Current through Register Vol. 63, No. 3, March 1, 2024
(1)
Annual
Financial Report. Every self-insured employer must file an annual
financial report with the director, subject to the following:
(a) The report must include the employer's
audited financial statements or annual report with audited financial statement
for the just completed fiscal year, and SEC Form 10K, if issued;
(b) The report must be filed within the
following time frames:
(A) A self-insured
employer that is not a municipal or public corporation as defined in ORS
297.405 must make the filing
within 120 days of the end of its fiscal year; or
(B) A self-insured employer that is a
municipal or public corporation as defined in ORS
297.405 must make the filing
within 180 days of the end of its fiscal year;
(c) If audited financial statements are not
available for filing within the time frames of subsection (b), the self-insured
employer may file a financial statement that is certified by the self-insured
employer that the financial statement is true and accurate and presents the
self-insured employer's financial condition and results of operations as of the
date of the statement. The director may require a self-insured employer to
submit an audited financial statement if the certified financial statement
submitted is insufficient to evaluate the self-insured employer's financial
status;
(d) The financial
statements and reports must include information sufficient to determine the
self-insured employer's financial viability under OAR 436-050-0150 or OAR
436-050-0260; and
(e) All financial
statements and annual financial reports filed under this section will be
retained by the director for a period of at least three years.
(2)
Additional requirements
for self-insured employer groups. In addition to the requirements of
section (1) of this rule, by March 1 of each year each self-insured employer
group must file with the director:
(a) A
statement certifying the group meets or exceeds the combined net worth
requirement under OAR 436-050-0260(3)(a), as of the date of the
statement;
(b) A copy of the
fidelity bond furnished to the group by the administrator or a copy of the
comprehensive crime policy obtained by the group, in an amount sufficient to
protect the group against the misappropriation or misuse of any moneys or
securities. If the group previously filed a copy of a fidelity bond or policy
that covers more than one year, and that fidelity bond or policy is still in
effect, the group may include a statement in their annual report referring the
director to the copy on file in place of providing an additional copy;
and
(c) If the self-insured
employer group consists of private employer members:
(A) A statement certifying that each member
of the group meets the individual net worth requirement under OAR
436-050-0260(3)(b), as of the member's most recent fiscal year end;
and
(B) A list of the group's
current board members and their professional affiliations.
(3)
Claim loss data
reporting. The self-insured employer must report claim loss data to the
director by March 1 of each year for the purposes of experience rating
modification, retrospective rating calculations, and determining deposits.
Bulletin 209 provides guidelines for self-insured employers and their
authorized representatives to use in submitting the required data. The report
must be certified to be true and accurate by an authorized representative of
the self-insured employer, and must include:
(a) A report of losses for each year in the
experience rating period. The report must cover all claims incurred during the
reporting period and must be valued as of January 1 of the current year, and
must include:
(A) Contract medical
expenses;
(B) Total medical
reimbursement amount;
(C) The
number of claims for which medical reimbursement is claimed; and
(D) Separate lists including all claims with
total incurred losses above and below the National Council on Compensation
Insurance split point published in Bulletin 209. The lists must include:
(i) The worker's name, listed in alphabetical
order;
(ii) The date of
injury;
(iii) The claim
number;
(iv) The total amount
paid;
(v) The medical reimbursement
amount claimed, if applicable;
(vi)
Outstanding reserves; and
(vii)
Total incurred losses;
(b) A report of losses covering the
self-insured employer's non-experience period. The report must list all open
claims and must be valued as of January 1 of the current year, and must
include:
(A) The worker's name, listed in
alphabetical order;
(B) The date of
injury;
(C) The claim
number;
(D) The total amount
paid;
(E) Outstanding reserves;
and
(F) Total incurred
losses;
(c)
Identification of claims involving:
(A)
Catastrophes;
(B) The Workers with
Disabilities Program;
(C) Permanent
total disability;
(D) Fatal
benefits;
(E) Third party
recoveries; and
(F) Total incurred
losses that exceed, or are expected to exceed, the self-insured retention level
of the self-insured employer's excess insurance policy;
(d) If the self-insured employer is a
self-insured city, county, or qualified self-insured employer group that is
exempted from the security deposit requirements under ORS
656.407(3) and
OAR 436-050-0185:
(A) The procedures, methods,
and criteria used in the process of determining the amount of their actuarially
sound workers' compensation loss fund, including procedures for determining the
amount for injuries incurred but not reported; and
(B) Upon the director's request, an actuarial
study that demonstrates its loss reserve account is actuarially sound and
adequately funded under OAR 436-050-0185(2)(a)(D).
(4)
Director's requests for
additional information. The director may require a self-insured employer
to provide additional information, or submit financial statements, reports, or
claims loss data more frequently.
(a) The
director may require additional information or financial statements for reasons
including, but not limited to:
(A) Changes in
the financial status or viability of a self-insured employer or group;
and
(B) Changes in the net worth,
group membership, or private employer group's board membership of a
self-insured employer group.
(b) The director may require a self-insured
employer to submit additional claim loss data if the nature of the self-insured
employer's business has changed since the last annual loss report for reasons
including, but not limited to, mergers or acquisitions, changes in employment
level, nature of employment, or incurred claims costs.
(5)
Sanctions for failure to comply
with this rule. If a self-insured employer does not comply with the
requirements of this rule, the director may:
(a) Require the self-insured employer to
increase its deposit and premium assessments by 25 percent;
(b) Conduct an audit to obtain the necessary
loss information at the self-insured employer's expense;
(c) Assess civil penalties of up to $250 per
day that the information is not provided beyond the deadline; or
(d) Revoke the employer's certification for
self-insurance under OAR 436-050-0200 or OAR 436-050-0340.
(6)
Claims reserve audits. To
ensure each self-insured employer's claims are valued appropriately for use in
deposit, experience rating, and retrospective rating calculations, the director
will perform routine claims reserve audits.
(a) The values determined at audit will be
used to calculate the self-insured employer's security deposit, experience
rating factor, and retrospective rating adjustment.
(b) If there is a 10 percent or greater
difference between the values determined by the director at audit and the
values that were reported by the self-insured employer, the director may assess
civil penalties against the employer.
Statutory/Other Authority: ORS
656.407, ORS
656.430 & ORS
656.726(4)
Statutes/Other Implemented: ORS
656.407 & ORS
656.430
