OAR 436-050-0160
Applying for Certification as a Self-Insured Employer

(1)

Required information. An employer applying for certification as a self-insured employer must submit:

(a)

A completed Form 1868, “Application for Self-Insurance;”

(b)

Proof of an adequate staff qualified to process the employer’s claims under OAR 436-050-0150 (Qualifications of a Self-Insured Employer)(2);

(c)

The employer’s audited financial statements or audited annual reports for the last three fiscal or calendar years, subject to the following:

(A)

If the audited financial statements of a parent company are provided in place of statements for the employer, the director will not authorize the individual employer to be self-insured under its own program, unless a parental company guarantee can be obtained. Otherwise, it will be necessary for the parent company to be the self-insured employer or to separately insure the employer. In the context of this section, a parent company is a legal entity that owns a majority interest in the employer, or owns a majority interest in another entity or succession of entities that own a majority interest in the employer; or

(B)

If audited financial statements are not available at the time of application, the employer may submit certified financial statements in place of audited financial statements or annual reports. However, if the certified financial statements submitted are insufficient to evaluate the employer’s financial ability, the director may require the employer to submit audited financial statements;

(d)

The employer’s most recent experience rating modification worksheet and supporting documentation. Applicants with prior Oregon experience who do not submit this data will be assigned a 1.50 experience rating modification pending receipt of the data. All those without prior Oregon experience will be assigned a 1.00 experience rating modification;

(e)

The type, retention, and limitation levels of excess workers’ compensation insurance the employer is planning to obtain as required by OAR 436-050-0170 (Excess Insurance Requirements);

(f)

If applicable, a service agreement between the employer and service company that has been signed by both parties that meets the requirements of OAR 436-050-0210 (Notice of Self-Insurer’s Place of Business in State; Records Self-Insured Must Keep in Oregon). The agreement must:

(A)

Be submitted at least 14 days before the desired date of certification, and be approved by the director before the service company begins processing claims, regardless of the effective date established in the agreement; and

(B)

The agreement must also contain the location, mailing address, telephone number, and any other contact information of the service company;

(g)

Proof of the employer’s ability to provide an acceptable security deposit, including either:

(A)

Evidence from a surety bond company admitted to do surety business in this state that they will issue a surety bond for the employer, as Principal, and the Oregon Department of Consumer and Business Services, Workers’ Compensation Division, as Obligee; or

(B)

Evidence from a qualified bank that they will issue an irrevocable standby letter of credit for the employer with the Oregon Department of Consumer and Business Services as the beneficiary;

(h)

Evidence of an occupational safety and health loss control program in accordance with OAR 437-001 as required by ORS 656.430 (Certification of self-insured employer)(10); and

(i)

Evidence of:

(A)

The employer’s authorization to do business in this state under ORS chapters 58, 60, 62, 63, 65, 67, 70, and 648, as applicable; or

(B)

The employer’s status as a municipal or public corporation as defined in ORS 297.405 (Definitions for ORS 297.020, 297.230, 297.405 to 297.740 and 297.990).

(2)

Review of application. Within 30 days of receipt of all information required in section (1) of this rule, the director will review the application and notify the employer that the request for certification as a self-insured employer is approved or denied.

(a)

If the request is denied, the notice will include the reason for denial; or

(b)

If the request is approved, the notice will include:

(A)

Confirmation of the type and the amount of the security deposit required;

(B)

Approval of the type, retention, and limitation levels of the excess insurance required; and

(C)

Approval of a service agreement submitted under OAR 436-050-0110 (Notice of Insurer’s Place of Business in State; Coverage Records Insurer Must Keep in Oregon), if applicable.

(3)

Issuance of certification. If approved, the certification of self-insurance will be issued upon receipt of the security deposit and the appropriate excess insurance binder. The effective date of certification will be the first day of the month following the date the certificate is issued, or a later date specified by the applicant.

Source: Rule 436-050-0160 — Applying for Certification as a Self-Insured Employer, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=436-050-0160.

436‑050‑0003
Purpose and Applicability 436‑050‑0005
Definitions 436‑050‑0008
Requests for Hearings or Administrative Review 436‑050‑0015
Suspension and Revocation of Authorization to Issue Workers’ Compensation Insurance Policies 436‑050‑0025
Service of the Notice of Civil Penalty Orders 436‑050‑0040
Responsibility for Providing Coverage When a Contract is Awarded 436‑050‑0045
Nonsubject Workers 436‑050‑0050
Corporate Officers, Limited Liability Company Members, Partners 436‑050‑0055
Extraterritorial Coverage 436‑050‑0110
Notice of Insurer’s Place of Business in State 436‑050‑0120
Records Insurers Must Keep in Oregon 436‑050‑0150
Qualifications of a Self-Insured Employer 436‑050‑0160
Applying for Certification as a Self-Insured Employer 436‑050‑0165
Security Deposit Requirements 436‑050‑0170
Excess Insurance Requirements 436‑050‑0175
Annual Reporting Requirements 436‑050‑0180
Determination of Amount of Self-Insured Employer’s Deposit 436‑050‑0185
Qualifications for Deposit Exemption for Self-Insured Cities, Counties, and Qualified Self-Insured Employer Groups, Application Procedures, Conditions and Requirements, Revocation and Requalification 436‑050‑0190
Using Self-Insured Employers’ Security Deposit/Self-Insured Employer Adjustment Reserve/Self-Insured Employer Group Adjustment Reserve/Director-Ordered Assessments of Private Employer Members of Self-Insured Employer Groups 436‑050‑0195
Requirements for Changes in Self-Insured Employer Entity 436‑050‑0200
Self-Insured Certification Cancellation 436‑050‑0205
Notice of Self-Insurer’s Personal Elections 436‑050‑0210
Notice of Self-Insurer’s Place of Business in State 436‑050‑0220
Records Self-Insured Employer Must Keep in Oregon 436‑050‑0230
Out-of-State Recordkeeping and Claims Processing by Self-Insured Employer 436‑050‑0260
Qualifications of a Self-Insured Employer Group 436‑050‑0270
Applying for Certification as a Self-Insured Employer Group: Private Employers 436‑050‑0280
Applying for Certification as a Self-Insured Employer Group: Governmental Subdivisions 436‑050‑0290
Commencement/Termination/Cancellation of Employers with a Self-Insured Employer Group 436‑050‑0300
Self-Insured Employer Group, Common Claims Fund 436‑050‑0340
Group Self-Insurance Revocation
Last Updated

Jun. 8, 2021

Rule 436-050-0160’s source at or​.us