Or. Admin. Code § 836-043-0044

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

Section 836-043-0044 - Binding Coverage

(1) The Plan Administrator may issue binders to eligible employers in accordance with the provisions of this Plan. The servicing carrier shall provide coverage under any binder issued by the Plan Administrator, subject to the provisions of the Plan, any applicable policy terms or conditions, and any applicable laws, rules, or regulations. The Plan Administrator shall send copies of the binder to the employer's representative, if any, the servicing carrier to which the Plan Administrator assigned the employer and the Director of the Department of Consumer and Business Services.

(2) The Plan Administrator shall issue a binder for an employer when the Plan Administrator determines all of the following occur:

(a) The employer is eligible for coverage;

(b) The Plan Administrator has received an application that is complete and signed by an officer, owner or other designee with power of attorney and includes any additional information within the established time frame; and

(c) The Plan Administrator has received the total initial premium or deposit premium within the established time frame.

(3) After the Plan Administrator binds coverage, the Plan Administrator shall provide the servicing carrier with the following:

(a) A copy of the binder;

(b) The initial or deposit premium;

(c) The application forms as set forth in Exhibits 1 and 2 to OAR 836-043-0024;

(d) Copies of any provided election or rejection forms;

(e) Other forms submitted during the application review process; and

(f) Any information to assist the servicing carrier in providing the proper coverage and correct rates including but not limited to experience rating modification worksheet data, NCCI's Inspection and Classification Report, and change of ownership information form if applicable.

(4) Upon receipt of the assignment package, the servicing carrier shall review the documents to ensure that all documentation needed to properly issue the policy is attached. Based on the separate review of the servicing carrier, the servicing carrier may request additional information or premium from the employer. The servicing carrier must receive all additional requested information or premium before the servicing carrier issues a policy.

(5) The servicing carrier shall issue the policy in accordance with Plan rules, state law and the Assigned Carrier Performance Standards.

(6) The binder or verification page remains in effect until cancelled or until the servicing carrier issues a policy in accordance with the Assigned Carrier Performance Standards or state law. If the Plan Administrator does not issue a binder, coverage does not exist.

(7)

(a) The employer or the representative of the employer may request an effective date no later than sixty days after the date of application. However, such requested effective date must be the later of the following:

(A) The established effective date as outlined in the tables set forth in subsection (8) of this rule;

(B) The date of expiration of existing coverage; or

(C) A date the employer requested.

(b) To secure a requested effective date, the employer or the representative of the employer shall:

(A) Submit to the Plan Administrator a signed and completed application as described in Exhibits 1 and 2 to OAR 836-043-0024 using one of the submission methods described in OAR 836-043-0024(5).

(B) For an application submitted by U.S. Postal Service or private overnight delivery service, at a minimum, include in the application submission the required critical threshold elements as defined in NCCI's Assigned Risk Supplement to the Basic Manual.

(C) If submitting an application via mail or an overnight delivery service, include the appropriate initial or deposit premium. The Plan Administrator will consider the receipt of the application at the specified mailing address receipt.

(8) The earliest effective date for coverage is dependent on the method used to submit the application and shall be determined in accordance with the following tables: [Table not included. See ED. NOTE.]

(9) If the Plan Administrator fails to issue a binder to an eligible employer by the 14th day after receiving a completed application and the total initial or deposit premium, coverage is bound at 12:01 a.m. on the later of the dates specified in section (8) of this rule.

(10) A binder issued to a worker leasing company applicant in compliance with requirements for an initial worker leasing company license under OAR 436-050-0440 is extended as provided in this section until the Director of the Department of Consumer and Business Services either licenses or refuses to license the applicant, as follows:

(a) The binder is conditional upon the subsequent initial worker leasing company licensing by the Director. The binder does not obligate the Plan to provide coverage to the worker leasing company for its clients until the worker leasing company is licensed by the Director of the Department of Consumer and Business Services.

(b) Upon the conditional binding of the applicant worker leasing company, the Plan Administrator shall send the binder to those entities listed in section (1) of this rule, except for the servicing carrier.

(c) Upon the initial licensing of a worker leasing company applicant by the Director of the Department of Consumer and Business Services, and receipt of proof of licensing, the Plan Administrator shall assign an unconditional binder to a servicing carrier and send an unconditional binder to all entities listed in section (1) of this rule.

(d) Upon the refusal to license a worker leasing company applicant by the Director of the Department of Consumer and Business Services, and upon receipt of proof of refusal, the Plan Administrator shall send notice to all entities listed in section (1) of this rule that the conditional binder has been rescinded and the applicant was not covered.

Or. Admin. Code § 836-043-0044

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

Tables referenced are available from the agency.

Stat. Auth.: ORS 656.427, 656.730 & 731.244

Stats. Implemented: ORS 656.427, 656.730 & 737.265