the final
			 premium audit billing is based in whole or in part on a determination by the
			 insurer that one or more persons are employees rather than independent
			 contractors, then the name of each person, a description of the positions or
			 tasks of each named person, and the basis for the determination;
(e) The notice required by ORS
			 737.318(3)(d)
			 and OAR 836-043-0110; and
(f) The
			 front page of the billing bears the title "Final Premium Audit
			 Billing."