OAR 436-050-0195: Requirements for Changes in Self-Insured Employer Entity

(1) Notification of deletion of entity or changes in entity, contact information, or ownership. If there is any change in the entity, changes in addresses, telephone numbers, and points of contact, or ownership of a self-insured employer, or if the self-insured employer wishes to delete an entity from the employer’s certification, the employer must notify the director in writing within 30 days after the change occurs. (2) Adding entities. If a self-insured employer wishes to add entities to the employer’s certification: (a) The self-insured employer must submit a completed Form 1865, “Endorsement to Include Legal Entity in Self-Insured Certification,” signed by an officer of the employer; (b) Each entity must enter into an agreement, signed by an officer of the entity, making the entity jointly and severally liable for the payment of any compensation and moneys due to the director by the self-insured employer or any other entity included in the employer’s certification; and (c) The director will determine, based on the information provided, the effect of the change on the deposit required and whether the entities can be combined for experience rating purposes.