INSURANCE CARRIER/SELF-INSURER LIST OF DESIGNATED …

1 State of New Jersey Department of Labor & Workforce Development Division of Workers Compensation INSURANCE CARRIER/SELF-INSURER LIST OF DESIGNATED CONTACTS 2008 Chapter 96, effective October 1, 2008, applies to workers compensation INSURANCE carriers and authorizedself-insured employers. The law provides that:Every carrier and self-insured employer shall designate a contact person who is responsible for responding to issues concerning medical and temporary disability benefits where no claim petition has been filed or where a claim petition has not been answered. The full name, telephone number, address, e-mail address, and fax number of the contact person shall be submitted to the division. Any changes ininformation about the contact person shall be immediately submitted to the division as they occur.

2 Afteran answer is filed with the division, the attorney of record for the respondent shall act as the contactperson in the case. Failure to comply with the provisions of this section shall result in a fine of $2,500 foreach day of noncompliance, payable to the Second Injury Division has compiled the attached contact person listing from information submitted to us by workers compensation INSURANCE carriers and authorized self-insurers. You can search for a particular company in this document by using the Find tool in Adobe Reader or by clicking on the embedded bookmarks. If you find an error with a particular entry in the attached list, please contact the following to verify our records: Melpomene Kotsines at tel: 609-292-0165 Carriers/self-insurers that have not yet DESIGNATED a contact person as required by law must do so by downloading and completing the INSURANCE Carrier Contact form available on our website: Note: If you are a representative from a specific CARRIER/SELF-INSURER who has already submitted an INSURANCE Carrier Contact Form to the Division but cannot locate your company in this listing, please contact us to verify that the form has been received by us.

3 This form should also be used to submit any changes to the Division. Thank revised: 6/22/21 ABF FREIGHT SYSTEM, :RACHELLE PRATT, WC CLAIMS SPECIALISTATTN: RISK BOX 10048 FORT SMITH, AR 72917 Address:Tel:479 785 6233 Fax:479 785 KING, MANAGER, WORKERS' BOX 10048 FORT SMITH, AR 72917 Address:Tel:479 785 6218 Fax:479 785 INSURANCE COMPANYName:KIMBERLY MOORE, WC CLAIMS MANAGERBERKLEY MID-ATLANTIC GROUP4820 LAKE BROOK DRIVESUITE 300 Address:Tel:804 237 5189 Fax:877 684 SANDS, COUNSELACADIA INSURANCE COMPANYONE ACADIA COMMONSWESTBROOK ME 04092 Address:Tel:207 228 1932 Fax:207 771 INDEMNITY INSURANCE COMPANYName:CASSANDRA GOMEZ, MANAGER CLAIM SERVICESACCEPTANCE INDEMNITY INSURANCE COMPANY215 SHULMAN 400 Address:Tel:630 864 3450 Fax.

4 630 864 BLINSON, SVP CORPORATE SECRETARYHARCO NATIONAL INSURANCE COMPANY702 OBERLIN ROADRALEIGH NC 27605 Address:Tel:919 831 8176 Fax:919 831 FUND GENERAL INSURANCE COMPANYName:JOE WROZEK, COMPLIANCE SPECIALISTAF GROUP200 N. GRAND AVENUELANSING, MI 48901 Address:Tel:517 708 5277 Fax:517 316 OSOWSKI, COMPLIANCE SPECIALISTAF GROUP15200 W. SMALL BERLIN WI 53151 Address:Tel:262 787 7818 Fax:262 787 FUND INSURANCE COMPANY OF AMERICAName:JOE WROZEK, COMPLIANCE SPECIALISTAF GROUPPO BOX 40790 LANSING MI 48901 Address:Tel:517 708 5277 Fax:517 316 1 of 9406/22/2021 INSURANCE Company / Self-Insurer ContactsLast Updated:Name:NELLIE OSOWSKI, COMPLIANCE SPECIALISTAF BOX 40790 LANSING MI 48901 Address:Tel:262 787 7818 Fax:262 787 FUND NATIONAL INSURANCE COMPANYName:JOE WROZEK, COMPLIANCE SPECIALISTAF GROUP200 N.

5 GRAND , MI 48901 Address:Tel:517 708 5277 Fax:517 316 OSOWSKI, COMPLIANCE SPECIALISTAF GROUP15200 W. SMALL ROADNEW BERLIN WI 53151 Address:Tel:262 787 7818 Fax:262 787 SURETY & CASUALTY COMPANY INCName:CHRIS BARTHOLET, SR CLAIMS MANAGER4798 NEW BROAD STREETSUITE 200 ORLANDO FL 32814 Address:Tel:407 629 2131 Fax:407 629 FERRELL, CLAIMS MANAGER4798 NEW BROAD STREETSUITE 200 ORLANDO FL 32814 Address:Tel:407 629 2131 Fax:407 629 AMERICAN INSURANCE COMPANYName:CHANDRA WINTERS, MANAGER,DISABILITY COMP PROGRAMCSAA INSURANCE GROUP3055 OAK ROADWALNUT CREEK CA 94597 Address:Tel:925 279 4158 Fax:877 813 FIRE UNDERWRITERS INSURANCE COMPANYName:TOM EASON, AVP WORKERS' COMPENSATION CLAIMSCHUBB NORTH AMERICA CLAIMS1 BEAVER VALLEY ROADWILMINGTON DE 19803 Address:Tel:302 476 7824 Fax.

6 302 476 KROLL, AVP WORKERS' COMPENSATION CLAIMSCHUBB NORTH AMERICA BOX 5118 SCRANTON PA 19803 Address:Tel:818 428 3753 Fax:818 428 2 of 9406/22/2021 INSURANCE Company / Self-Insurer ContactsLast Updated:ACE PROPERTY & CASUALTY INSURANCE COMPANYName:TOM EASON, AVP WORKERS' COMPENSATION CLAIMSCHUBB NORTH AMERICA CLAIMS1 BEAVER VALLEY ROADWILMINGTON, DE 19803 Address:Tel:302 476 7824 Fax:302 476 KROLL, AVP WORKERS' COMPENSATION CLAIMSCHUBB NORTH AMERICA BOX 5118 SCRANTON PA 18505 Address:Tel:818 428 3753 Fax:818 428 INSURANCE COMPANYName:PHIL OGLESBY, CLAIMS MANAGERACIG INSURANCE COMPANY2600 NORTH CENTRAL EXPRESSWAYSUITE 800 Address:Tel:972 702 9004 Fax:972 687 PINSON, VICE PRESIDENT - CLAIMSACIG INSURANCE COMPANY2600 NORTH CENTRAL EXPRESSWAYSUITE 800 Address:Tel:972 702 9004 Fax:972 687 INSURANCE COMPANYName:JANET SHEMANSKE, ASSISTANT SECRETARYADMIRAL INSURANCE COMPAY C/O BERKLEY E & S CENTER7233 E.

7 BUTHERUS DRIVEA ddress:Tel:480 922 4045 Fax:480 281 MIHALOVICH, REGULATORY ANALYSTADMIRAL INSURANCE COMPANY C/O W. R. BERKLEY E & S CENTER7233 E. BUTHERUS DRIVEA ddress:Tel:480 509 6627 Fax:480 477 CLAIMS INCName:JANICE MOORE, BOX 25991 SHAWNEE MISSION KS 66225 Address:Tel:302 765 1635 Fax:302 765 CLAIMS SERVICES WAWA UNITName:JANICE MOORE, BOX 25991 SHAWNEE MISSION KS 66225 Address:Tel:302 765 1635 Fax:302 765 PROPERTY CASUALTY COMPANYName:JANICE MOORE, ASST. VICE PRESIDENTP O BOX 25991 SHAWNEE MISSION KS 66225 Address:Tel:302 765 1635 Fax:302 765 3 of 9406/22/2021 INSURANCE Company / Self-Insurer ContactsLast Updated:AIU INSURANCE COMPANYName:JANICE MOORE, ASST. VICE BOX 25991 SHAWNEE MISSION KS 66225 Address:Tel:302 765 1635 Fax:302 765 INSURANCE COMPANYName:JOHN MAHONEY, CHIEF CLAIM OFFICERALAMANCE INSURANCE COMPANY185 ASYLUM STREET7TH FLOORA ddress:Tel:860 756 7771 Fax:860 723 ROBERTS, DIRECTOR, HO CLAIMALAMANCE INSURANCE COMPANY185 ASYLUM STREET7TH FLOORA ddress:Tel:860 723 8217 Fax:860 723 NORTH AMERICA INSURANCE COMPANYName:SUSANNE MAZZONE, VICE PRESIDENT, COMPLIANCE55 CAPITAL HILL, CT 06067 Address:Tel:860 258 6508 Fax:860 258 FETTER, SR.

8 VP, HEAD OF CLAIMS55 CAPITAL HILL, CT 06067 Address:Tel:860 258 6512 Fax:860 258 AMERICA INSURANCE COMPANYName:JAMIE WIECHART, CLAIMS MANAGERALL AMERICA INSURANCE COMPANY800 S. WASHINGTON STREETVAN WERT OH 45891 Address:Tel:800 786 9169 Fax:800 736 BUTLER, CLAIM REPALL AMERICAN INSURANCE COMPANY800 S. WASHINGTON STREETVAN WERT OH 45891 Address:Tel:800 736 7000 Fax:800 736 NATIONAL INSURANCE COMPANYName:JOHN EAGEN, MANAGER220 W. GERMANTOWN PIKEPLYMOUTH MEETING, PA 19462 Address:Tel:610 242 2000 Fax:610 828 BETH TORUNIAN, UNDERWRITER220 W. GERMANTOWN PIKEPLYMOUTH MEETING, PA 19462 Address:Tel:610 242 2000 Fax:610 828 4 of 9406/22/2021 INSURANCE Company / Self-Insurer ContactsLast Updated:ALLIED EASTERN INDEMNITY COMPANYName:ROBERT ALCOCK, SUPERVISOR OF REGIONAL CLAIMSALLIED EASTERN INDEMNITY COMPANY25 RACE AVENUELANCASTER PA 17603 Address:Tel:855 533 3444 ext: 1624 Fax:717 481 HOOPER, DIRECTOR OF REGIONAL CLAIMSALLIED EASTERN INDEMNITY COMPANY25 RACE AVENUELANCASTER PA 17603 Address:Tel:855 533 3444 ext: 1645 Fax:717 481 FINANCIAL ALLIANCE INSURANCE COMPANYName:KERRI HOLLENKAMP, UNIT MANAGER WCTHE hanover INSURANCE GROUPPO BOX 15144440 LINCOLN STREETA ddress:Tel:508 855 9314 Fax.

9 508 926 OCONNER, UNIT MANAGER WCTHE hanover INSURANCE GROUPPO BOX 15144440 LINCOLN STREETA ddress:Tel:508 855 5184 Fax:508 926 FINANCIAL BENEFIT INSURANCE COMPANYName:KERRI HOLLENKAMP, UNIT MANAGER WCTHE hanover INSURANCE GROUPPO BOX 15144440 LINCOLN STREETA ddress:Tel:508 855 9314 Fax:508 926 OCONNOR, UNIT MANAGER WCTHE hanover INSURANCE GROUPPO BOX 15144440 LINCOLN STREETA ddress:Tel:508 855 5184 Fax:508 926 ALTERNATIVE INSURANCE COMPANYName:CHARLES KROH, VICE PRESIDENT555 COLLEGE ROAD EASTPRINCETON, NJ 08543 Address:Tel:609 243 4846 Fax:609 243 DIONISIO, VICE PRESIDENT555 COLLEGE ROAD EASTPRINCETON, NJ 08543 Address:Tel:609 243 4514 Fax:609 243 AUTOMOBILE INSURANCE COMPANYName:JASON FREDRICK, CLAIMS MANAGERAMERICAN AUTOMOBILE INSURANCE COMPANY1 PROGRESS POINT PARKWAY, ST.

10 2O'FALLON MO 63368 Address:Tel:314 817 2806 Fax:888 887 5 of 9406/22/2021 INSURANCE Company / Self-Insurer ContactsLast Updated:Name:SARA MAREK, WORKERS' COMPENSATION SUPERVISORAMERICAN AUTOMOBILE INSURANCE COMPANY1 PROGRESS POINT PARKWAY, ST. 2 OFALLON MO 63368 Address:Tel:314 513 1014 Fax:314 552 CASUALTY COMPANY OF READING PAName:TANYA BELTRAN, ASSISTANT VICE PRESIDENT5786 WIDEWATERSDEWITT NY 13214 Address:Tel:315 431 6894 Fax:714 256 SOWERS, WORKERS' COMPENSATION CLAIM MANAGERONE MERIDIAN BOULEVARDWYOMISSING PA 19610 Address:Tel:610 320 4410 Fax:877 371 COMPENSATION INSURANCE COMPANYName:SUSAN PILON, CARE DIRECTORSTATE AUTO/RTW INSURANCE COMPANIESPO BOX 390327 MINNEAPOLIS, MN 55439 Address:Tel:952 897 5543 Fax:800 563 TOWNSEND, CARE DIRECTORSTATE AUTO/RTW INSURANCE COMPANIESPO BOX 390327 MINNEAPOLIS, MN 55439 Address:Tel:952 893 3744 Fax:800 563 EUROPEAN INSURANCE COMPANYName.