Or. Admin. Code § 836-043-0024

Current through Register Vol. 63, No. 12, December 1, 2024

Section 836-043-0024 - Right to Apply

(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.

Or. Admin. Code § 836-043-0024

ID 10-1996, f. 6-27-96, cert. ef. 7-1-96; ID 1-2003, f. & cert. ef. 1-17-03; ID 18-2008, f. 12-9-08, cert. ef. 1-1-09

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