reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0039 - Duties of Insurers with Respect to Direct Response Solicitations

Current through Register Vol. 63, No. 7, July 1, 2024
(1) In the case of
			 an application that is initiated as a result of a direct response solicitation,
			 the insurer shall require, with or as part of each completed application for a
			 policy or contract, a statement asking whether the applicant, by applying for
			 the proposed policy or contract, intends to replace, discontinue or change an
			 existing policy or contract. If the applicant indicates a replacement or change
			 is not intended or if the applicant fails to respond to the statement, the
			 insurer shall send the applicant, with the policy or contract, a notice
			 regarding replacement in
Appendix B
to this rule, or other
			 substantially similar form approved by the Director.
(2) If the insurer has proposed the
			 replacement or if the applicant indicates a replacement is intended and the
			 insurer continues with the replacement, the insurer shall:
(a) Provide to the applicant or prospective
			 applicant with the policy or contract a notice, as described in
Appendix
			 C
to this rule, or other substantially similar form approved by the
			 Director. In these instances the insurer may delete the references to the
			 insurance producer, including the insurance producer's signature, and
			 references not applicable to the product being sold or replaced, without having
			 to obtain approval of the form from the Director. The insurer's obligation to
			 obtain the applicant's signature shall be satisfied if it can demonstrate that
			 it has made a diligent effort to secure a signed copy of the notice referred to
			 in this subsection. The requirement to make a diligent effort shall be deemed
			 satisfied if the insurer includes in the mailing a self-addressed postage
			 prepaid envelope with instructions for the return of the signed notice referred
			 to in this section; and
(b) Comply
			 with the requirements of OAR 836-080-0029(1)(b), if the applicant furnishes the
			 names of the existing insurers, and the requirements of OAR 836-080-0029(1)(c)
			 and (d), and (2).
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0043 - Violations and Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any
			 failure to comply with OAR 836-080-0001  to 836-080-0043  shall be considered an
			 unfair trade practice for purposes of ORS
			 746.240. Examples of violations
			 include:
(a) Any deceptive or misleading
			 information set forth in sales material;
(b) Failing to ask the applicant in
			 completing the application the pertinent questions regarding the possibility of
			 financing or replacement;
(c) The
			 intentional incorrect recording of an answer;
(d) Advising an applicant to respond
			 negatively to any question regarding replacement in order to prevent notice to
			 the existing insurer; or
(e)
			 Advising a policyholder or contract owner to write directly to the insurer in
			 such a way as to attempt to obscure the identity of the replacing insurance
			 producer or insurer.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0050 - Authority; Purpose and Scope

Current through Register Vol. 63, No. 7, July 1, 2024
This rule is issued under the Commissioner's general rulemaking
				authority set forth in ORS
				731.244(2). The
				purpose of this rule is to identify particular insurance practices involving
				distinctions between men and women, or between married and unmarried
				individuals, that will be regarded as unfair discrimination which violates
				746.015.
Stat. Auth.: ORS 731
Stats. Implemented: ORS
				  746.015(1)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0055 - Unfair Discrimination Identified

Current through Register Vol. 63, No. 7, July 1, 2024
Distinctions based on sex or marital status made in the
				following matters will be regarded as unfair discrimination:
(1) The availability of a particular
			 insurance policy.
(2) The
			 availability of a particular amount of insurance or set of coverage delimiting
			 factors.
(3) The availability of a
			 particular policy coverage or type of benefit, except for those relating to
			 physical characteristics unique to one sex.
(4) The premium for a particular policy,
			 unless demonstrably based on reasonable supporting data.
Stat. Auth.: ORS 731
Stats. Implemented: ORS
				  746.015(1)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0080 - Definition, Claims Handling Services; Claims Procedures and Information

Current through Register Vol. 63, No. 7, July 1, 2024
(1) As used in
			 sections 2 and 3, chapter 747, Oregon Laws 2001, "clean claim" means a claim
			 under a health benefit plan that has no defect, impropriety, lack of any
			 required substantiating documentation or particular circumstance requiring
			 special treatment that prevents timely payment.
(2) For purposes of section 2(1), chapter
			 747, Oregon Laws 2001, an insurer is considered to have received a claim when
			 the claim is received by the insurer itself or when the claim is received by a
			 representative of the insurer that performs claims handling on the sole behalf
			 of the insurer, whichever receipt date is earlier. A representative may include
			 but is not limited to a third party administrator, a claims service or a
			 pricing service. When an insurer uses such a representative, then the insurer
			 shall include for purposes of section 2(1), chapter 747, Oregon Laws 2001, the
			 days in which a claim is in the control of the representative, including the
			 date on which the representative received the claim.
(3) For the purpose of communicating the
			 information necessary for claim form completion as required by section 2(3),
			 chapter 747, Oregon Laws 2001, an insurer shall include any specific
			 description of standard supporting documentation, information and data
			 routinely required to be submitted with a claim form. Compliance with the
			 standard transaction requirements established under the federal
Health
			 Insurance Portability and Accountability Act
at 45
CFR parts
			 160
and
162
shall be considered to be compliance with this
			 section.
Stat. Auth.: ORS
				  731.244; Sec. 2, Ch. 747, OL
				  2001
Stats. Implemented: Sec. 2, Ch. 747, OL
				  2001
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0085 - Annual Report; Sampling

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 Each insurer shall report to the Director annually on its compliance with
			 Section 2, Chapter 747, Oregon Laws 2001 (Enrolled Senate Bill 894), governing
			 claims received by an insurer from a provider on behalf of an enrollee,
			 according to the requirements of this rule.
(2) Not later than March 1 of each year, each
			 insurer shall submit the following to the Director:
(a) A count of all claims for which final
			 disposition has been made by the insurer during the immediately preceding
			 calendar year.
(b) A count of all
			 claims included in the count in subsection (a) of this section that were each
			 finally disposed of later than the 30th day after the date on which the insurer
			 received the claim.
(c) A data file
			 that includes a population list with respect to the claims described in
			 subsection (b) of this section, in the form and manner specified by the
			 Director.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0090 - Suitability in the Sale of Life Insurance

Current through Register Vol. 63, No. 7, July 1, 2024
A person may not recommend to a consumer the purchase, sale or
				replacement of a life insurance policy, or any rider, endorsement or amendment
				to the policy, without reasonable grounds to believe that the recommendation or
				transaction is not unsuitable for the consumer based upon reasonable inquiry
				concerning the consumer's insurance objectives, financial situation and needs,
				age and other relevant information known by the person. For the purpose of this
				rule, when a person recommends a group life insurance policy, "consumer" refers
				to the intended group policyholder.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.100,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0105 - Statutory Authority; Purpose; Effective Date

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-080-0105  to 836-080-0155  are
			 adopted pursuant to the general rulemaking authority of the Commissioner in ORS
			 731.244 to aid in the
			 effectuation of ORS Chapter 746, especially the enforcement of
			 746.015,
			 746.075,
			 746.160(3), and
			 746.240, as well as the
			 effectuation and enforcement of
			 737.205 to
			 737.348,
			 742.003,
			 742.005,
			 742.009 and other related
			 provisions of the
Oregon Insurance Code
.
(2) The purpose of OAR 836-080-0105  to
			 836-080-0155  is to regulate the content and use of participation provisions in
			 commercial lines of property and casualty insurance policies so as to prevent
			 misrepresentations and other unfair practices relating to future dividends, to
			 prevent unfair and coercive practices in the allocation and payment of
			 dividends, and to effectuate the statutes governing ratemaking, classification
			 of risks, and approval of policy forms, with respect to commercial lines of
			 property and casualty insurance issued on the participating basis.
Publications: Publications referenced are available from the
				  agency.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS 746, ORS
				  746.015, ORS
				  746.075, ORS
				  746.160 & ORS
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0110 - Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
OAR 836-080-0105  to 836-080-0155:
(1) Apply to all authorized insurers, whether
			 stock, mutual, or reciprocal, and to the State Accident Insurance
			 Fund.
(2) Apply to those forms of
			 property and casualty insurance known by custom as "commercial lines"; and do
			 not apply to other lines or forms of insurance.
Stat. Auth.: ORS 731 & ORS 746
Stats. Implemented: ORS
				  746.015(1), ORS
				  746.075, ORS
				  746.160(3)
				  & ORS 746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0115 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-080-0105  to 836-080-0155, unless the context
				requires otherwise:
(1) "Dividend
			 statement" has the meaning given the term by OAR 836-080-0130.
(2) "Insurer" has the meaning given the term
			 by ORS 731.106 and includes the State
			 Accident Insurance Fund.
(3)
			 "Issue" when referring to an insurance policy includes "renew" and
			 "endorse."
(4) "Participating
			 policy" means a policy that grants participation rights to the
			 policyholder.
(5) "Participation"
			 means the right of a policyholder to share in the distribution of profits or
			 other assets of the insurer, whether or not the right is conditional or limited
			 by other provisions.
(6) "Policy"
			 has the meaning given the term by ORS
			 731.122, and the term includes
			 endorsements and the agreements between the State Accident Insurance Fund and
			 individual contributing employers by which the Fund provides workmen's
			 compensation coverage.
(7)
			 "Policyholder" means a person who owns or has an interest in a policy and the
			 term includes a prospective policyholder.
(8) "Prospective policyholder" includes a
			 policyholder who is considering the renewal or discontinuance of an existing
			 policy.
Stat. Auth.: ORS 731 & ORS 746
Stats. Implemented: ORS
				  746.015(1), ORS
				  746.075, ORS
				  746.160(3)
				  & ORS 746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0120 - Statement as to Participation Required Upon Request Before Delivery of Policy; Provision Required in Participating Policy; Contents of Provision

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Upon the
			 request of a policy-holder to an insurer, the policyholder is entitled to
			 receive a written statement, before the policy is delivered, specifying whether
			 the policy is or is not a participating policy.
(2) If the insurer intends the policy to
			 grant participation rights to policyholders, the policy shall contain a
			 provision designated "Participation Provision." The participation provision
			 shall include the following wording or substantially equivalent wording
			 approved by the Commissioner: "It is unlawful in Oregon for an insurer to
			 promise to pay policyholder dividends for any unexpired portion of the policy
			 term or to misrepresent the conditions for dividend payment. Dividends will be
			 due and payable only for a policy period that has expired, and only if declared
			 by and under conditions prescribed by the Board of Directors of the
			 Insurer."
Stat. Auth.: ORS 731 & ORS 746
Stats. Implemented: ORS
				  746.015(1), ORS
				  746.075, ORS
				  746.160(3)
				  & ORS 746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0125 - Prohibited Representations Regarding Participation Rights

Current through Register Vol. 63, No. 7, July 1, 2024
Prior to the declaration of a dividend, an insurer shall not
				represent, orally or in writing, that the insurer agrees or will agree:
(1) To pay a specified amount as a dividend;
			 or
(2) To a formula that fixes, or
			 to factors that fix or can be used to fix:
(a)
			 The amount of a dividend;
(b) The
			 percentage of premium that will be paid as a dividend; or
(c) The amount or percentage of premium to be
			 retained by the insurer after payment of dividends.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0130 - Dividend Statement Permitted; Required to Be Written; Prohibited and Permitted Advice

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer
			 may advise a policy holder of the kinds of information the insurer expects to
			 take into consideration in determining whether to declare a dividend and the
			 amount thereof. Any such advice is considered a "dividend statement" as the
			 term is used in this section. A dividend statement shall not, however, be of
			 such a nature as to make it possible to determine, directly or indirectly:
(a) The amount of a dividend;
(b) The percentage of premium that will be
			 paid as a dividend; or
(c) The
			 amount or percentage of premium to be retained by the insurer after payment of
			 dividends.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0135 - Dividend Rights Accrue Upon Declaration of Dividends; Contents of Dividend Declaration Resolution

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 right of a policyholder to a dividend, or to a determination of whether any
			 dividend will be paid to the policyholder or the amount of a dividend that will
			 be paid to the policyholder, shall not accrue unless the board of directors or
			 other governing body of the insurer:
(a)
			 Determines that the insurer has a surplus from which the dividend may lawfully
			 be paid; and
(b) Declares the
			 dividend by resolution adopted after the expiration of the policy period for
			 which the dividend was earned.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0140 - Unfair Discrimination in Allocation of Dividends Prohibited; Criteria for Allocation; Prima Facie Evidence of Unfair Discrimination

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer shall not unfairly
			 discriminate in the allocation of dividends.
(2) The dividend plans, scales, tables,
			 formulas, schedules and factors specified in the dividend declaration may
			 provide for allocation of dividends at a fixed percentage of premiums, or may
			 provide for variations in the percentage of premium paid as dividends or other
			 variations in determining the amounts of dividends. The variations may be based
			 on loss or expense factors, or on any other reasonable considerations, such as
			 risk size, risk location, or industry or trade hazard classification, which
			 have a probable effect on losses or expenses.
(3) Failure to apply in a consistent manner
			 the plans, scales, tables, formulas, schedules, and factors adopted and
			 specified in a dividend declaration is prima facie evidence of unfair
			 discrimination. However, a variation from procedures set forth in a dividend
			 statement that was provided to a policyholder prior to inception of the policy
			 will not of itself be considered unfairly discriminatory.
Stat. Auth.: ORS 731 & ORS 746
Stats. Implemented: ORS
				  746.015(1), ORS
				  746.075, ORS
				  746.160(3)
				  & ORS 746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0145 - Unfair Forfeiture of Dividend for Failure to Renew Prohibited

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer shall not reduce or deny a policyholder dividend
				because of the policy-holder's refusal to accept renewal of the policy or
				another policy from the same insurer. A reasonable change in the time schedule
				for computing or paying a policyholder dividend will not of itself be
				considered a reduction or denial of the dividend, or unfairly discriminatory,
				if:
(1) The change is applied
			 uniformly to the policyholders in like circumstances; and
(2) The nature of the change is set forth in
			 a dividend statement that was provided to the policyholder before the inception
			 of the policy for which the change is made.
Stat. Auth.: ORS 731 & ORS 746
Stats. Implemented: ORS
				  746.015(1), ORS
				  746.075, ORS
				  746.160(3)
				  & ORS 746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0150 - Policyholder Dividend Rights of Group Members and Dividend Group Policyholders; Reduction or Denial Without Prior Advice Prohibited; "Dividend Group" Defined; Standards for Dividend Groups

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
			 When used in this section:
(a) "Group" means a
			 collection of insurance buyers who are members of a common organization and who
			 are treated collectively by an insurer for determining insurance dividends;
			 and
(b) "Laws of the group" means
			 the articles of incorporation, bylaws, agreements of association, rules, or
			 regulations of the organization to which members of a group belong.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0155 - False or Deceptive Publications by Insurer Prohibited

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer shall not knowingly adopt, or cause or permit to be
				issued, circulated or used, any representation, plan, schedule, letter, or
				advertising material of any kind stating or implying that the insurer has acted
				or will in the future act in any manner at variance with OAR 836-080-0105  to
				836-080-0155.
Stat. Auth.: ORS 731 & 746
Stats. Implemented: ORS
				  746.015(1),
				  746.075,
				  746.160(3)
				  & 746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0160 - Use of Special Certifications and Professional Designations by Insurance Producers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 person may not use a certification or designation that falsely indicates or
			 implies that the person has special certification or training, in connection
			 with the offer, sale or purchase of insurance or providing advice as to the
			 value of or the advisability of purchasing insurance. The prohibition in this
			 section applies to the use of such a certification or designation directly or
			 indirectly, through a publication or writing, or by issuing or disseminating
			 information relating to insurance. The prohibited use of a certification or
			 designation includes but is not limited to the following activities:
(a) Use of a certification or professional
			 designation by a person who has not actually earned or is otherwise ineligible
			 to use the certification or designation.
(b) Use of a nonexistent or self-conferred
			 certification or professional designation.
(c) Use of a certification or professional
			 designation that indicates or implies a level of occupational qualifications
			 obtained through education, training or experience that the person using the
			 certification or professional designation does not have.
(d) Use of a certification or professional
			 designation that falsely states or implies specialized knowledge of the
			 insurance needs of a particular segment of the population or class of persons
			 that the person using the certification or professional designation does not
			 have. Examples of a particular segment of the population, or class of
			 investors, include but are not limited to senior citizens, elderly or retired
			 persons.
(e) Use of a certification
			 or professional designation that was obtained from a designating or certifying
			 organization that:
(A) Is primarily engaged in
			 the business of instruction in sales or marketing, or both;
(B) Does not have reasonable standards or
			 procedures for assuring the competency of its designees or
			 certificants;
(C) Does not have
			 reasonable standards or procedures for monitoring and disciplining its
			 designees or certificants for improper or unethical conduct;
(D) Does not have reasonable continuing
			 education requirements for its designees to maintain the designation or
			 certificate; or
(E) Has not been
			 certified or accredited by one of the following organizations or has been
			 certified or accredited by one of the following organizations but the
			 designation or credential issued from the organization primarily applies to
			 sales or marketing, or both:
(i) The American
			 National Standards Institute;
(ii)
			 The National Commission for Certifying Agencies; or
(iii) An organization that is on the United
			 States Department of Education's list entitled "Accrediting Agencies Recognized
			 for Title IV Purposes."
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0165 - Notice of Insurance Division Assistance

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer shall include in an individual
			 annuity contract and with any subsequent offer for sale of additional coverage
			 in connection with the annuity a statement to the effect that the Insurance
			 Division of the Department of Consumer and Business Services offers assistance
			 to consumers in the event of a dispute with the insurer. When the statement
			 appears in the contract, the statement must be displayed on the cover page, the
			 first page of the annuity terms, the page that contains the names of the
			 parties and basic coverage information or another prominent place. When the
			 statement appears in an offer for sale of additional coverage, the statement
			 must be displayed in a prominent place. The statement must include the
			 telephone number and website information for contacting the Insurance Division
			 for assistance.
(2) Violation of
			 this rule is an unfair trade practice for the purpose of ORS
			 746.240.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  742.009 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0170 - Statutory Authority; Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR
			 836-080-0170  to 836-080-0190  are issued under the general rulemaking authority
			 of the director in ORS
			 731.244 to aid in the
			 effectuation of ORS Chapter 746, especially the provisions of ORS
			 746.100,
			 746.110 and
			 746.240.
(2) The purpose of this rule is to require
			 insurers to establish a system to supervise recommendations and to set forth
			 standards and procedures for recommendations to consumers that result in
			 transactions involving annuity products so that the insurance needs and
			 financial objectives of consumers at the time of the transaction are
			 appropriately addressed.
(3)
			 Nothing in OAR 836-080-0170  to 836-080-0190  shall be construed to create or
			 imply a private cause of action for a violation of OAR 836-080-0170  to
			 836-080-0190.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.100,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0172 - Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
OAR 836-080-0170  to 836-080-0190  apply to any recommendation to
				purchase, exchange or replace an annuity made to a consumer by an insurance
				producer, or an insurer where no insurance producer is involved, that results
				in the purchase, exchange or replacement recommended.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.100,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0175 - Exemptions

Current through Register Vol. 63, No. 7, July 1, 2024
Unless otherwise specifically included, OAR 836-080-0170  to 836-080-0190  do not apply to transactions involving:
(1) Direct response solicitations where there is no recommendation based on information collected from the consumer pursuant to OAR 836-080-0170  to 836-080-0190;
(2) Contracts used to fund:
(a) An employee pension or welfare benefit plan that is covered by the federal Employee Retirement and Income Security Act as amended;
(b) A plan described by sections  401(a),  401(k),  403(b),  408(k) or  408(p) of the Internal Revenue Code, as amended, if established or maintained by an employer;
(c) A government or church plan defined in section  414 of the Internal Revenue Code, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under section  457 of the Internal Revenue Code;
(d) A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;
(e) Settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or
(f) Formal prepaid funeral contracts.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0178 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) "Annuity" means
			 an insurance product that is individually solicited, whether the product is
			 classified as an individual or group annuity.
(2) "Insurer" means a company required to be
			 licensed under the laws of this state to provide insurance products, including
			 annuities.
(3) "Insurance producer"
			 means a person required to be licensed under the laws of this state to sell,
			 solicit or negotiate insurance, including annuities.
(4) "Recommendation" means advice provided by
			 an insurance producer, or an insurer where no insurance producer is involved,
			 to an individual consumer that results in a purchase, exchange or replacement
			 of an annuity in accordance with that advice.
(5) "Replacement" has the meaning given in
			 OAR 836-080-0005.
(6) "Suitability
			 information" means information that is reasonably appropriate to determine the
			 suitability of a recommendation, including the following:
(a) Age;
(b) Annual income;
(c) Financial situation and needs, including
			 the financial resources used for the funding of the annuity;
(d) Financial experience;
(e) Financial objectives;
(f) Intended use of the annuity;
(g) Financial time horizon;
(i) Existing assets, including investment and
			 life insurance holdings;
(j)
			 Liquidity needs;
(k) Liquid net
			 worth;
(l) Risk tolerance;
			 and
(m) Tax status.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0180 - Duties of Insurers and of Insurance Producers

Current through Register Vol. 63, No. 7, July 1, 2024
(1) As used in this
			 rule, "FINRA" means the Financial Industry Regulatory Authority or a succeeding
			 agency.
(2) In addition to the
			 disclosure requirements of OAR 836-051-0900  to 836-051-0925, in recommending to
			 a consumer the purchase of an annuity or the exchange of an annuity that
			 results in another insurance transaction or series of insurance transactions,
			 the insurance producer, or the insurer where no insurance producer is involved,
			 shall have reasonable grounds for believing that the recommendation is suitable
			 for the consumer on the basis of the facts disclosed by the consumer as to his
			 or her investments and other insurance products and as to his or her financial
			 situation and needs, including the consumer's suitability information, and that
			 there is a reasonable basis to believe all of the following:
(a) The consumer has been reasonably informed
			 of various features of the annuity, such as the potential surrender period and
			 surrender charge, potential tax penalty if the consumer sells, exchanges,
			 surrenders or annuitizes the annuity, mortality and expense fees, investment
			 advisory fees, potential charges for and features of riders, limitations on
			 interest returns, insurance and investment components and market
			 risk;
(b) The consumer would
			 benefit from certain features of the annuity, such as tax deferred growth,
			 annuitization or death or living benefit;
(c) The particular annuity as a whole, the
			 underlying subaccounts to which funds are allocated at the time of purchase or
			 exchange of the annuity, and riders and similar product enhancements, if any,
			 are suitable (and in the case of an exchange or replacement, the transaction as
			 a whole is suitable) for the particular consumer based on his or her
			 suitability information; and
(d) In
			 the case of an exchange or replacement of an annuity, the exchange or
			 replacement is suitable including taking into consideration whether:
(A) The consumer will incur a surrender
			 charge, be subject to the commencement of a new surrender period, lose existing
			 benefits (such as death, living or other contractual benefits), or be subject
			 to increased fees, investment advisory fees or charges for riders and similar
			 product enhancements;
(B) The
			 consumer would benefit from product enhancements and improvements;
			 and
(C) The consumer has had
			 another annuity exchange or replacement and, in particular, an exchange or
			 replacement within the preceding 36 months.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0183 - Insurance Producer Training

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurance
			 producer shall not solicit the sale of an annuity product unless the insurance
			 producer has adequate knowledge of the product to recommend the annuity and the
			 insurance producer is in compliance with the insurer's standards for product
			 training. An insurance producer may rely on insurer-provided product-specific
			 training standards and materials to comply with this section.
(2)
(a)
(A) An insurance producer who engages in the
			 sale of annuity products shall complete a one-time four credit training course
			 provided by a continuing education provider registered with the
			 department.
(B) Individuals who
			 obtain a life insurance line of authority on or after the effective date of OAR
			 836-080-0170  to 836-080-0190  may not engage in the sale of annuities until the
			 insurance producer completes the annuity training course required under this
			 section.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0185 - Compliance Mitigation; Penalties

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer is
			 responsible for compliance with OAR 836-080-0170  to 836-080-0190. If a
			 violation occurs, either because of the action or inaction of the insurer or
			 its insurance producer, the director may order:
(a) An insurer to take reasonably appropriate
			 corrective action for any consumer harmed by violation of OAR 836-080-0170  to
			 836-080-0190  by the insurer, or by the insurer's producer;
(b) A general agency, independent agency or
			 the insurance producer to take reasonably appropriate corrective action for any
			 consumer harmed by the insurance producer's violation of OAR 836-080-0170  to
			 836-080-0190; and
(c) Appropriate
			 penalties and sanctions.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0188 - Recordkeeping

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Insurers,
			 general agents, independent agencies and insurance producers shall maintain or
			 be able to make available to the Director records of the information collected
			 from the consumer and other information used in making the recommendations that
			 were the basis for insurance transactions for three years after the insurance
			 transaction is completed by the insurer. An insurer is permitted, but shall not
			 be required, to maintain documentation on behalf of an insurance
			 producer.
(2) Records required to
			 be maintained by under section (1) of this rule may be maintained in paper,
			 photographic, micro-process, magnetic, mechanical or electronic media or by any
			 process that accurately reproduces the actual document.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.100,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0190 - Annuity Sales; Disclosure Not a Defense

Current through Register Vol. 63, No. 7, July 1, 2024
The fact that a person made a disclosure to a consumer about
				the nature of an annuity in connection with the sale of the annuity to the
				consumer is not a defense by itself to a determination by the Director under
				OAR 836-080-0170  to 836-080-0188  that the sale was unsuitable with respect to
				the consumer.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.100,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0193 - Effective Date and Operative Date

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR
			 836-080-0170  to 836-080-0190  and the amendments to OAR 836-080-0090  become
			 operative on July 1, 2011, except that the requirement under OAR 836-080-0183 (2)  shall become operative on August 1, 2011 or six months after the director
			 determines that the requisite training is available.
(2) Insurance producers who hold a life
			 insurance line of authority on the effective date of OAR 836-080-0170  to
			 836-080-0190  and who desire to sell annuities shall complete the requirements
			 of OAR 836-080-0183  within six months after July 1, 2011.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.100,
				  746.110 &
				  746.240
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0205 - Statutory Authority, Purpose, and Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-080-0205  to 836-080-0250  are
			 adopted by the Director of the Department of Consumer and Business Services
			 pursuant to the director's general rulemaking authority in ORS
			 731.244, to aid in the proper
			 effectuation of 746.230.
(2) The purpose of OAR 836-080-0205  to
			 836-080-0250  is to define certain minimum standards the violation of which will
			 be considered to constitute unfair claims settlement practices within the
			 purview of ORS 746.230.
(3) OAR 836-080-0205  to 836-080-0250:
(a) Apply with respect to all insurance
			 except fidelity and surety bonds;
(b) Apply to workers' compensation insurance
			 only as provided in OAR 836-080-0250; and (c) Are not exclusive, and the
			 Director may also consider other acts not herein specified to be violations of
			 ORS 746.230.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0210 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-080-0205  to 836-080-0240, unless the context
				requires otherwise:
(1) "Claim file"
			 includes, but is not limited to, microfilm files, computer information systems
			 and other types of files, containing information on individual claims without
			 necessarily containing hard copies of documents.
(2) "Claimant" includes any first party
			 claimant and any third party claimant, the designated legal representative of
			 any such claimants and any members of a claimant's immediate family who are
			 designated for this purpose by the claimant.
(3) "First party claimant" means a person
			 asserting a right to payment under an insurance policy arising out of the
			 occurrence of the contingency or loss covered by the policy.
(4) "Insurer" includes any person authorized
			 to represent the insurer with respect to a claim who is acting within the scope
			 of the person's authority.
(5)
			 "Investigation" means the activities of an insurer directly or indirectly
			 related to the determination of liabilities under coverages provided by an
			 insurance policy.
(6) "Notification
			 of claim" means any notification, whether in writing or other means acceptable
			 under the terms of an insurance policy, to an insurer by a claimant that
			 reasonably apprises the insurer of the facts pertinent to the claim.
(7) "Third party claimant" means any person
			 asserting a claim against any person insured under an insurance
			 policy.
(8) "Crash parts" are motor
			 vehicle replacement parts, sheet metal or plastic, that constitute the visible
			 exterior of the vehicle, including inner and outer panels, and are generally
			 repaired or replaced as the result of a collision.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.230
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0215 - Claim Files

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer's claim files shall contain the information
				pertaining to each claim in sufficient detail that pertinent events and their
				dates can be reconstructed.
Stat. Auth.: ORS 731
Stats. Implemented: ORS
				  746.230(1)(d)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0220 - Misrepresentation and Other Prohibited Claim Practices

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer shall not:
(1) Fail to fully disclose to a first party
			 claimant all pertinent benefits, coverages and other provisions of an insurance
			 policy under which the claim is asserted.
(2) Conceal from a first party claimant any
			 insurance policy benefits, coverages or other provisions that are pertinent to
			 the claim.
(3) Deny a claim on the
			 grounds of the claimant's failure to exhibit the relevant property without
			 proof of the insurer's demand and the claimant's unfounded refusal.
(4) Except where there is such time limit
			 specified in the policy, make statements, written or otherwise, that require a
			 claimant to give written notice of loss or proof of loss within a specified
			 time and that seek to relieve the insurer of its obligations if the time limit
			 is not complied with, unless the failure to comply with the specified time
			 limit prejudices the insurer's rights.
(5) Request a first party claimant to sign a
			 release that extends beyond the subject matter that gave rise to the claim
			 payment.
(6) Issue checks or drafts
			 in partial settlement of a loss or claim under a specific policy coverage that
			 contain language releasing the insurer or its insured from its total
			 liability.
Stat. Auth.: ORS 731
Stats. Implemented: ORS
				  746.230(1)(a),
				  ORS 746.230(f), ORS
				  746.230(j)
				  & ORS 746.230(m)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0225 - Required Claim Communication Practices

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer shall:
(1)
			 Not later than the 30th day after receipt of notification of claim, acknowledge
			 the notification or pay the claim. An appropriate and dated notation of the
			 acknowledgment shall be included in the insurer's claim file.
(2) Not later than the 21st day after receipt
			 of an inquiry from the Director about a claim, furnish the Director with an
			 adequate response.
(3) Make an
			 appropriate reply, not later than the 30th day after receipt, to all other
			 pertinent communications about a claim from a claimant that reasonably indicate
			 a response is expected.
(4) Upon
			 receiving notification of claim from a first party claimant, promptly provide
			 necessary claim forms, instructions and assistance that is reasonable in the
			 light of the information possessed by the insurer, so that the claimant can
			 comply with the policy conditions and the insurer's reasonable requirements.
			 Compliance with this section not later than the 30th day after receipt of
			 notification of a claim constitutes compliance with section (1) of this
			 rule.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.230
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0230 - Standard for Prompt Claim Investigation

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer shall complete its claim investigation not later
				than the 45th day after its receipt of notification of claim, unless the
				investigation cannot reasonably be completed within that
				time.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.230
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0245 - Statutory Authority and Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-080-0245  is adopted pursuant
			 general rulemaking authority in ORS
			 731.244.
(2) For the purpose of complying with ORS
			 742.053(3)(b),
			 if a total loss of contents of a residence occurred as a result of a major
			 disaster in a location subject to a state of emergency declaration under ORS
			 401.165, and the loss was
			 directly related to the emergency that was the subject of the declaration, then
			 the insurer shall be subject to the provisions of ORS
			 742.053(3)(b)(A)-(E)
			 if the policyholder provides the insurer with a written attestation in a form
			 substantially similar to Exhibit 1 available on the website of the Department
			 of Consumer and Business Services at
https://dfr.oregon.gov/laws-rules/Documents/OAR/div80-0245_ex1.pdf
.
Statutory/Other Authority: ORS
				  731.244
Statutes/Other Implemented: ORS
				  742.053
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0250 - Workers' Compensation Insurance Unfair Claim Settlement Practices Standards

Current through Register Vol. 63, No. 7, July 1, 2024
For the purposes of ORS
				746.230(1)(d),
				the following applies to a workers' compensation insurer:
(1) The insurer is required to conduct a
				"reasonable" investigation based on all available information in ascertaining
				whether to deny a claim. A reasonable investigation is whatever steps a
				reasonably prudent person with knowledge of the legal standards for determining
				compensbility would take in a good faith effort to ascertain the facts
				underlying a claim, giving due consideration to the cost of the investigation
				and the likely value of the claim.
(2) In determining whether an investigation
				is reasonable, the Director will only look at information contained in the
				claim record at the time of denial. The insurer may not relay on any fact not
				documented in the claim record at the time of denial to establish that an
				investigation was reasonable.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.230(1)(d)
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 80 - TRADE PRACTICES › Section 836-080-0305 - Statutory Authority; Purpose; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-080-0305  to 836-080-0370  are
			 adopted by the Director of the Department of Consumer and Business Services
			 pursuant to the general rulemaking authority in ORS
			 731.244, to aid in the
			 effectuation of 746.045,
			 746.055,
			 746.160, and
			 746.240.
(2) The purpose of these rules is to define
			 certain fair trade practice standards for title companies, the violation of
			 which will be considered to constitute a practice prohibited by ORS
			 746.045,
			 746.055,
			 746.160(3), or
			 746.240.
(3) These rules are intended to regulate the
			 marketing activities of title companies involving only intermediaries. These
			 rules do not limit the Director's authority to determine that other activities
			 of title companies with any person constitute violations of ORS
			 746.045,
			 746.055,
			 746.160(3), or
			 746.240.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  746.045,
				  746.055,
				  746.160 &
				  746.240