Or. Admin. Code § 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 common control with, another insurer
specified, and is required to participate in the Plan pursuant to OAR
836-043-0009. For purposes of
this definition, "control" means possession, direct or indirect, of the power
to direct or cause the direction of the management and policies of an insurer,
whether through the ownership of voting securities, by contract or otherwise.
Control is deemed to exist if any person or business enterprise, directly or
indirectly, owns, controls, holds with the power to vote, or holds proxies,
representing ten percent or more of the voting securities of any other
insurer.
(2) "Application" means
the form approved for use in the assigned risk market by the Plan Administrator
for the purpose of securing workers compensation insurance under the Plan,
which contains the required information as described in NCCI's Assigned Risk
Supplement to the Basic Manual for Workers' Compensation and Employers
Liability Insurance.
(3) "Assigned
risk market" means a state insurance plan that provides employers unable to
secure coverage in the voluntary market with a means for insuring their
operations through a designated insurance carrier.
(4) "Assigned Carrier Performance Standards"
means the minimum level of performance for servicing carriers writing coverage
on behalf of the Plan. The purpose of the Assigned Carrier Performance
Standards is to provide policy issuance and service level requirements that
servicing carriers must adhere to in order to provide assigned risk market
policyholders with uniform service while reducing the overall loss
ratio.
(5) "Board" means the Board
of Directors or governing entity of the reinsurance organization selected by
the Director to implement the assigned risk plan under ORS
656.730.
(6) "Bona Fide Premium Dispute" means a
disagreement relating to a workers' compensation premium established under OAR
836-043-0071(1).
(7) "Client" means any person to whom workers
are provided under contract and for a fee on a leased basis.
(8) "Common management interest" means an
interest that exists when one or more individuals are or were owners or
officers of, or performs or performed management functions for, two or more
entities, or for a succession of entities.
(9) "Employer" means any business
organization or enterprise that has a statutory right to maintain workers'
compensation insurance in Oregon. "Employer" includes:
(a) Any business organization or enterprise
that is affiliated at any time as a result of common management or ownership;
or
(b) A client business of a
worker leasing company as established in ORS
656.850.
(10) "Governing state" means the state that
generates the largest amount of payroll.
(11) "Insured" means the employer designated
in the information page of a policy to which this Plan is applied and issued by
a servicing carrier.
(12)
"Insurance Commissioner" means the Director of the Department of Consumer and
Business Services or the person appointed by the director to serve as Insurance
Commissioner under ORS
705.115.
(13) "Insurer" means the State Accident
Insurance Fund Corporation or a person licensed under ORS chapter 731 for
workers' compensation that satisfies its participation obligation by
subscribing to the organizing principles. By subscribing to the organizing
principles, an insurer shares in the results of the reinsurance pooling
mechanisms on a pro-rata basis of their net premiums written within the state.
The insurer may be assessed or receive disbursements depending upon the
reinsurance pooling mechanism's operating results.
(14) "National Council on Compensation
Insurance, Inc." and "NCCI" mean a rating organization that is licensed in
Oregon to make and file rates, rating values, classifications and rating plans
for workers' compensation insurance, and is an organization that authorized
workers' compensation insurers may be members for the purpose of satisfying ORS
737.560.
(15) "Net premiums written" means the gross
direct premiums charged less all premiums (except dividends and savings
refunded under participating policies) returned to insureds for all workers'
compensation and occupational disease insurance, exclusive of premiums for
employers subject to the Plan, and for employers written under the National
Defense Projects Rating Plan and under excess policies.
(16) "Organizing principles" means the
agreement and principles of the reinsurance organization, approved by the
Director, that govern the management of and participation in the Plan. A
carrier participating in the Plan subscribes to the organizing principles.
"Organizing principles" may include any of the following, as applicable:
(a) The National Pool reinsurance mechanism
that is filed with and approved by the Insurance Commissioner and that is
authorized under the Plan to provide reinsurance to the servicing carriers on
employers assigned to them under the Plan.
(b) The Bylaws of the National Workers'
Compensation Reinsurance Association NFP (NWCRA or Association), whose member
insurers participate in the Reinsurance Agreement(s) authorized under this Plan
to provide reinsurance to the servicing carriers on employers assigned to them
under this Plan. The Bylaws are the agreement subscribed to by insurers
selecting Option 2 -- Subscription to organizing principles as their means of
satisfying their participation in the Plan.
(c) The agreement or management rules of any
reinsurance organization selected by the Director to implement Oregon's
assigned risk plan.
(17)
"Plan" means the Oregon Workers' Compensation Insurance Plan.
(18) "Plan Administrator" means the
organization designated in OAR
836-043-0017, and its
agents.
(19) "Producer" means a
person who is licensed as an insurance producer under ORS
744.052 to
744.089, whose privileges under
this Plan have not been suspended or revoked, designated by the employer or
applicant applying under this Plan to secure and maintain workers' compensation
and employers liability insurance on behalf of the employer. For purposes of
this Plan, the producer is considered to be acting on behalf of the insured or
employer applying for coverage under this Plan and not as a producer of the
Plan Administrator or of any servicing carrier for Plan business.
(20) "Reasonable offer of voluntary coverage"
means any offer for voluntary coverage where the total estimated annual premium
is less than or equal to the assigned risk total estimated annual premium
including any applicable assigned risk surcharges or pricing programs for all
comparable coverage. Subject to the Plan Administrator's discretion,
"reasonable offer of coverage" does not include:
(a) An offer that does not provide all of the
required coverage (e.g., carrier cannot provide federal coverage or limits of
liability);
(b) An offer that
includes a deductible or deposit that is a financial burden to the employer as
determined by the producer or employer; or
(c) The carrier's financial rating status is
below that required by the producer or employer.
(21) "Regulatory authority" means the
commissioner, director or superintendent of a state's insurance regulatory
agency, or a properly appointed designee of the commissioner, director or
superintendent.
(22) "Reinsurance
Agreement" means a contractual arrangement among association members providing
a quota share reinsurance facility for workers' compensation insurance in a
number of states and for which administrative services are provided by the
National Council on Compensation Insurance, Inc. in its capacity as
administrator as designated under the organizing principles.
(23) "Reinsurance Organization" means the
entity selected by the Director to implement Oregon's workers compensation
assigned risk plan under ORS
656.730. "Reinsurance
Organization" may include:
(a) The National
Workers' Compensation Reinsurance Association, a nonprofit corporation whose
members provide for contractual quota share reinsurance through reinsurance
agreements among themselves as workers' compensation insurers, which affords
the insurers an option for complying with state insurance plan requirements by
sharing in the experience of certain policies written pursuant to such
insurance plans;
(b) The National
Workers' Compensation Reinsurance Pool, a contractual reinsurance mechanism
among participating workers' compensation insurers, that affords insurers in
certain states an option for complying with state insurance plan requirements
by sharing in the experience arising out of certain policies written pursuant
to such insurance plans; or
(c) Any
other entity selected by the Director to implement the Oregon assigned risk
plan.
(24) "Servicing
carrier" means an insurer, including the State Accident Insurance Fund
Corporation, approved by the Insurance Commissioner that has been assigned to
provide coverage to an eligible employer who has applied for workers'
compensation insurance pursuant to the Plan.
(25) "State" means any state of the United
States and the District of Columbia.
(26) "Undisputed premium obligation" means a
workers' compensation insurance premium obligation that is not the subject of a
bona fide dispute pursuant to ORS
737.318 or
737.505 or by a judicial action,
and for which there is no written payment plan in effect between an insurer and
employer.
(27) "Workers'
compensation insurance" means:
(a) Statutory
workers' compensation and occupational disease liability insurance, including
insurance for liability under the Longshore and Harbor Workers' Compensation
Act, as amended, and the Federal Coal Mine Health and Safety Act of 1969, as
amended;
(b) Employers liability
insurance written in connection with a workers' compensation insurance policy;
and
(c) Such additional coverage as
determined by the Plan Administrator and approved by the Insurance
Commissioner.
(28)
"Workers' Compensation Rating System Review and Advisory Committee" means the
committee established pursuant to OAR
836-043-0200 to hear employer
grievances pursuant to ORS
737.505.
Note: The Bylaws and the National Pool reinsurance mechanism (Articles of Agreement) are attached to this rule as Exhibit 4.
Notes
Exhibits referenced are available from the agency.
Stat. Auth.: ORS 656.427, 656.730 & 731.244
Stats. Implemented: ORS 656.427, 656.730 & 737.265
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