OAR 836-080-0085
Annual Report; Sampling

(1)

Each insurer shall report to the Director annually on its compliance with Section 2, Chapter 747, Oregon Laws 2001 (Enrolled Senate Bill 894), governing claims received by an insurer from a provider on behalf of an enrollee, according to the requirements of this rule.

(2)

Not later than March 1 of each year, each insurer shall submit the following to the Director:

(a)

A count of all claims for which final disposition has been made by the insurer during the immediately preceding calendar year.

(b)

A count of all claims included in the count in subsection (a) of this section that were each finally disposed of later than the 30th day after the date on which the insurer received the claim.

(c)

A data file that includes a population list with respect to the claims described in subsection (b) of this section, in the form and manner specified by the Director.

(3)

The Director shall select a number of sample files from each insurer’s data file submitted under section (2) of this rule, using a methodology determined by the Director to provide a representative and statistically valid sampling of the insurer’s insured population and shall deliver to the insurer the file numbers and the format in which the information required under section (4) of this rule shall be captured and submitted to the Director.

(4)

Each insurer shall examine each sample selected under section (3) of this rule against its records to determine information requested by the Director. The information shall include but not be limited to the following:

(a)

The date on which the claim was received;

(b)

The date on which the insurer requested additional information on the claim;

(c)

The date on which the insurer received the additional information;

(d)

The date on which the insurer paid or denied the claim.

(e)

Whether interest was owed or paid on the claim under section 3, chapter 747, Oregon Laws 2001, or whether the insurer was not required to pay interest as provided in Section 3(2), Chapter 747, Oregon Laws 2001.

(f)

Whether the claim was paid or denied. For the purpose of this subsection, a claim that is paid in part and denied in part shall be treated as a paid claim.

(5)

Not later than the 60th day after the date on which an insurer receives the selection of sample files from the Director under section (3) of this rule, the insurer shall submit to the Director a report of its data determined under section (4) of this rule in the format prescribed by the Director.

(6)

For the purpose of the annual report that is due for calendar year 2002, an insurer shall sample and count only those claims that were submitted to an insurer on or after January 1, 2002 and on or before December 31, 2002.

Source: Rule 836-080-0085 — Annual Report; Sampling, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-080-0085.

836‑080‑0001
Statutory Authority 836‑080‑0005
Definitions 836‑080‑0014
Duties of Agent 836‑080‑0022
Duties of Insurers that Use Agents Insurance Producers 836‑080‑0029
Duties of Replacing Insurers that Use Agents 836‑080‑0034
Duties of the Existing Insurer 836‑080‑0039
Duties of Insurers with Respect to Direct Response Solicitations 836‑080‑0043
Violations and Penalties 836‑080‑0050
Authority 836‑080‑0055
Unfair Discrimination Identified 836‑080‑0080
Definition, Claims Handling Services 836‑080‑0085
Annual Report 836‑080‑0090
Suitability in the Sale of Life Insurance 836‑080‑0105
Statutory Authority 836‑080‑0110
Applicability 836‑080‑0115
Definitions 836‑080‑0120
Statement as to Participation Required Upon Request Before Delivery of Policy 836‑080‑0125
Prohibited Representations Regarding Participation Rights 836‑080‑0130
Dividend Statement Permitted 836‑080‑0135
Dividend Rights Accrue Upon Declaration of Dividends 836‑080‑0140
Unfair Discrimination in Allocation of Dividends Prohibited 836‑080‑0145
Unfair Forfeiture of Dividend for Failure to Renew Prohibited 836‑080‑0150
Policyholder Dividend Rights of Group Members and Dividend Group Policyholders 836‑080‑0155
False or Deceptive Publications by Insurer Prohibited 836‑080‑0160
Use of Special Certifications and Professional Designations by Insurance Producers 836‑080‑0165
Notice of Insurance Division Assistance 836‑080‑0170
Statutory Authority 836‑080‑0172
Applicability 836‑080‑0175
Exemptions 836‑080‑0178
Definitions 836‑080‑0180
Duties of Insurers and of Insurance Producers 836‑080‑0183
Insurance Producer Training 836‑080‑0185
Compliance Mitigation 836‑080‑0188
Recordkeeping 836‑080‑0190
Annuity Sales 836‑080‑0193
Effective Date and Operative Date 836‑080‑0200
Electronic Payment of Claims 836‑080‑0205
Statutory Authority, Purpose, and Applicability 836‑080‑0210
Definitions 836‑080‑0215
Claim Files 836‑080‑0220
Misrepresentation and Other Prohibited Claim Practices 836‑080‑0225
Required Claim Communication Practices 836‑080‑0230
Standard for Prompt Claim Investigation 836‑080‑0235
Standards for Prompt and Fair Settlements — Generally 836‑080‑0240
Standards for Prompt and Fair Total Loss Settlements — Automobile Insurance 836‑080‑0250
Workers’ Compensation Insurance Unfair Claim Settlement Practices Standards 836‑080‑0305
Statutory Authority 836‑080‑0310
Definitions 836‑080‑0315
Providing Things of Value to Intermediaries Generally Prohibited 836‑080‑0320
Miscellaneous Things of Value 836‑080‑0325
Business Development Activities 836‑080‑0335
Gifts 836‑080‑0337
Real Property Information 836‑080‑0340
Assistance in Qualifying a Subdivision 836‑080‑0345
Automatic Change in Monetary Limits 836‑080‑0355
Title Insurer Responsible for Violations by Agent 836‑080‑0360
Use by Title Company of an Intermediary’s Office 836‑080‑0365
Filing Escrow Rates Required 836‑080‑0370
Instruction of Title Company Employees About Rules Required 836‑080‑0425
Applicability 836‑080‑0430
Disclosure of Use of Credit History or Insurance Scores 836‑080‑0435
Policies Governing Credit Histories and Insurance Scores 836‑080‑0436
Absence of or Inability to Determine Credit History 836‑080‑0438
Definition of Adverse Underwriting Decision 836‑080‑0440
Unfair Insurance Trade Practice 836‑080‑0501
Authority 836‑080‑0506
Definitions and Examples 836‑080‑0511
Application of Notice Requirements 836‑080‑0516
Initial Notice to Consumers 836‑080‑0519
Information to be Included in Initial Privacy Notice 836‑080‑0523
Annual Notice 836‑080‑0526
Information to be Included in Annual Notice 836‑080‑0531
Revised Privacy Notices 836‑080‑0536
Delivery 836‑080‑0541
Opt in Notice 836‑080‑0546
Limits on Sharing Account Number Information for Marketing Purposes 836‑080‑0551
Authorization Request Delivery 836‑080‑0600
Authority 836‑080‑0610
Definitions and Examples 836‑080‑0615
Personal Information Notice 836‑080‑0620
Notice of Personal Financial Information Practices 836‑080‑0625
Alternative Procedures 836‑080‑0630
Application of Notice Requirements 836‑080‑0635
Initial Notice to Consumers 836‑080‑0640
Information to Be Included in Initial Privacy Notice 836‑080‑0645
Annual Notice 836‑080‑0650
Information to Be Included in Annual Notice 836‑080‑0655
Revised Privacy Notices 836‑080‑0660
Delivery 836‑080‑0665
Authorization 836‑080‑0670
Authorization Exemptions 836‑080‑0675
Disclosure Without Authorization 836‑080‑0680
Opt in Notice 836‑080‑0685
Limits on Sharing Account Number Information for Marketing Purposes 836‑080‑0690
Authorization Request Delivery 836‑080‑0695
Access to Recorded Personal Information 836‑080‑0700
Correction, Amendment or Deletion of Recorded Personal Information 836‑080‑0750
Purpose 836‑080‑0755
Application of OAR 836-080-0750 to 836-080-0775 836‑080‑0760
Definitions for OAR 836-080-0750 to 836-080-0775 836‑080‑0765
Practices Declared False, Misleading, Deceptive or Unfair on a Military Installation 836‑080‑0770
Practices Declared False, Misleading, Deceptive or Unfair, Regardless of Location 836‑080‑0775
Severability 836‑080‑0800
Definitions 836‑080‑0805
Statutory Authority, Purpose, and Applicability 836‑080‑0810
Provision of Commercial Loss Runs
Last Updated

Jun. 8, 2021

Rule 836-080-0085’s source at or​.us