(1) A third party administrator licensed under ORS 744.702 may transact business as a third party administrator only pursuant to a written agreement between the third party administrator and the insurer. The agreement shall contain all provisions required by this section. However, any provision that does not apply to the functions to be performed by the third party administrator need not be included.
(2) An insurer and a third party administrator transacting business under an agreement required in subsection (1) of this section shall each retain the agreement with its records for the duration of the agreement and for five years following the date of its termination.
(3) An agreement required by this section shall include at least the following, in addition to any other requirements of ORS 744.700 to 744.740:
(a) A statement of duties that the third party administrator is expected to perform on behalf of the insurer and the lines, classes or types of insurance for which the third party administrator is to be authorized to administer;
(b) Provisions with respect to underwriting or other standards pertaining to the business underwritten by the insurer. The agreement shall also state the responsibilities of the third party administrator for determining the benefits, premium rates, underwriting criteria and claims payment procedures, and for securing any reinsurance, subject to the responsibilities of the insurer established in ORS 744.740;
(c) Provisions for the third party administrator to periodically render an accounting to the insurer detailing all transactions performed by the administrator pertaining to the business underwritten by the insurer;
(d) Provisions governing withdrawals from the fiduciary account required under ORS 744.730, and provisions otherwise relating to the fiduciary account, addressing at least the following matters:
(A) Remittance to an insurer entitled to the remittance;
(B) Deposit in an account maintained in the name of the insurer;
(C) Transfer to and deposit in a claims-paying account, with claims to be paid as provided in ORS 744.730;
(D) Payment to a group policyholder for remittance to the insurer entitled to the remittance;
(E) Payment to the third party administrator of its commission fees or charges; and
(F) Remittance of return premiums to the person entitled to the return premium; and
(e) Provisions establishing which disputes, if any, arising under the contract shall be decided by arbitration, mediation or other means of dispute resolution.
(4) Upon written notice, the insurer or third party administrator may terminate the written agreement for cause as provided in the agreement. The insurer may suspend the underwriting authority of the third party administrator during any dispute regarding the cause for termination of the written agreement. The insurer must fulfill any lawful obligations with respect to policies affected by the agreement, regardless of any dispute between the insurer and the third party administrator.
(5) A third party administrator shall make available for inspection to the Director of the Department of Consumer and Business Services copies of all contracts, and amendments thereto, with insurers or other persons using its services. [1991 c.812 §12]
Section: Previous 744.706 744.708 744.710 744.712 744.714 744.716 744.718 744.720 744.722 744.724 744.726 744.728 744.730 744.732 744.734 NextLast modified: August 7, 2008