OAR 836-043-0071
Dispute Resolution Procedures


(1)

Intentionally left blank —Ed.

(a)

A bona fide premium dispute is established when the employer or its representative provides:

(A)

Written notice to the Plan Administrator that includes all of the following:
(i)
All documentation relevant to the dispute, including written notice to the insurer or the servicing carrier detailing the specific areas of dispute;
(ii)
Description of the attempts to reconcile the differences; and
(iii)
A specific request for a review of all documentation, appropriate action to resolve the areas of dispute and if necessary, a hearing before the appropriate administrative or regulatory body having jurisdiction over assigned risk related appeals.

(B)

An estimate of the premium the employer believes to be correct, with an explanation of the premium calculation.

(C)

Verification of payment of the undisputed portion of the premium provided to the servicing carrier or insurer, and the Plan Administrator.

(b)

If the premium in dispute is in litigation, the employer shall provide documentation to the Plan Administrator.

(c)

The Plan Administrator shall notify the servicing carrier when a bona fide premium dispute is confirmed. Upon notification, the servicing carrier shall act according to the Plan Administrator’s direction pending the resolution of the dispute. The Plan Administrator may direct the servicing carrier to:

(A)

Suspend collection activity;

(B)

Suspend cancellation if a dispute exists prior to the effective date of cancellation; or

(C)

For policies already cancelled, refer to rules set forth in by the Plan Administrator.

(2)

Any assigned risk policyholder and the producer of an assigned risk policyholder affected by the actions of their servicing carrier or NCCI shall follow the procedures set forth in ORS 731.240 (Hearings in general), 737.340 (Initiation of proceedings by aggrieved person to determine lawfulness of filings) or 737.505 (Insured entitled to rate information) to review, resolve or request a hearing on any grievance.

(a)

An individual employer dispute is subject to ORS 731.240 (Hearings in general), 737.340 (Initiation of proceedings by aggrieved person to determine lawfulness of filings) or 737.505 (Insured entitled to rate information) as applicable and the conditions outlined in the Bona Fide Premium Dispute and Undisputed Premium Obligation. The intervention of the Plan Administrator in a dispute is limited to matters involving:

(A)

Experience rating modification factors;

(B)

Application of rules contained in NCCI manuals;

(C)

Eligibility and assignment under the Workers’ Compensation Insurance Plan;

(D)

Classification assignments;

(E)

Assigned risk pricing programs; or

(F)

A dispute involving other matters arising under the Plan.

(b)

Upon receipt of all necessary information regarding the dispute, the Plan Administrator shall review the matter and provide a written decision within 30 days.

(3)

Intentionally left blank —Ed.

(a)

When an employer dispute concerns any of the above matters, other than the application of NCCI’s rating plan rules, or involves more than one state, the Plan Administrator shall determine the appropriate jurisdiction for the dispute to be heard, based upon the following factors:

(A)

Governing state which shall be the state generating the greatest payroll;

(B)

The state covered by the servicing carrier with the greatest exposure insured;

(C)

The state where the operations are best represented; or

(D)

In accordance with the following jurisdiction table: [Table not included. See ED. NOTE.]

(b)

When a dispute concerns the application of NCCI’s rules for interstate rated risks, the Plan Administrator shall determine the appropriate jurisdiction for the dispute to be heard.

(c)

Unless state-specific rules apply, the ruling of the state appeals mechanism (as determined by the Plan Administrator to have jurisdiction over the dispute) will apply to all assigned risk policies whether written by one or more servicing carriers.

(4)

Upon receipt of all necessary information regarding the dispute, the Plan Administrator shall review disputes relating to the calculation or payment of producer fees and producer of record changes and provide a written decision within 30 days.

(5)

Intentionally left blank —Ed.

(a)

Any Plan participant who has a dispute with respect to any aspect of the Plan or Reinsurance Agreement including any dispute arising out of the organizing principles must first seek a review of the matter under this section by providing the following to the Plan Administrator:

(A)

Written documentation detailing specific areas of the dispute;

(B)

Specific request for a review of all documentation; and

(C)

Appropriate actions of areas to resolve the dispute.

(b)

The Plan Administrator may request additional information necessary to make a decision. All disputes submitted to the Plan Administrator are governed as follows:

(A)

For disputes relating to the general operation of the Plan, including but not limited to, performance standards for servicing carrier performance, compensation and incentives and application assignment determination, the Plan Administrator shall review the matter and provide a written decision within 30 days of receipt of all necessary information regarding the dispute.

(B)

Within 30 days after the Plan Administrator makes a decision and at the expense of the party, a party affected by the decision may submit a written request for binding arbitration or the party may seek a de novo review by the Insurance Commissioner.

(C)

For any de novo review, the Insurance Commissioner shall follow the procedures provided in ORS 183.310 (Definitions for chapter) to 183.540 (Reduction of economic impact on small business) and 737.360 (Rating organization to accept insurers as subscribers) for review of a contested case.

(D)

For a dispute relating to the servicing carrier selection process, refer to the Bid Protest Procedures contained in the applicable servicing carrier Request for Proposal (RFP).

(6)

Intentionally left blank —Ed.

(a)

Within 30 days after receipt of all necessary information regarding a dispute that arises under the organizing principles or a Reinsurance Agreement, the Plan Administrator or the administrator of the Reinsurance Agreement shall review the matter and provide a detailed written decision. Any party affected by the decision may request the board to review the decision by submitting a written request for review within 30 days after the date of the decision by the Reinsurance Administrator under the organizing principles. The board may:

(A)

Consider the matter and render its written decision pursuant to the procedures set forth in the organizing principles, or

(B)

Waive its decision and offer the aggrieved party the option of appealing directly to the Insurance Commissioner or submitting the dispute to arbitration in accordance with the terms and conditions established by the board.

(b)

Any party affected by a decision of the board may seek a de novo review by the Insurance Commissioner by submitting a written request for review, within 30 days after the date of the board decision.

(c)

If the dispute relates to the expulsion of a participating company under the organizing principles by the board or the noncontinuation of the reinsurance afforded under the organizing principles, the party may take the appeal directly to the Insurance Commissioner pursuant to ORS 737.360 (Rating organization to accept insurers as subscribers) without first complying with the procedures contained in this rule. The Insurance Commissioner has exclusive jurisdiction over all such disputes. For a review under this paragraph, the Insurance Commissioner shall follow the procedures provided in ORS 183.310 (Definitions for chapter) to 183.540 (Reduction of economic impact on small business) and 737.360 (Rating organization to accept insurers as subscribers) applicable to review of a contested case.
[ED. NOTE: Tables referenced are available from the agency.]

Source: Rule 836-043-0071 — Dispute Resolution Procedures, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-043-0071.

836–043–0001
Statutory Authority
836–043–0005
Definitions for the Workers’ Compensation Insurance Plan
836–043–0009
Participation by Insurers and Insurance Producers
836–043–0017
Plan Administrator
836–043–0021
Servicing Carriers
836–043–0024
Right to Apply
836–043–0028
Application by Electronic Transmission or Telephone
836–043–0032
Nonelectronic Application
836–043–0034
Surety Bonds
836–043–0041
Application Review
836–043–0044
Binding Coverage
836–043–0046
Rates and Forms, Policy Term, Additional Coverages and Other Provisions
836–043–0048
Additional States’ Coverage
836–043–0050
Interstate Assignments
836–043–0053
Premium Obligations
836–043–0056
Insurer Cancellation and Nonrenewal of Workers’ Compensation Insurance Policies or Surety Bonds
836–043–0060
Assignment Formula
836–043–0062
Issuance and Continuation of Policy
836–043–0064
Renewal, Nonrenewal
836–043–0066
Reassignment
836–043–0068
Cancellation
836–043–0071
Dispute Resolution Procedures
836–043–0072
Voluntary Coverage
836–043–0076
Takeout Credit
836–043–0079
Notification of Outstanding Premium
836–043–0082
Policyholder Services
836–043–0087
Producer Changes and Compensation
836–043–0089
Confidentiality of Information
836–043–0091
Self-Funded Plan
836–043–0101
Statutory Authority
836–043–0105
Definitions
836–043–0110
Insurer Premium Audit Program
836–043–0115
Insurer Audit Procedure Guide
836–043–0120
Minimum Standards of Insured Education Program
836–043–0125
Purpose
836–043–0130
Selection of Risks for Test Audit
836–043–0135
Test Audits
836–043–0145
Disposition of Test Audits
836–043–0150
Summary of Test Audit Results
836–043–0155
Test Audit Standards
836–043–0165
Monitoring Audit Program System
836–043–0170
Premium Audit Hearings
836–043–0175
Statutory Authority
836–043–0180
Definitions
836–043–0185
Insurer Classification Notice
836–043–0200
Statutory Authority
836–043–0210
Definitions
836–043–0220
Committee Participation
836–043–0230
Committee Operating Rules
836–043–0240
Committee Activities
836–043–0300
Qualifications for Workers’ Compensation Rating Oganizations
836–043–0310
Exchange of Data Among Workers’ Compensation Rating Organizations
836–043–0320
Competitive Selection Process
Last Updated

Jun. 8, 2021

Rule 836-043-0071’s source at or​.us