Current through Register Vol. 63, No. 9, September 1, 2024
(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
reasonable offer of voluntary coverage. The employer must apply on the forms
and according to the directions prescribed in Exhibits 1,
2, and 3 to this rule.
(2) For purposes of section (1) of this rule,
the offer of a rating plan approved by the Insurance Commissioner is considered
an offer of voluntary coverage or insurance. Any dispute arising from the
application or interpretation of this rule is subject to the dispute resolution
procedure provided in OAR 836-043-0070. As used in this section, "reasonable
rating plan" means any rating program approved for use in a state by the
regulatory authority.
(3) An
employer seeking coverage under the Plan or a representative of the employer
must:
(a) Within 60 days before applying for
coverage under the Plan, apply for workers' compensation insurance and receive
a declination from at least one insurer licensed to write and actively writing
workers' compensation insurance in Oregon. The declination must be from the
insurer providing workers' compensation insurance to the employer at the time
of application, if any. Proof of cancellation or nonrenewal from the insurer
shall be considered to be the required declination.
(b) Maintain a record of all insurer
declinations for the policy period in force. The employer must provide this
information to the Plan Administrator or servicing carrier upon request. The
information must include:
(A) Insurer
name;
(B) Person contacted at
insurer;
(C) Mailing address and
phone number of insurer contact; and
(D) Date of declination.
(4) For purposes of section (1) of
this rule, an employer is presumed to be eligible in the absence of clear and
convincing evidence to the contrary. An employer is not eligible if any of the
following circumstances exists at the time of application or thereafter:
(a) A self-insured employer knows and is
aware of pending bankruptcy proceedings, insolvency, cessation of operations or
conditions that will probably result in occupational disease or cumulative
injury claims from exposures incurred while the employer was
self-insured.
(b) The employer,
while insurance issued under the Plan is in force:
(A) Knowingly refuses to meet reasonable
health, safety or loss control requirements;
(B) Does not allow any insurer or the
servicing carrier reasonable access to its records for audit or inspection
under the policy; or
(C) Does not
comply with any other policy obligation.
(c) The employer has an outstanding workers'
compensation insurance premium obligation or other monetary policy obligation
including but not limited to an obligation under a deductible program, on
previous workers' compensation insurance that is not subject to a bona fide
dispute.
(d) The employer, a
representative of the employer, or the producer knowingly fails to comply with
Plan procedures, or knowingly makes a material misrepresentation on the
application by express statement, omission or otherwise, including but not
limited to:
(A) Estimated payroll;
(B) Offers of workers' compensation
insurance;
(C) Nature of
business;
(D) Name of
business;
(E) Management or
ownership of business;
(F) Previous
insurance history;
(G) Avoidance of
an experience rating modification;
(H) An outstanding workers' compensation
insurance premium obligation or other monetary policy obligation of the
employer;
(I) Noncompliance with
any applicable state licensing or registration requirement;
(J) Fails to accept any reasonable offer of
voluntary coverage; or
(K) Other
evidence exists that shows the employer is not entitled to insurance
(5) An eligible
employer may submit a completed application for assigned risk coverage through
the Plan by any method approved by the Plan Administrator, including:
(a) Online -- Through ncci.com ;
(b) Mail -- The U.S. Postal Service or
private overnight delivery service; or
(c) Telephone -- By contacting the Plan
Administrator.
(6) The
Plan Administrator shall conditionally bind coverage of a worker leasing
company applicant for an initial worker leasing company license under OAR
436-050-0440 pending issuance of
the license by the Director.
(7) An
eligible employer or the representative of the employer must submit the total
initial or deposit premium by a method approved by the Plan Administrator
including:
(a) Electronic fund
transfer;
(b) Credit card;
or
(c) Check.
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
