Or. Admin. R. 836-043-0017

Current through Register Vol. 63, No. 9, September 1, 2024

Section 836-043-0017 - Plan Administrator

(1) The Plan Administrator is a rating organization for workers' compensation insurance in Oregon that is designated as the plan administrator by the Director. The National Council on Compensation Inc. is designated as the Plan Administrator. The Plan Administrator shall continue to serve from the effective date of the Plan unless the Plan Administrator resigns. The Plan Administrator must give advance written notice of its resignation to the Director at least one year in advance of the effective date of resignation.

(2) The Plan Administrator has the following duties and responsibilities in addition to any others set forth in the Plan and the organizing principles:

(a) Determining the methodology and formula for making assignments to servicing carriers pursuant to OAR 836-043-0060 and securing the necessary information in order to make the assignments;

(b) Developing and implementing assigned risk operating rules and forms approved by the Director to the extent necessary to carry out the purposes of the Plan;

(c) Processing assigned risk applications pursuant to OAR 836-043-0041;

(d) Establishing written Assigned Carrier Performance Standards for servicing carriers, subject to approval by the Insurance Commissioner, including, but not limited to:

(A) Verification of ongoing Plan eligibility of the employer;

(B) Issuance of policies and endorsements;

(C) Filings with administrative agencies;

(D) Maintenance of premiums on policies, consistent with manual rules, rates, rating plans, and classifications;

(E) Completion and billing of final audits;

(F) Collection of premium;

(G) Claim services, including investigation, disability management and medical cost control;

(H) Loss control services and safety information to encourage employers to make safety a part of their business;

(I) Payment of producer fees;

(J) Issuance of renewal proposals and non-renewal notices;

(K) Assurance of insured and insurer compliance with all terms and conditions of the policy contract;

(L) Resolution of complaints and response to insured and insurance producer inquiries; and

(M) Reporting financial and statistical data;

(e) Monitoring servicing carrier performance and enforcing Assigned Carrier Performance Standards and incentives;

(f) Administering the dispute resolution mechanism as provided in OAR 836-043-0070;

(g) Developing and implementing assigned risk operating rules and forms to the extent necessary to carry out the purposes of the Plan;

(h) Informing the Insurance Commissioner of any insurer that is not participating in this Plan;

(i) Monitoring the performance and operation of the Plan and initiating amendments thereto as appropriate;

(j) Determining the expenses for operation of the Plan, including but not limited to the Plan Administrator's fees or legal expenses associated with Plan matters, and assess each insurer participating in the Plan for those expenses on an equitable basis as determined by the Plan Administrator and approved by the Director; and

(k) Developing and administering a take-out credit program as provided in OAR 836-043-0076.

(3) The Plan Administrator shall also publish and make available to all affected insurers and producers, upon request and at no charge, both the necessary information for placement in the Plan and the listings of all employers that have been placed into the Plan. The listings shall include each employer's name, address, policy expiration date, latest experience modification, if applicable, the Simplified Assigned Risk Adjustment Program factor and the governing class code.

(4) The Plan Administrator shall monitor compliance by servicing carriers with occupational safety and health consultative service requirements of ORS 731.480. The Plan Administrator shall file with the Insurance Commissioner by May 1 of each year a report regarding such compliance for the preceding calendar year. The Plan Administrator shall also determine the expenses for operation of the Plan, not including the Plan Administrator's expenses incurred in connection with responsibilities it has under the Articles, and shall assess each insurer participating in the Plan for those expenses on an equitable basis as determined by the Plan Administrator.

Or. Admin. R. 836-043-0017

ID 4-1994, f. & cert. ef. 4-19-94; ID 10-1996, f. 6-27-96, cert. ef. 7-1-96, Renumbered from 836-043-0030; ID 8-2005, f. 5-18-05, cert. ef. 8-1-05; ID 18-2008, f. 12-9-08, cert. ef. 1-1-09

Stat. Auth.: ORS 656.427, 656.730 & 731.244

Stats. Implemented: ORS 656.427, 656.730 & 737.265