Oregon Administrative Code

836-042-0420 Anniversary Filings Not later than the 45th day before each anniversary of the effective date of each policy of insurance issued to a group under OAR 836-042-0400 to 836-042-0430, the insurer must file with the Director a statement whether premiums have been reduced …

836-042-0425 Statistics (1) An insurer selling casualty insurance on commercial risks to groups shall maintain separate relevant statistics as to loss and expense experiences of the groups insured. (2) An insurer selling insurance under group policies to members of groups of day …

836-042-0430 Disclosure Required for Day Care Facilities Every insurer selling insurance under a group policy for day care facilities shall make full and fair disclosure to prospective insureds, prior to sale, of all features of the plan, whether favorable or unfavorable, includi…

836-042-0501 Statutory Authority; Purpose; Applicability; Effective Date (1) OAR 836-042-0501 to 836-042-0520 are adopted pursuant to: (a) The general rulemaking authority of the Director in ORS 731.244 as an aid to the effectuation of 737.320(6) which enables the Director to req…

836-042-0505 Definitions As used in OAR 836-042-0501 to 836-042-0520, unless the context requires otherwise: (1) “Anniversary Rating Date” means the month and day that rates, rating plans and rating systems are initially applied to a policy in effect and each annual anniversary t…

836-042-0510 Rates, Rating Plans System — Prior Review (1) An insurer or rating organization shall submit to the Director its filing of rates, rating plans and rating systems for a commercial liability insurance market specified in OAR 836-042-0512 prior to the effective date of …

836-042-0512 Specified Commercial Liability Markets The conditions for a prior review in OAR 836-042-0510 apply to: (1) Average annual rate level increases greater than 15 percent for the following commercial liability markets: (a) Products liability; (b) Medical professional lia…

836-042-0515 Commercial Liability Filings — Procedural Rules for Insurers and Rating Organizations (1) Each filing of a commercial casualty insurance premium rate, rating plan or rating system that is certified by a member of the American Academy of Actuaries or by an executive o…

836-042-0520 Supporting Data Supporting actuarial data shall accompany every filing of a commercial liability insurance rate, rating plan and rating system. The data shall be in sufficient detail to: (1) Demonstrate compliance with ORS 737.207; and (2) Demonstrate the statistical…

836-043-0001 Statutory Authority; Purpose; (1) OAR 836-043-0001 to 836-043-0091 are adopted by the Insurance Commissioner pursuant to the authority and requirements of ORS 656.427, 656.730 and 731.244 for the purpose of implementing ORS 656.427, 656.730, and 737.265, and may be c…

836-043-0005 Definitions for the Workers’ Compensation Insurance Plan As used in OAR 836-043-0001 to 836-043-0091: (1) "Affiliated insurer" or "affiliate" means an insurer that directly, or indirectly through one or more intermediaries, controls, or is controlled by, or is under …

836-043-0009 Participation by Insurers and Insurance Producers (1) All insurers authorized to transact workers' compensation insurance in Oregon are required to participate in the Plan and subscribe to the organizing principles for Oregon. (2) Failure of an insurer to comply with…

836-043-0017 Plan Administrator (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 P…

836-043-0021 Servicing Carriers (1) The Plan Administrator shall establish written requirements that insurers must meet in order to be eligible to act as a servicing carrier. The Plan Administrator shall provide the written requirements to the board for review and acceptance. Fro…

836-043-0024 Right to Apply (1) An employer who is eligible for workers’ compensation insurance as set forth in this rule may apply to the Plan Administrator for workers' compensation insurance under the Plan as provided in this rule if the employer is unable to obtain a reasonab…

836-043-0028 Application by Electronic Transmission or Telephone (1) An application made by electronic transmission or telephone must be completed in full and must be signed. The signature may be submitted by facsimile transmission. The effective date of coverage shall be determi…

836-043-0032 Nonelectronic Application (1) An employer or the representative of an employer may submit a signed and completed application as set forth in Exhibits 1 and 2 of OAR 836-043-0024 by United States mail or a private overnight mail delivery service. The application must …

836-043-0034 Surety Bonds For all submission options under OAR 836-043-0028 or 836-043-0032, the employer submitting an application may satisfy a portion of the deposit premium with an authorized surety’s financial guaranty bond, but the cash portion of the deposit premium must b…

836-043-0041 Application Review (1) Upon receiving an application submitted under OAR 836-043-0028 or 836-043-0032, the Plan Administrator shall review the application for completeness and determine whether the employer is eligible for coverage under the Plan. (2) The Plan Admini…

836-043-0044 Binding Coverage (1) The Plan Administrator may issue binders to eligible employers in accordance with the provisions of this Plan. The servicing carrier shall provide coverage under any binder issued by the Plan Administrator, subject to the provisions of the Plan, …

836-043-0046 Rates and Forms, Policy Term, Additional Coverages and Other Provisions (1) An insurer issuing a policy to an employer to which the Plan applies shall write the policy according to the classifications, forms including but not limited to policy endorsements, change of…

836-043-0048 Additional States’ Coverage Except as shown on the binder or verification page, all assignments under the plan are to be made on an intrastate basis. An employer seeking insurance for operations in one or more states other than the state listed in the Policy Informat…

836-043-0050 Interstate Assignments (1) Any employer assigned under this Plan and desiring workers' compensation insurance for operations for physical locations in states other than that covered by the Plan may request its servicing carrier to furnish such insurance in such addit…

836-043-0053 Premium Obligations (1)(a) The Plan Administrator shall not knowingly make an assignment unless the employer has met all undisputed workers' compensation premium obligations on any previous workers’ compensation insurance including but not limited to obligations to: …

836-043-0056 Insurer Cancellation and Nonrenewal of Workers’ Compensation Insurance Policies or Surety Bonds The following provisions of this rule govern when an insurer cancels or fails to renew a workers’ compensation insurance policy or surety bond: (1) An insurer canceling co…

836-043-0060 Assignment Formula (1) This rule describes the mechanism used to provide for the random and equitable distribution of employers under the Plan to servicing carriers. The Plan Administrator may override the random assignment process to ensure the availability of reque…

836-043-0062 Issuance and Continuation of Policy (1) A policy must be issued, renewed or reinstated without a lapse in coverage when premium, including an interim premium audit or installment payment, is received by the carrier or postmarked by the United States Postal Service pr…

836-043-0064 Renewal, Nonrenewal (1) A servicing carrier shall send a renewal or nonrenewal notice of impending expiration of coverage to the insured, the representative of the insured and the Plan Administrator at least 45 days before the expiration date of insurance. Upon recei…

836-043-0066 Reassignment (1) An employer may submit to the Plan Administrator a written request for reassignment to a different carrier, if available. The employer must submit the request in writing to the Plan Administrator not later than the 30th day and not earlier than the 6…

836-043-0068 Cancellation (1) The servicing carrier may cancel a policy after its issuance, with the approval of the Insurance Commissioner, for any of the reasons stated in this section. The servicing carrier must first provide an opportunity for cure and must file the reasons f…

836-043-0071 Dispute Resolution Procedures (1)(a) A bona fide premium dispute is established when the employer or its representative provides: (A) Written notice to the Plan Administrator that includes all of the following: (i) All documentation relevant to the dispute, including…

836-043-0072 Voluntary Coverage Notwithstanding OAR 836-043-0089, an insurer that wishes to insure an employer as voluntary business may do so at any time. If a servicing carrier wishes to insure voluntarily one of its plan accounts, the servicing carrier must provide written not…

836-043-0076 Takeout Credit The Plan Administrator shall establish a take-out credit program. The take-out credit program shall operate in accordance with the following guidelines: (1) Each insurer participating in the Plan who removes an employer insured through the Plan is elig…

836-043-0079 Notification of Outstanding Premium A servicing carrier or its representative shall furnish information regarding outstanding assigned risk and voluntary workers' compensation insurance premium or other workers' compensation monetary policy obligations identified by …

836-043-0082 Policyholder Services A servicing carrier shall provide all of the following to each policyholder or a representative of the insured and its producer: (1) Access to audit, loss control and safety services. (2) Prompt, professional handling of claims, including invest…

836-043-0087 Producer Changes and Compensation (1) The servicing carrier must pay a fee to the licensed agency on all new and renewal policies after the policy is issued. The servicing carrier shall pay the producer as premium is collected. The servicing carrier must process and …

836-043-0089 Confidentiality of Information The servicing carrier shall keep in confidence and must not, except as directed by the insured or the producer of record, or as otherwise may be required by law or the Insurance Commissioner, disclose to any third party, or use for the …

836-043-0091 Self-Funded Plan It is essential for maintaining the viability of the Plan to establish and maintain rates at a level that will permit the Plan to operate with no more than a reasonable subsidy required from voluntary insured employers. The NCCI shall maintain necess…

836-043-0101 Statutory Authority; Purpose; Applicability (1) OAR 836-043-0101 to 836-043-0170 are adopted by the Director of the Department of Consumer and Business Services pursuant to the requirements of ORS 737.318. (2) OAR 836-043-0101 to 836-043-0170 establish a premium audi…

836-043-0105 Definitions As used in OAR 836-043-0101 to 836-043-0170, unless the context requires otherwise: (1) "Audit" means a process of verification of information used to determine the premium for a workers’ compensation insurance policy that is performed in one of the follo…

836-043-0110 Insurer Premium Audit Program (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…

836-043-0115 Insurer Audit Procedure Guide Each insurer shall develop audit procedures that include all of the features described in this rule or, in place thereof, more comprehensive alternative procedures that will consistently achieve minimum standards as measured by the Orego…

836-043-0120 Minimum Standards of Insured Education Program (1) At or before policy issuance, an insurer shall make available to the insured information covering the matters identified in this section. This information may be delivered via electronic means, as provided for under …

836-043-0125 Purpose A Test Audit Program shall be conducted by the bureau to carry out ORS 737.318. To perform this function, the bureau shall maintain the test audit staff for examining pertinent records of a number of Oregon insureds and insurers established according to the s…

836-043-0130 Selection of Risks for Test Audit (1) All insurers or insurer groups shall be test audited on a continuous basis. Each quarter, the bureau shall send a list of policies selected for test audit to each insurer's Oregon policy issuing office or other office designated …

836-043-0135 Test Audits (1) An analysis of test audit results shall be completed on each test audit. (2) The test auditor shall interview the insured or an authorized representative of the insured in order to solicit the insured's cooperation and also to obtain all factual data …

836-043-0145 Disposition of Test Audits (1) The bureau shall submit individual results of each test audit to the office or offices designated by the insurer as soon as the bureau audit is completed. (2) For audits that do not result in a significant premium difference, defined as…

836-043-0150 Summary of Test Audit Results (1) Test audit results shall be summarized quarterly for the individual insurer or insurer group, as well as for the industry as a whole. The summary must include all prior quarters up to but not exceeding a total of six quarters. The su…

836-043-0155 Test Audit Standards (1) An insurer meets the test audit performance standard when the number of premium differences for field audits and desk audits in excess of $500 or two percent of the insured's standard premium, whichever is greater, does not exceed the maximum…

836-043-0165 Monitoring Audit Program System The director may examine every insurer for the purpose of determining its compliance with: (1) The statistical reporting requirements of OAR 836-042-0045; (2) The premium audit program requirements of OAR 836-043-0110 and 836-043-0115;…