Workers Compensation Cancellation Notice - Oregon 2026

1. Click ‘Get Form’ to open the Workers Compensation Cancellation Notice in the editor.
2. Begin by entering the name of the insurer and their address where policy information can be accessed. This ensures that all parties are informed correctly.
3. Fill in the employer’s legal name and mailing address, along with the policy number, FEIN, and BIN or WCD number. Accurate details here are crucial for proper identification.
4. Specify the cancellation effective date at midnight. This indicates when coverage will cease.
5. Select a reason for cancellation from the provided options, such as nonpayment of premium or no longer employing in Oregon. If applicable, provide details about a new carrier and their policy number.
6. Ensure to include the insurer representative's signature along with their contact name and phone number for any follow-up inquiries.
7. Finally, note the date when this cancellation notice is mailed to the employer to maintain a record of communication.

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