OAR 836-043-0110
Insurer Premium Audit Program

(1)

The rates, rating plans and rating systems filed with and approved by the Director of the Department of Consumer and Business Services shall govern the audited payroll and the adjustment of premiums, subject to the provisions of this rule.

(2)

For the purpose of determining the premium for an insurance policy producing an annual standard premium of $10,000 or more, the insurer must perform a field audit of the insured at least once annually, except as provided in this section. For as long as the insurer continues to provide coverage to an insured, when the insurer finds that the audit premium difference is less than five percent for each of two consecutive policy years for which the insurer provided coverage, the insurer need audit only every third renewal policy subsequent to the policy most recently audited. If the insurer finds at any audit that the audit premium difference is five percent or greater, the insurer must again audit the insured’s policy at least annually until the insurer finds an audit premium difference of less than five percent for each of two consecutive policy years. For each policy year for which a policy is not audited, the insurer shall obtain a payroll report from the insured. For purposes of this section, the basis for the audit premium difference for an insured will be the audited standard premium as defined in each insurer’s approved rating system.

(3)

An insurer shall perform a field audit of at least five percent of all policies that are issued by the insurer and produce an annual standard premium of less than $10,000 but more than $1,000. In each year when a field audit of such a policy is not performed, the insurer shall perform a desk audit or obtain a payroll report from the insured. If neither a field or desk audit is performed nor a payroll report is obtained, the insurer shall give satisfactory reason to the director.

(4)

When an insurer performs an initial or revised audit, the insurer shall send to the insured a written final premium audit billing, as described in this rule and in OAR 836-043-0170 (Premium Audit Hearings).

(5)

A final premium audit billing must include the following wording, or substantially equivalent wording approved by the director, that is prominently displayed and in not less than 12-point type:
Notice: You, the insured, may request a hearing to dispute the results of the audit described in this final premium audit billing. If you want to request a hearing, you must send a written request for a hearing to the Insurance Division of the Department of Consumer and Business Services, State of Oregon. The Insurance Division must receive the request not later than the 60th day after you received this billing.
Who may request a hearing?
1. If the insured is a sole proprietor, then the insured or an attorney for the insured may request a hearing.
2. If the insured is a partnership, then an attorney for the partnership or any member of the partnership may request a hearing.
3. If the insured is a corporation, association or organized group, then an attorney for the corporation, association or organized group or an authorized officer or authorized employee of the corporation, association or organized group may request a hearing.
4. If the insured is a governmental authority other than a state agency, then an attorney for the governmental agency or an authorized officer or authorized employee of the governmental authority may request a hearing. Please state in your request the date you received this final premium audit billing. You must send the request for a hearing using at least one of the following methods:
By delivery:
Insurance Division
Department of Consumer and Business Services
350 Winter St. NE
Salem, OR 97301-3883
By mail:
Insurance Division
Department of Consumer and Business Services
PO Box 14480
Salem, OR 97309-0405
By e-mail:
DCBS.INSMAIL@state.or.us
By fax: 503-378-4351 Assistance is available on the Insurance Division’s web page, at http://www.cbs.state.or.us/external/ins/ and by e-mail, at DCBS.INSMAIL@state.or.us If the Insurance Division timely receives your request for a hearing, the Insurance Division will send or make available to you a petition form. In the petition, you must explain why you believe the billing is incorrect and describe the actions you want the director to take to correct the matter. The completed petition, along with a complete copy of the final premium audit billing, must be received by the Insurance Division not later than the 60th day after the date the Insurance Division received your request for a hearing. You are entitled to a hearing only if the Insurance Division timely receives your request for a hearing and completed petition and determines that the director has jurisdiction over the matter. You may send a copy of your request for hearing to your insurer so that you may attempt to resolve the dispute with your insurer prior to a hearing. However, please remember:
1. The 60-day period for initiating your request continues to run even though you may be negotiating with your insurer.
2. Your request must be received by the Insurance Division not later than the 60th day after you received this billing. You may wish to consult with an attorney about your case.

Source: Rule 836-043-0110 — Insurer Premium Audit Program, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-043-0110.

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 836-043-0110’s source at or​.us