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Danae Hammitt
503-947-7751
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In-Office Audit & Self-Insurance
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Purpose
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To review and authorize
payments and reimbursements to insurers and self-insured employers from the Workers'
Benefit Fund in accordance with statutorily mandated programs; ensure continued claim
payments for insolvent self-insured employers and bankrupt insurers; and administer
the Social Security offset program. To audit annual claims reserves and calculate experience
rating modification figures for self-insured employers.
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Responsibilities
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Reimbursements
from the Workers' Benefit Fund - Authorize reimbursements to insurers and self-insured
employers for the Reemployment Assistance Program, Employer-at-Injury Program (EAIP),
Retroactive Program, Reopened Claims Program, Workers with Disabilities Program, and
Second Injury Program. To authorize payments and reimbursements to workers, insurers,
and self-employers for Supplemental Disability Benefits. (See the Fact Sheet on the Workers'
Benefit Fund for program descriptions)
Claim payments for insolvent self-insured employers or bankrupt insurers - Coordinate
claim payments to injured workers from the Self-Insured Employer (Group) Adjustment Reserve
(reserves within the Consumer and Business Services Fund) or security deposits of self-insured
employers who have become insolvent. Coordinate and ensure continued claim payments to
injured workers when a workers' compensation insurance company is bankrupt until accounts
can be transferred to the Oregon Insurance Guarantee Association.
Social Security Offset Program - Review permanent total disability claims to ensure
funds from combined Social Security disability and workers' compensation disability do
not exceed the federal maximum.
Self-Insurance Program - Certify employers to become self-insured for Workers'
Compensation purposes. Monitors certified self-insured employers to ensure appropriate
levels or types of security are maintained and that excess insurance policies are in
place.
Audits - To audit annual claims reserves and calculate experience rating modification
figures. |
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Functions
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auditors receive applications for reimbursement on a quarterly basis from insurers and
self-insured employers. They review the applications and authorize payment if the application
meets the statutory and rule requirements. Staff also review permanent total disability
claims to determine if the workers' compensation benefits combined with the Social Security
disability payments exceed the federal maximum. If the federal maximum is exceeded the
unit orders the insurer to reduce the workers' compensation benefit. Another staff function
is to use claim loss and payroll information to conduct through the annual claims reserve
audit and to calculate experience rating modifications for self-insured employers. The
experience rating modification is used by the self-insured employer to determine what
their premium would be if they were paying an insurer, and, subsequently, determine a
comparative assessment amount to submit for the Consumer and Business Services Fund. |
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Primary
governing rules
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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
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For
more information contact:
In-Office
Audit & Certification Unit: 503-947-7562
FAX: 503-947-7725 |
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If you have questions about this webpage, please contact
Danae Hammitt, 503-947-7751.
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