Self-Insurer Report of Losses - Non-Experience Rating Period - Oregon 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the 'Period covered' and 'Valuation date' at the top of the form. This sets the timeframe for your report.
  3. Fill in the 'Self-insured employer name' to identify your organization clearly.
  4. In the main section, list each worker's name, date of injury, and claim number. Ensure accuracy as this data is crucial for reporting.
  5. For each claim, input the 'Total paid' and 'Outstanding reserves'. The platform will automatically calculate 'Total incurred losses' by summing these two values.
  6. At the bottom of each page, ensure you total all amounts accurately and transfer these totals to Page 1 as required.
  7. Review all entries for completeness before submitting your report by March 1.

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