(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
Division of Financial Regulation of the Department of Consumer and Business
Services, State of Oregon. The Division of Financial Regulation 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:
Division of Financial Regulation
Department of Consumer and Business Services
350 Winter St. NE
Salem, OR 97301-3883
By mail:
Division of Financial Regulation
Department of Consumer and Business Services
PO Box 14480
Salem, OR 97309-0405
By e-mail:
DCBS. PremiumAudit@DCBS.oregon.gov.
By fax:
503-378-4351.
Assistance is available on the Division of Financial
Regulation's web page, at DFR.oregon.gov/rates-forms/workers-comp and by
e-mail, at DCBS.PremiumAudit@DCBS.oregon.gov. If the Division of Financial
Regulation timely receives your request for a hearing, the Division of
Financial Regulation 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 Division of Financial Regulation not later
than the 60th day after the date the Division of Financial Regulation received
your request for a hearing. You are entitled to a hearing only if the Division
of Financial Regulation 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 Division of Financial Regulation not later than the 60th day
after you received this billing. You may wish to consult with an attorney about
your case.
Notes
Or. Admin. Code
§
836-043-0110
ID 1-1988, f.
& cert. ef. 1-20-88; ID 13-1988(Temp), f. & cert. ef. 7-27-88; ID
15-1988(Temp), f. & cert. ef. 9-2-88; ID 4-1989, f. & cert. ef.
2-28-89; ID 9-1990, f. 5-10-90, cert. ef. 6-1-90; ID 6-1997(Temp), f. &
cert. ef. 5-30-97; ID 17-1997, f. 11-25-97, cert. ef. 11-26-97; ID 1-2000, f.
& cert. ef. 2-10-00; ID 1-2007, f. & cert. ef. 1-17-07; ID 13-2012, f.
7-16-12, cert. ef. 1-1-13;
ID
39-2024, minor correction filed 12/09/2024, effective
12/9/2024
Statutory/Other Authority: ORS
737.318,
731.244 &
737.310
Statutes/Other Implemented: ORS
737.318 &
737.505
