Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0110 - Insurer Premium Audit Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The rates, rating plans and rating
			 systems filed with and approved by the Director of the Department of Consumer
			 and Business Services shall govern the audited payroll and the adjustment of
			 premiums, subject to the provisions of this rule.
(2) For the purpose of determining the
			 premium for an insurance policy producing an annual standard premium of $10,000
			 or more, the insurer must perform a field audit of the insured at least once
			 annually, except as provided in this section. For as long as the insurer
			 continues to provide coverage to an insured, when the insurer finds that the
			 audit premium difference is less than five percent for each of two consecutive
			 policy years for which the insurer provided coverage, the insurer need audit
			 only every third renewal policy subsequent to the policy most recently audited.
			 If the insurer finds at any audit that the audit premium difference is five
			 percent or greater, the insurer must again audit the insured's policy at least
			 annually until the insurer finds an audit premium difference of less than five
			 percent for each of two consecutive policy years. For each policy year for
			 which a policy is not audited, the insurer shall obtain a payroll report from
			 the insured. For purposes of this section, the basis for the audit premium
			 difference for an insured will be the audited standard premium as defined in
			 each insurer's approved rating system.
(3) An insurer shall perform a field audit of
			 at least five percent of all policies that are issued by the insurer and
			 produce an annual standard premium of less than $10,000 but more than $1,000.
			 In each year when a field audit of such a policy is not performed, the insurer
			 shall perform a desk audit or obtain a payroll report from the insured. If
			 neither a field or desk audit is performed nor a payroll report is obtained,
			 the insurer shall give satisfactory reason to the director.
(4) When an insurer performs an initial or
			 revised audit, the insurer shall send to the insured a written final premium
			 audit billing, as described in this rule and in OAR 836-043-0170.
(5) A final premium audit billing must
			 include the following wording, or substantially equivalent wording approved by
			 the director, that is prominently displayed and in not less than 12-point type:
Notice:
You, the insured, may request a hearing to
				dispute the results of the audit described in this final premium audit billing.
				If you want to request a hearing, you must send a written request for a hearing
				to the Insurance Division of the Department of Consumer and Business Services,
				State of Oregon. The Insurance Division must receive the request not later than
				the 60th day after you received this billing.
Who may request a hearing?
1. If the insured is a sole proprietor, then
			 the insured or an attorney for the insured may request a hearing.
2. If the insured is a partnership, then an
			 attorney for the partnership or any member of the partnership may request a
			 hearing.
3. If the insured is a
			 corporation, association or organized group, then an attorney for the
			 corporation, association or organized group or an authorized officer or
			 authorized employee of the corporation, association or organized group may
			 request a hearing.
4. If the
			 insured is a governmental authority other than a state agency, then an attorney
			 for the governmental agency or an authorized officer or authorized employee of
			 the governmental authority may request a hearing. Please state in your request
			 the date you received this final premium audit billing. You must send the
			 request for a hearing using at least one of the following methods:
By delivery:
Insurance Division
Department of Consumer and Business Services
350 Winter St. NE
Salem, OR 97301-3883
By mail:
Insurance Division
Department of Consumer and Business Services
PO Box 14480
Salem, OR 97309-0405
By e-mail:
DCBS. INSMAIL@state.or.us
By fax: 503-378-4351 Assistance is available on the Insurance
				Division's web page, at http://www.cbs.state.or.us/external/ins/ [File Link Not
				Available] and by e-mail, at DCBS.INSMAIL@state.or.us If the Insurance Division
				timely receives your request for a hearing, the Insurance Division will send or
				make available to you a petition form. In the petition, you must explain why
				you believe the billing is incorrect and describe the actions you want the
				director to take to correct the matter. The completed 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 your request for a hearing. You are entitled to a hearing
				only if the Insurance Division timely receives your request for a hearing and
				completed petition and determines that the director has jurisdiction over the
				matter. You may send a copy of your request for hearing to your insurer so that
				you may attempt to resolve the dispute with your insurer prior to a hearing.
				However, please remember:
1. The
			 60-day period for initiating your request continues to run even though you may
			 be negotiating with your insurer.
2. Your request must be received by the
			 Insurance Division not later than the 60th day after you received this billing.
			 You may wish to consult with an attorney about your case.