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. (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 Division of Financial Regulation of the Department of Consumer and Business Services, State of Oregon. The Division of Financial Regulation 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: Division of Financial Regulation Department of Consumer and Business Services 350 Winter St. NE Salem, OR 97301-3883 By mail: Division of Financial Regulation Department of Consumer and Business Services PO Box 14480 Salem, OR 97309-0405 By e-mail: DCBS.PremiumAudit@DCBS.oregon.gov. By fax: 503-378-4351. Assistance is available on the Division of Financial Regulation's web page, at DFR.oregon.gov/rates-forms/workers-comp and by e-mail, at DCBS.PremiumAudit@DCBS.oregon.gov. If the Division of Financial Regulation timely receives your request for a hearing, the Division of Financial Regulation 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 Division of Financial Regulation not later than the 60th day after the date the Division of Financial Regulation received your request for a hearing. You are entitled to a hearing only if the Division of Financial Regulation 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 Division of Financial Regulation not later than the 60th day after you received this billing. You may wish to consult with an attorney about your case.