Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES
Section 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 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 Insurance Division of the Department of Consumer and Business Services, State of Oregon. The Insurance Division must receive the request not later than the 60th day after you received this billing.

Who may request a hearing?

By fax: 503-378-4351 Assistance is available on the Insurance Division's web page, at http://www.cbs.state.or.us/external/ins/ [File Link Not Available] and by e-mail, at DCBS.INSMAIL@state.or.us If the Insurance Division timely receives your request for a hearing, the Insurance Division 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 Insurance Division not later than the 60th day after the date the Insurance Division received your request for a hearing. You are entitled to a hearing only if the Insurance Division 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: