Oregon Department of Consumer and Business Services, Workers' Compensation Division

Rule Rule 436-180-0110
Notice of Client Coverage; Changes to Coverage Information; Termination; Reinstatements


(1) Notice of client coverage. When a worker leasing company provides coverage to a client under OAR 436-180-0100 (Responsibility for Providing Coverage under a Lease Arrangement)(2), the worker leasing company must file written notice with the director and its insurer, using Form 2465, “Worker Leasing Notice,” subject to the following:
(a) The Form 2465 must be filed within 30 days after the effective date of the worker leasing contract; and
(b) The Form 2465 must be correct, complete, signed by an authorized representative of the worker leasing company, and must include:
(A) The client’s:
(i) Legal name and assumed business names, if any;
(ii) FEIN;
(iii) Type of ownership;
(iv) North American Industry Classification System Code;
(v) Governing class code or National Council on Compensation Insurance (NCCI) code;
(vi) Phone number, email address, and mailing address; and
(vii) Street address of Oregon location; and
(B) The worker leasing company’s:
(i) Legal name and assumed business names, if any;
(ii) FEIN;
(iii) Oregon worker leasing license number;
(iv) Effective date of Oregon client coverage; and
(v) Contact name and phone number.
(2) Changes or corrections to client coverage information. A worker leasing company must notify the director and its insurer of changes or corrections to information provided under section (1) of this rule using Form 3270, “Worker Leasing Update Notice,” within 30 days after the effective date of a change, or knowledge a correction is needed.
(3) Termination of client coverage. A worker leasing company may terminate its obligation to provide coverage to a client by providing written notice of the termination, subject to the following:
(a) The worker leasing company may use Form 3271, “Worker Leasing Termination Notice,” to satisfy the requirements of this section;
(b) The notice must state:
(A) The requested effective date of the termination;
(B) The reason for the termination;
(C) The client’s:
(i) Legal name and assumed business names, if any;
(ii) FEIN;
(iii) Phone number, email address, and mailing address; and
(D) The name, phone number, and signature of an authorized representative of the worker leasing company;
(c) The notice must be sent to the client’s last-known address by U.S. mail, and copied to the worker leasing company’s insurer and the director;
(d) The notice must be sent within 30 days after the final date of the lease arrangement, or knowledge that the client obtained other coverage;
(e) Regardless of the requested effective date stated under paragraph (3)(b)(A), termination of the worker leasing company’s obligation to provide coverage to the client will not be effective until at least:
(A) The 30th day after the notice is received by the director; or
(B) The effective date of other coverage for the client that has been filed with the director.
(4) Reinstatement of client coverage. When a worker leasing company reinstates coverage to a client following a termination under section (3) of this rule, the worker leasing company must notify the director using Form 5361, “Worker Leasing Reinstatement Notice,” subject to the following:
(a) The Form 5361 must be filed within 30 days after the reinstatement becomes necessary; and
(b) The Form 5361 must be correct, complete, signed by an authorized representative of the worker leasing company, and must include:
(A) The client’s:
(i) Legal name and assumed business names, if any;
(ii) FEIN;
(iii) Phone number, and
(iv) Email address, if known;
(B) The worker leasing company’s:
(i) Legal name and assumed business names, if any;
(ii) FEIN;
(iii) Oregon worker leasing license number; and
(iv) Contact name and phone number.
Source

Last accessed
Jun. 8, 2021