§ 731.475 — Claims processing by workers’ compensation insurer; permission for remote claims processing; availability and disposition of claims records; auditing and examinations by director; rules

Oregon § 731.475

• Jurisdiction: Oregon
• Vol.: 18
• Title 56: Insurance
• Ch. 731: Administration and General Provisions

Text

(1)(a) Every insurer authorized to issue workers’ compensation coverage to subject employers as required by ORS chapter 656 shall maintain a place of business in this state where the insurer shall:
(A) Process claims and make available complete records of claims for compensation made to the insurer under ORS chapter 656.
(B) Make available upon request complete records, including all records submitted electronically, of all workers’ compensation insurance policies issued as required by ORS chapter 656.
(C) Make available records identifying the specific persons covered by an employer electing coverage pursuant to ORS 656.039.
(b) Notwithstanding the requirement in paragraph (a) of this subsection that an insurer process claims at a place of business in this state, the Director of the Department of Consumer and Business Services by rule may allow the insurer to process claims remotely from a place of business in this state.
(2) An insurer may dispose of the records described in subsection (1) of this section only in accordance with the rules of the director. The records must be available to the Department of Consumer and Business Services for examination and audit at all reasonable times upon notice by the department to the insurer.
(3) In lieu of maintaining a place of business in this state for the purpose of complying with this section, an insurer may make such records available at places of business in this state operated by service companies, if:
(a) Each service company is incorporated in or authorized to do business in this state;
(b) An agreement between the insurer and the service company grants each service company a power of attorney to act for the insurer in workers’ compensation coverage and claims proceedings under ORS chapter 656; and
(c) The agreement between the insurer and each service company is approved by the director.
(4) Notwithstanding subsection (3) of this section, an insurer may not:
(a) Enter into a service agreement contract with one of the insurer’s insureds unless the insured has service contracts with other insurers; or
(b) Process claims or maintain claims records at more than eight locations at any one time.

Legislative History

1975 c.585 §2; 1981 c.874 §8; 1987 c.373 §80a; 1989 c.630 §1; 1991 c.67 §194; 2003 c.170 §10; 2007 c.241 §23; 2021 c.21 §3