As part of the Workers’ Compensation Division’s effort to promote better industry performance, WCD is posting information about penalties assessed against insurers and self-insured employers on our website. The high numbers of penalties suggest industry performance in areas such as claims processing, coverage reporting, and responsiveness to division requests are not improving.
In response, WCD has determined that making penalty data more readily available to the public is necessary to increase accountability and transparency for industry performance and the division’s regulatory activities.
Our initial posting includes information for penalties issued against insurers or self-insured employers during the first quarter of 2017, subsequent postings will be made quarterly. Postings will only include penalties that have become final by operation of law; any penalties that are reversed on appeal or withdrawn by the division will not be posted.
Copies of the penalty orders are included; however, confidential information that can identify a worker is redacted.
You can search penalties by order number, date, type, insurer or self-insured employer name, and the associated service company, if any.
Audit penalties issued to insurers who are noncompliant with ORS 656 and OAR 436 relating to accuracy and timeliness of benefit payments, claims processing, and reporting to the division.
Claims penalties issued to insurers and self-insured employers, under ORS 656.745 for violation of statute or rule (OAR 436). Penalties are issued under ORS 656.262 for violation of statute or rule (OAR 436), which resulted in delayed compensation to the worker (e.g., late or nonpayment of medical bills, worker reimbursements, time loss, or Disputed Claim Settlements and Claim Disposition Agreements).
Coverage penalties are issued to insurers who were noncompliant with ORS 656.423, 656.427, or 656.419, or failed to timely comply with an order of the director under ORS 656.745.
- Proof of coverage (R) penalties and termination of coverage (TM) penalties are issued when insurers file less than 90 percent of their proof of coverage or terminations timely during a quarter.
- Pending Coverage (PC) penalties are issued when insurers do not comply within 30 days when ordered to file proof of coverage or respond in writing.
Self-insured audit penalties issued to self-insured employers for failure to comply with OAR 436-050. These penalties are issued for, but are not limited to:
- Failure to timely submit annual financial statements, excess insurance policies, or annual reports of loss.
- Failure to obtain approval of a service agreement before claims processing.
- Failure to provide proof of adequate staff to process claims.
- Failure to timely notify the division of claim moves; failure to provide current contact information.
- Failure to adequately set claim reserves.