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    Adam Breitenstein   
503-947-7751   

Self-Insurance, Registration, and Audit & Reimbursements

 

Purpose

Certify employers to become self-insured for workers' compensation purposes; ensure that self-insurer's claims are valued appropriately and assess the potential claims liability exposure for the Self-Insured Employer Adjustment Reserve or the Self-Insured Employer Group Adjustment Reserve; determine the amount of security deposits required for self-insured employers to ensure the appropriate levels of security in the event of a default.

To coordinate and monitor the process whereby Oregon insurers, self-insured employers, and third party administrators are accurately and timely registered into the agency's data system, verify coverage relationships, and review service agreements between the parties to ensure they comply with requirements.

To coordinate and monitor the process whereby Oregon insurers, self-insured employers, and third party administrators are accurately and timely registered into the agency's data system, verify coverage relationships, and review service agreements between the parties to ensure they comply with requirements.

 

Responsibilities

Employer compliance with rules governing self-insurance: Conduct claims reserves audits to ensure that self-insured employers are valuing claims appropriately and reporting accurate and complete loss data that the division uses to establish experience-rating modifications and security deposits. Conduct on-site audits of bankrupt self-insured employers' claims to ensure adequate funding in the Self Insured Employer Adjustment Reserve (SIEAR). Conduct reviews to help ensure that self-insured employers accurately report and pay premium assessment money, as well as help resolve circumstances where employers are delinquent in paying Workers' Benefit Fund assessment money.

Monitor registration of Third Party Administrators (TPAs): Provide technical and consultative support to division management, program specialists, insurers, and TPAs on related laws, rules, policies, and processes. Research and verify coverage relationships to ensure correct insurer is assigned to employers. Review claims that have employer, insurer, or TPA discrepancies in order to ensure that correct coverage and claim data is captured in the claims system. Instruct insurers and TPAs in the accurate completion and filing of registration documents to ensure correct relationships between insurers, TPAs, and employers are captured in the Employer Data System and comply with requirements.

Reimbursements from the Workers' Benefit Fund: Authorize reimbursements to insurers and self-insured employers for the Re-employment Assistance Program, Employer-at-Injury Program (EAIP), Retroactive Program, Reopened Claims Program, Workers with Disabilities Program, and Second Injury Program. Authorize payments and reimbursements to workers, insurers, and self-insured employers for supplemental disability benefits.
 

Functions

Audits are conducted to determine self-insured employers are valuing claims appropriately and reporting accurate and complete loss data. Self-insurance specialists review and approve certification of self-insured employers and determine the annual security deposit requirements.

The Insurer Registration Team interprets and explains applicable laws, rules, and policies to instruct parties in the necessary actions to properly register to provide workers' compensation coverage in Oregon. They contact insurers or service companies for information about claims processing locations, service agreements, other required filings, and resolve issues involving service agreements.

The Audit & Reimbursements Team receives applications for reimbursement from insurers and self-insured employers. The team reviews the applications and authorizes payment if the application meets the statutory and rule requirements. Staff members also review permanent total disability claims to determine if the workers' compensation benefits combined with the Social Security disability payments exceed the federal maximum. The unit orders the insurer to reduce the workers' compensation benefit if the federal maximum is exceeded. The team also uses claim loss and payroll information to calculate experience rating modifications for self-insured employers. The experience rating modification is used by the self-insured employer to determine what its premium would be if it were paying an insurer, and subsequently, determines a comparative assessment amount to submit for the Consumer and Business Services Fund.
 

Primary governing rules

OAR 436-040: Workers with Disabilities Program
OAR 436-075: Retroactive Program
OAR 436-045: Reopened Claims Program
OAR 436-100: Workers' Compensation Benefits Offset
OAR 436-110: Reemployment Assistance Program
OAR 436-050: Self-Insurance Certification

 
 
For more information contact:
Self-Insurance, Registration and Audit & Reimbursements Unit: 503-947-7751
FAX: 503-947-7725

If you have questions about this webpage, please contact Adam Breitenstein, 503-947-7751.