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Get Proof Of Insurance Oregon Form

Form 4821 Oregon Proof of Coverage EDI Insurer Profile Workers Compensation Division Insurers must complete this form before submitting or authorizing a vendor to send proof-of-coverage data to the department through electronic data interchange EDI. If an insurer is direct reporting proof-of-coverage information list the insurer name and FEIN under the vendor section. A separate form is required for each subsidiary insurer within an insurance gro.

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