WORKERS' COMPENSATION / AUTO PAYER LIST 05/15/2020 …...WORKERS' COMPENSATION / AUTO PAYER LIST 05/15/2020 Payer ID TX MN CA IL LA NJ NY OR WI NC NM OK TN VA All States 837P 837I

WORKERS' COMPENSATION / AUTO PAYER LIST

06/12/2020Payer ID TX MN CA IL LA NJ NY OR WI NC NM OK TN VA

All

States 837P 837I

WORK

COMP AUTO 835

1st Auto & Casualty J1585 x x x x x

21st Century Insurance 41556 x x x x Rejects Only

22125 Roscoe Corp. 41556 x x x x Rejects Only

AAA Minnesota/Iowa 11983 x x x x x

AAA Northern California, Nevada & Utah Insurance Exchange 41556 x x x x Rejects Only

ABC Const. Company 41556 x x x x Rejects Only

ABF Freight System, Inc. (Arkbest) J3789 x x x x x

Accd J3729 x x x x x

Accident Fund Insurance Co of America J1790 x x x x x

Accuride Corporation J1024 x x x x x x

Ace Property & Casualty Ins Co 41556 x x x x Rejects Only

ACIG Insurance Company J1578 x x x x x x

ACTS Retirement - Life Communities J2163 x x x x x

Acuity, A Mutual Insurance Company J1240 x x x x Rejects Only

AD-COMP J1667 x x x x x

Adelanto Correctional Facility (CA) J1798 x x x x x

Administaff J1241 x x x x x x x x x x x

Administrative Claim Service, Inc J1005 x x x x Rejects Only

Adminsure J2292 x x x x Rejects Only

Admiral Linen & Uniform Service J2144 x x x x Rejects Only

Advance America Cash Advance Centers J1843 x x x x x

Advance Services, Inc. J1608 x x x x x

Advanced Auto Parts - All states EXCEPT TX MN J2162 x x x x x

Advanced Auto Parts - TX MN J2161 x x x x x x

Adventist Health System (Bunch CareSolutions) (also includes CO, FL, GA, KS, KY) J1973 x x x x x x x

Advocare MCO, Inc J1896 x x x x x

Affiliated Foods, Inc. J1977 x x x x

AG Facilities Operations, LLC 41556 x x x x Rejects Only

Agri Beef Co. 41556 x x x x Rejects Only

AIG-Chartis 19402 x x x x Rejects Only

Alarm Contractors (WC Only) J3859 x x x x x

Alaska National Insurance J1577 x x x x x

Albertsons, Inc. J2376 x x x x x

Alcoa Fasteners Systems J1244 x x x Rejects Only

Alex Lee, Inc. J2166 x x x x

Align Networks (One Call Physical Therapy) J1716 x x x x Rejects Only

Allen Canning J1740 x x x x x

Allergan W.C. Holding, INC. J2341 x x x x Rejects Only

Alliant Energy J1619 x x x x x x

Allianz Global Corporate & Specialty (AGCS) - dates of injury on or after 1/1/2018 J2332 x x x x x

Allianz Resolution Management (ARM) - dates of injury on or before 12/31/2012 J2326 x x x x x

Allied Claims Administration, Inc. J1733 x x x x x

Allied Construction (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Allied Insurance Companies J1550 x x x x x x x x x

Allied Property and Casualty Ins Co J1550 x x x x x x x x x

Allmerica Financial Benefits Insurance Company J1589 x x x x x

Allstate - Except New Jersey C1037 x x x x x

Allstate - NJ Only (Auto Only) C1089 x x x x Rejects Only

Alta Healthcare 41556 x x x x Rejects Only

Alternative Service Concepts (ASC) J2149 x x x x Rejects Only

Aluminum Precision (Carl Warren) * Paper Only x

Alvey Systems (AON Risk) J1025 x x x x x

AMCO Ins Co J1550 x x x x x

America First J1427 x x x x Rejects Only

American Airlines - DOI after 9/1/2014 ONLY J2000 x x x x x x x x x x x

American Alternative Insurance Corporation J4030 x x x x x

American Apparel, LLC (DOI after 7/14/16) J2189 x x x x x

American Claims Management (ACM) J1236 x x x x Rejects Only

American Coin Merchandising, Inc J1026 x x x x x

American Country (Auto Only) C1075 x x x x x

American Country (WC Only) J1249 x x x x x

Page 1 of 38



All

States 837P 837I

WORK

COMP AUTO 835

American Cyanamid J1027 x x x x x

American Family Home Insurance Company J4031 x x x x x

American Family Mutual Insurance Company J2134 x x x x Rejects Only

American Furniture Warehouse 41556 x x x x Rejects Only

American Home Craft J1250 x x x x Rejects Only

American Liberty Insurance Company 41556 x x x x Rejects Only

American Millennium J4021 x x x x x

American Mining Insurance Group, LLC J1524 x x x x x

American Modern Home Insurance Company J4032 x x x x x

American Select J3317 x x x x x

American Specialty Companies J1028 x x x x x

American Specialty Ins. / MIB J1029 x x x x x

American Standard Insurance Company of Ohio (AUTO ONLY) C1055 x x x x x

American Standard Insurance Company of Wisconsin (AUTO ONLY) C1055 x x x x x

Ameriprise (Auto Only) C1097 x x x x Rejects Only

Amerisure Insurance J1206 x x x x x Rejects Only

Amerisure Mutual Insurance J1205 x x x x Rejects Only

AmFed Companies LLC (Amfed National Insurance) J3735 x x x x x

AmGuard Insurance Company - Guard DBA J1453 x x x x x

Amica Insurance Company (Auto Only) C1098 x x x x Rejects Only

Amtrust North America J1868 x x x x x x x x x x x

ANACO 41556 x x x x Rejects Only

ANAIC Cibus 41556 x x x x Rejects Only

Anchor Glass Container Corporation J2136 x x x x x

Anheuser Busch J1620 x x x x x

Antelope Valley Community Hospital J2197 x x x x x

Antelope Valley Ret. 41556 x x x x Rejects Only

Antelope Valley Union High School District J2185 x x x x x

APM Terminals J3788 x x x x x

Applied Materials J2160 x x x x x

Applied Underwriters (Except AZ) J1775 x x x x Rejects Only

Archer Daniels Midland Company J1735 x x x x x

Ardagh Group J2344 x x x x Rejects Only

Areas USA, Inc. J1944 x x x x x

Argent (Subsidiary of West Bend but this route is Argent only) J1420 x x x x x

Argonaut Insurance Company(ARGO) 19801 x x x x x

Argus Claims J3307 x x x x Rejects Only

Arizona & 21st Corp. DBA Berkley East Conv. Hospital 41556 x x x x Rejects Only

Arkansas Best J2142 x x x x Rejects Only

Arrowpoint J1564 x x x x x

Association Casualty Insurance Company J1254 x x x x x

Association County Commissioners of Georgia (ACCG). J1869 x x x x x Rejects Only

Athens J1914 x x x x Rejects Only

Athens - ABF Freight Systems, Inc J2096 x x x x Rejects Only

Athens - Alemeda Health Systems J2097 x x x x Rejects Only

Athens - American Apparel, Inc (DOI prior to 7/14/16) J2098 x x x x Rejects Only

Athens - American Brass & Iron Foundry J2099 x x x x Rejects Only

Athens - Angelus Block J2100 x x x x Rejects Only

Athens - Bay Area Housing Authority Risk Management J2101 x x x x Rejects Only

Athens - Central County Fire Department J2102 x x x x Rejects Only

Athens - Children's Hospital Los Angeles J2103 x x x x Rejects Only

Athens - City of Beverly Hills J2104 x x x x Rejects Only

Athens - City of Mountain View J2105 x x x x Rejects Only

Athens - City of San Jose J2106 x x x x Rejects Only

Athens - City of Vernon J2107 x x x x Rejects Only

Athens - County of Solano J2108 x x x x Rejects Only

Athens - Crum J3728 x x x x x

Athens - East Bay Municipal Utility District J2109 x x x x Rejects Only

Athens - East Bay Regional Parks District J2110 x x x x Rejects Only

Athens - Fairmont Hotel J2111 x x x x Rejects Only

Athens - FASIS J2112 x x x x Rejects Only

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All

States 837P 837I

WORK

COMP AUTO 835

Athens - Golden Gate Bridge Highway & Transportation J2113 x x x x Rejects Only

Athens - Goodwill Industries (San Francisco, San Mateo, Marin Counties) J2114 x x x x Rejects Only

Athens - H&S Venture J2335 x x x x x

Athens - Household Industries Self Insured Group J2115 x x x x Rejects Only

Athens - Kings Seafood Company J2116 x x x x Rejects Only

Athens - KPC Healthcare J2117 x x x x Rejects Only

Athens - Long Beach Public Transportation Company J2118 x x x x Rejects Only

Athens - McKesson Corporation J2119 x x x x Rejects Only

Athens - Orora North American J2120 x x x x Rejects Only

Athens - Placentia-Yorba Linda Unified School District J2121 x x x x Rejects Only

Athens - Presbyterian Intercommunity Hospital PIH J2122 x x x x Rejects Only

Athens - San Francisco Unified School District J2124 x x x x Rejects Only

Athens - Sony Corporation of America J2126 x x x x Rejects Only

Athens - Sunsweet Growers, Inc. J2127 x x x x Rejects Only

Athens - Temecula Valley Unified School District J2128 x x x x Rejects Only

Athens - The Conco Companies - ARCH WC J2129 x x x x Rejects Only

Athens - The Conco Companies - Zurich J2130 x x x x Rejects Only

Athens - The Permanente Medical Group, Inc. J2131 x x x x Rejects Only

Athens - Vintage Senior Living J2132 x x x x Rejects Only

Atlantic PPO to Atlantic Imaging Group J2013 x x x x Rejects Only

Atlantic PPO to Hartford Insurance J2035 x x x x Rejects Only

Atlantic PPO to Merchants Mutual J2046 x x x x Rejects Only

Atlantic PPO to NY City Transit J2055 x x x x Rejects Only

Atlantic PPO to NYC Dept. of Sanitation J2056 x x x x Rejects Only

Atlantic PPO TO QBE Insurance J2067 x x x x Rejects Only

Atlantic PPO to Sedgwick WC Insurance J2071 x x x x Rejects Only

Atlantic PPO to Sentry Insurance J2074 x x x x Rejects Only

Atlantic PPO to Travelers J2079 x x x x Rejects Only

Atlantic PPO to U.S. Department of Labor-PA J2081 x x x x Rejects Only

Atlantic PPO to US DOL NJ claims J2083 x x x x Rejects Only

Atlantic PPO to US DOL NY claims J2084 x x x x Rejects Only

Aureon HR Solutions (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Austin Mutual Ins J1682 x x x x x

Auto Club Group 11983 x x x x x

Auto Club Group Insurance Company 11983 x x x x x

Auto Club Insurance (ACIA) 11983 x x x x x

Auto Club Insurance Association 11983 x x x x x

Auto Club Property-Casualty Insurance Company 11983 x x x x x

Auto One Insurance (Auto Only) C1082 x x x x Rejects Only

Automobile Dealers Insurance Company Inc J1861 x x x x Rejects Only

Auto-Owners \ Home-Owners Insurance Company J1580 x x x x x

Auto-Owners \ Owners Insurance Company J1583 x x x x x

Auto-Owners \ Property-Owners Insurance Co J1699 x x x x x

Auto-Owners \ Southern-Owners Company J1688 x x x x x

Auto-Owners Insurance Company J1556 x x x x x

Auto-Owners Life Insurance Company J1596 x x x x x

AVIR Inc. 41556 x x x x Rejects Only

Avizent J1415 x x x x Rejects Only

Ayers Trucking J1018 x x x x x

Azz Inc. J3773 x x x x x

Baker Tanks, Inc. 41556 x x x x Rejects Only

Balance Staffing Workforce J3844 x x x x Rejects Only

Baldwin County J4022 x x x x x

Bank of America J1729 x x x x x

Banner Health J3811 x x x x x

Baptist Healthcare Systems, Inc (KY ONLY) J2164 x x x x

Bardavon Health Innovations J2334 x x x x Rejects Only

Barker Claim Services J3818 x x x x Rejects Only

Barnes J1503 x x x x x

Barrett Business Services Inc (BBSI) J1686 x x x x x

BART - San Francisco Bay Area Rapid Transit J1770 x x x x x

Page 3 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Bashas Corporate Offices J3732 x x x x

Basic Resources, Inc. 41556 x x x x Rejects Only

Bass Pro Group, LLC J1958 x x x x x

Bauman Workers' Compensation Loss Fund Account J3305 x x x x x

Bb&T Corporation (Branch Banking & Trust) J1995 x x x x

Beacon Insurance Company Of America J3318 x x x x x

Beacon Mutual J1234 x x x x x

Beall's Inc / Midwest Employers J1030 x x x x x

Bed Bath & Beyond J2167 x x x x x

Beeville ISD 41556 x x x x Rejects Only

Belfor USA LTD INC J4023 x x x x

Belk, Inc. J2168 x x x x x

Benchmark Insurance J1257 x x x x Rejects Only

Berkley Agribusiness Risk Specialists J2190 x x x x x

Berkley Entertainment and Environmental (formerly Berkley Specialty Underwriters) TP019 x x x x x

Berkley Mid-Atlantic Group J3863 x x x x x

Berkley National Insurance Company J2192 x x x x x

Berkley Net Underwriters, LLC J1523 x x x x x

Berkley Regional Insurance Company J2194 x x x x x

Berkley Risk Administrators Company, LLC J1526 x x x x x

Berkley Southeast Insurance Group (BSIG) J2145 x x x x Rejects Only

Berkley Valley Conv Hospital 41556 x x x x Rejects Only

Berkshire Hathaway Direct Insurance Company J1975 x x x x x

Berkshire Hathaway Homestate Companies (BHHC) 20044 x x x x x x x x x x x x x

Bernardo H. Co. Club 41556 x x x x Rejects Only

Berwind Corporation J1031 x x x x x

Beverly Hills Carmel 41556 x x x x Rejects Only

Big 5 Corp J1738 x x x x x

Bighorn Construction 41556 x x x x Rejects Only

BI-Mart J2349 x x x x Rejects Only

Bituminous Fire and Marine J1691 x x x x x

Bituminous Insurance Company J1579 x x x x x

Bloomin' Brands Inc J3725 x x x x x

Bloomingdale's J1347 x x x x x

BMICO C1073 x x x x Rejects Only

BMW North America J1259 x x x Rejects Only

Bobrick Washroom 41556 x x x x Rejects Only

Boeing Company J1964 x x x x x x x x x x x

Boeing Company - WC ONLY J1964 x x x x x x x x x x x

Boise Cascade Company J1801 x x x x x

Boler Company J1870 x x x x x x x x

Boulder Community Hospital 41556 x x x x Rejects Only

Bremco Construction 41556 x x x x Rejects Only

Briad Restaurant Group, LLC J2169 x x x x x

Brickstreet (EXCEPT PA) J1761 x x x x x

Bridgefield Casualty J1437 x x x x x

Bridgefield Employers J1437 x x x x x

Bristol West J1764 x x x x x

Broadspire, a Crawford Company TP021 x x x x x

Brotherhood Mutual Insurance J1445 x x x x x x x x x x x

Broward County Board of Commissioners (Fl) J3843 x x x x x

Brownsville Independent School District 41556 x x x x Rejects Only

Brownyard Group Inc. (Arch Insurance) 11150 x x x x x

Brunswick Corporation J1032 x x x x x

Buffets Inc (Old Country Buffett, Ryan's, HomeTown Buffet, Fire Mountain, Country

Buffett, Granny's Buffett) J1501 x x x x x

Builders Group of MN J1391 x x x x Rejects Only

Builders Insurance Group (Georgia Only) (Work Comp and Auto) J3975 x x x x Rejects Only

Builders Mutual Insurance J1968 x x x x x

Page 4 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Bunch and Associates J1435 x x x x x

Burke Williams J4037 x x x x x

Burlington Coat Factory Wareho J1033 x x x x x

Burton Way Carmel 41556 x x x x Rejects Only

Business First J1437 x x x x x

Butler America Holdings, INC.- Corvel - CORVEL (WC Only) J3860 x x x x x

Bycor Gen Contract 41556 x x x x Rejects Only

C+A2:R1155ity Of New Orleans (LA) J2309 x x x x x

Cadet Uniform Supply 41556 x x x x Rejects Only

Caliber Holdings Corporation J1979 x x x x

California Fair Services Authority J1535 x x x x x

California Restaurant Mutual Benefit Corporation - Sig J4033 x x x x x

California Schools Risk Management J3326 x x x x x

California Water Service Company 41556 x x x x Rejects Only

Callahan, McCune 41556 x x x x Rejects Only

CalPortland Company J3758 x x x x x

Cambridge Healthcare Services, LLC J2182 x x x x x

Cambridge Integrated Services J1819 x x x x Rejects Only

Campbell Union School District 41556 x x x x Rejects Only

Capistrano Unified School District (CA) J1637 x x x x x

Capital Insurance Group Wc J1980 x x x x x

Capitol Indemnity J1262 x x x x Rejects Only

Capitol Insurance Companies J1809 x x x x x

CAPS-SIG 41556 x x x x Rejects Only

Captain D'S LLC J4024 x x x x x x

Cardenas Markets (Carl Warren) J1516 x x x x x

Care Logic (WC Only) J3868 x x x x x

Carewest J2258 x x x x x

CareWorks Consultants, Inc. (aka CareWorks USA and CCI) J1866 x x x x x x

Carhartt J1931 x x x x x

Carisk Imaging to Allstate Insurance - Auto Only J2007 x x x x Rejects Only

Carisk Imaging to Nationwide (Auto Only) J2051 x x x x Rejects Only

Carisk Imaging to New York City Law Department J2053 x x x x Rejects Only

Carisk Imaging to NJ-PLIGA J2054 x x x x Rejects Only

Carisk Imaging to NJ-PLIGA J2057 x x x x Rejects Only

Carisk Imaging to Progressive Insurance - Auto Only J2065 x x x x Rejects Only

Carisk Imaging to Pure (Auto Only) J2066 x x x x Rejects Only

Carisk Imaging to Safeco Insurance (Auto Only) J2069 x x x x Rejects Only

Carisk Imaging to SafeTPA, LLC (NY Only) J3919 x x x x Rejects Only

Carisk Imaging to Selective Insurance - Auto Only J2072 x x x x Rejects Only

Carisk Imaging to USAA (Auto Only) J2085 x x x x Rejects Only

Carolina Healthcare Systems (Chs) J3320 x x x x x

Casitas Municipal Water District (CA) J1630 x x x x x

Caterpillar J3799 x x x x x

Catholic Diocese of San Diego 41556 x x x x Rejects Only

Catholic Mutual - Preferred Professional Insurance Company 41556 x x x x Rejects Only

Catholic Mutual - Virginia Surety Company, Inc. 41556 x x x x Rejects Only

CC-Development Group, Inc. J1900 x x x x x

CCMSI - Claims serviced by Conduent Only J1010 x x x x Rejects Only

Cedars-Sinai Health System 41556 x x x x Rejects Only

Cendant Corporation J1034 x x x x x

Centennial Insurance Company 19895 x x x x x x

Central Contra Costa Transit Authority J1605 x x x x x

Central Florida Health J3909 x x x x Rejects Only

Central Garden & Pet Company J3737 x x x x x

Central Hockey League J1035 x x x x x

Central Mutual Insurance J4011 x x x x x x

Central Texas Iron Works J2293 x x x x Rejects Only

Chaffey Joint Union H. S. District (CA) J1646 x x x x x

Chandler's P. Verdes 41556 x x x x Rejects Only

Page 5 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Chapman Convalescent 41556 x x x x Rejects Only

Charming Shoppes, Inc. J1036 x x x x x

Cherokee Insurance J1970 x x x x x x x x x x x x x x

Chesapeake Insurance J1908 x x x x Rejects Only

Chesterfield Services, Inc.** J1479 x x x x x

Chico's Fas Inc J2315 x x x x x

Children's Hospital Colorado 41556 x x x x Rejects Only

Children's Hospital of Orange County - First Aid 41556 x x x x Rejects Only

Chireno ISD J3874 x x x x Rejects Only

CHS J3820 x x x x Rejects Only

Chubb (legacy Chubb & Son) - WC J1554 x x x x x

Chula Vista Elementary School District 41556 x x x x Rejects Only

Church Mutual Insurance Company (WC ONLY) J1265 / J1725 x x x x x

CIGA J1532 x x x x Rejects Only

Cincinnati Insurance J1562 x x x x Rejects Only

Citizens Insurance Company of America J1582 x x x x x

Citizens of Humanity J3759 x x x x x

Citrus Memorial Health Foundation Inc. (WC Only) J3908 x x x x Rejects Only

Citrus Valley Health Partners J1613 x x x x x

Citrus World, Inc. J1945 x x x x x

City And County Of Denver J3340 x x x x Rejects Only

City and County of San Francisco (CCSF) J1885 x x x x x

City of Adelanto J3867 x x x x x

City of Ames (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

City of Arlington A0033 x x x x x

City of Ashland 41556 x x x x Rejects Only

City Of Bakersfield J3336 x x x x Rejects Only

City of Baltimore J4043 x x x x x x

City of Banning (CA) J1792 x x x x x

City of Barstow (CA) J1793 x x x x x

City of Beaverton 41556 x x x x Rejects Only

City of Belmont (Self Insured) 41556 x x x x Rejects Only

City of Blythe (CA) J1794 x x x x x

City of Brea J1880 x x x x Rejects Only

City of Cambridge J3905 x x x x x

City of Campbell 41556 x x x x Rejects Only

City of Carlsbad 41556 x x x x Rejects Only

City of Carmel By The Sea 41556 x x x x Rejects Only

City of Carson 41556 x x x x Rejects Only

City of Charlotte J1928 x x x x Rejects Only

City Of Chino J2306 x x x x Rejects Only

City of Chula Vista * Paper Only x

City of Colton 41556 x x x x Rejects Only

City of Coronado 41556 x x x x Rejects Only

City of Costa Mesa J2343 x x x x Rejects Only

City of Dallas J1441 x x x x Rejects Only

City of Del Mar 41556 x x x x Rejects Only

City of Des Moines (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

City of Desert Hot Springs (CA) J1799 x x x x x

City Of Durham J3821 x x x x Rejects Only

City of Edinburg, Texas 41556 x x x x Rejects Only

City of El Paso A0046 x x x x x

City Of El Selgundo J4027 x x x x

City of Encinitas 41556 x x x x Rejects Only

City of Escondido 41556 x x x x Rejects Only

City Of Everett (Wa) J3332 x x x x x

City of Fort Worth (TX) J1680 x x x x x

City of Fountain Valley (CA) J1632 x x x x x

City of Fresno FPOA ADR1 J2337 x x x x Rejects Only

City of Gardena (CA) J1634 x x x x x

Page 6 of 38



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States 837P 837I

WORK

COMP AUTO 835

City of Glendale (AZ) J1800 x x x x x

City of Grand Junction 41556 x x x x Rejects Only

City of Hillsboro 41556 x x x x Rejects Only

City of Huntsville J2340 x x x x Rejects Only

City of Imperial Beach 41556 x x x x Rejects Only

City of Imperial Beach (Voucher) 41556 x x x x Rejects Only

City of Iowa City (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

City of Irving 41556 x x x x Rejects Only

City of Kansas City MO J2389 x x x x Rejects Only

City of La Mesa 11 (CA) J1711 x x x x x

City of Laguna Hills (CA) J1653 x x x x x

City Of Lake Charles (La) J1981 x x x x

City of Lakeland J2347 x x x x Rejects Only

City of Lemon Grove 41556 x x x x Rejects Only

City Of Lexington J3822 x x x x Rejects Only

City Of Longmont J3339 x x x x x

City of Los Altos 41556 x x x x Rejects Only

City of Los Angeles J1536 x x x x Rejects Only

City Of Margate (Fl)(Corvel) J3301 x x x x x

City of Merced 41556 x x x x Rejects Only

City of Miami Beach (FL) J1946 x x x x x

City of Milwaukee (WI) J3756 x x x x x

City of Minneapolis J1269 x x x x x

City of Murieta (CA) * Paper Only x

City of National City 41556 x x x x Rejects Only

City of Norfolk (VA) J3899 x x x x x

City of Oceanside 41556 x x x x Rejects Only

City of Ocoee (WC Only) J3910 x x x x Rejects Only

City of Omaha (NE) J1721 x x x x x

City of Ontario 41556 x x x x Rejects Only

City of Orange J1881 x x x x Rejects Only

City of Perris (CA) J1795 x x x x x

City of Pompano Beach (FL) J1947 x x x x x

City of Raleigh J2391 x x x x x

City of Redding (CA) J1617 x x x x x

City of Rialto, CA J1901 x x x x x

City of Richardson 41556 x x x x Rejects Only

City of Riverside J2377 x x x x Rejects Only

City of Salinas J1849 x x x x x

City of San Diego J1497 x x x x x

City Of San Fernando J3311 x x x x x

City of San Jacinto (CA) J1796 x x x x x

City Of San Marcos J4028 x x x x x

City Of San Mateo (Athens) J3304 x x x x x

City of San Mateo (CA) J1727 x x x x x

City of Santa Ana J2155 x x x x Rejects Only

City Of Santa Barbara J3312 x x x x x

City of Santee 41556 x x x x Rejects Only

City of Solana Beach 41556 x x x x Rejects Only

City of South San Francisco 41556 x x x x Rejects Only

City of St. Paul (MN) J1602 x x x x x

City of Stanton (CA) J1636 x x x x x

City of Stockton (CA) J1664 x x x x x

City of Topeka (KS) J1607 x x x x x

City of Torrance J3872 x x x x x

City Of Tucson J1982 x x x x

City of Upland (CA) J1645 x x x x x

City of Urbandale (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

City of Venice (WC Only) J3911 x x x x Rejects Only

City Of Ventura J3804 x x x x Rejects Only

Page 7 of 38



All

States 837P 837I

WORK

COMP AUTO 835

City of Virginia Beach (VA) - CORVEL (WC Only) J3861 x x x x x

City of Vista 41556 x x x x Rejects Only

City of Waco 41556 x x x x Rejects Only

City of West Des Moines (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

City of West Palm Beach (FL) J1948 x x x x x

City Of Wilson J3823 x x x x Rejects Only

City of Yorba Linda (CA) J1708 x x x x x

City of Yuma 41556 x x x x Rejects Only

Civil Constructors 41556 x x x x Rejects Only

Claims Administrative Services (CAS) J1271 x x x x x x x x

Classic Residence By Hyatt J1037 x x x x x

Clear Channel Outdoor Holdings, Inc. J3812 x x x x x

Clougherty Packing, LLC J1739 x x x x x

CNA Insurance 20443 x x x x x

Co Grande Casino 41556 x x x x Rejects Only

Coach USA J1272 x x x Rejects Only

Coachella Valley Water District (CA) J1902 x x x x x

Coast Converters 41556 x x x x Rejects Only

Coca-Cola Enterprises Inc. J1038 x x x x x

Collin County 41556 x x x x Rejects Only

Collins Einhorn Farrell PC J4025 x x x x x

Color Spot Nurseries J3817 x x x x x

Colorado Casualty J1428 x x x x Rejects Only

Colorado Contractors Program 41556 x x x x Rejects Only

Colorado HealthCare Assoc. - Safety National Casualty Corp. 41556 x x x x Rejects Only

Colorado Hospital Association J3356 x x x x x

Colorado Prime Corp. 41556 x x x x Rejects Only

Columbia Sussex Corporation J1039 x x x x x

Columbine Health Systems 41556 x x x x Rejects Only

Commerce & Industry/Greenwood J3877 x x x x Rejects Only

Commonwealth Of Virginia (COV) J3341 x x x x x

Community Development Commission (CA) J1655 x x x x x

Community Medical Centers (CA) J3743 x x x x x

Comp West J1925 x x x x Rejects Only

Companion Property and Casualty Insurance Company (dba Sussex Insurance

Company) J1829 x x x x x

Compass Group Usa, Inc. J1040 x x x x x

Conifer J1744 x x x x

Contech Construction Products J1041 x x x x x

Continental Airlines J1042 x x x x x

Continental Western Insurance Co (CWG) J1274 x x x x x

Continuing Life (Athens) J3302 x x x x Rejects Only

Contra Coastal County Schools Insurance Group (CCCSIG) J1715 x x x x Rejects Only

Contra Costa County Risk Management (CCCRM) J3688 x x x x x

Contra Costa Water District J3689 x x x x

Convergys Corporation J1043 x x x x x

Con-Way Inc. J1844 x x x x x

Cook & Solis Const. 41556 x x x x Rejects Only

Cook County Forest Preserve District J4026 x x x x x

Cook County Government J4009 x x x x x x

Copperpoint Mutual Insurance Company J2093 x x x x Rejects Only

Corecivic J3342 x x x x x

Correctional Management Service J1044 x x x x x

Corrections Corp of America J1045 x x x x x

Corrections Corporation of America (CCA) J1942 x x x x x

Cottingham & Butler Claim Services, Inc. J1683 x x x x x

Cottingham and Butler (Equian) J2089 x x x x Rejects Only

Country Casualty Insurance Company J1684 x x x x x x x x x

Country Financial \ Modern Service Casualty Insur Co J3760 x x x x x

Country Insurance \ Modern Service Casualty Insur Co J1712 x x x x x x x x x

Country Insurance \ Mountain States Insurance J1572 x x x x x x x x x

Page 8 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Country Insurance \ MSI Preferred Insurance Company J1591 x x x x x x x x x

Country Mutual Insurance Company J1702 x x x x x x x x x

Country Preferred Insurance Company J1705 x x x x x x x x x

Country Villa Health Services - SNCC 41556 x x x x Rejects Only

Country Villa Ox Hlth 41556 x x x x Rejects Only

Country Way / Agway (Auto Only) J2021 x x x x Rejects Only

Countryway Insurance Company (Auto Only) C1083 x x x x Rejects Only

County Of Alameda/AIG 41556 x x x x Rejects Only

County of Chesterfield J1525 x x x x x

County Of Dupage J3346 x x x x x

County of Humboldt (CA) J1603 x x x x x

County of Imperial J1960 x x x x Rejects Only

County of Kern J1935 x x x x x

County of Los Angeles (1000) J1625 x x x x x

County of Los Angeles (2000) J1722 x x x x Rejects Only

County of Los Angeles (3000) J1967 x x x x Rejects Only

County of Los Angeles (4000/5000) J1723 x x x x Rejects Only

County Of Marin 41556 x x x x Rejects Only

County of San Diego J1513 x x x x x

County of Santa Barbara (CA) J1631 x x x x x

County of Santa Barbara-CSAC (CA) J1631 x x x x x

County of Santa Barbara-Non-CSAC (CA) J1631 x x x x x

County of Shasta (CA) J1616 x x x x x

County of Sonoma (CA) J1662 x x x x x

County of Tulare (CA) J1666 x x x x x

Courtyard Health C. 41556 x x x x Rejects Only

Coworx Staffing, LLC J1046 x x x x x

Cox Construction Co 41556 x x x x Rejects Only

CPS Security Solutions 41556 x x x x Rejects Only

Craftworks Holdings - CORVEL (WC Only) J3862 x x x x x

Creative Risk Solutions J1455 x x x x x Rejects Only

Crescent Crown Distributing J1965 x x x x x

Crescent Crown Distributing J1965 x x x x x

Crescent Facilities Operations, LLC J2170 x x x x x

Crestbrook Insurance Company J1550 x x x x x

Crum & Forster Indemnity Co 31348 x x x x x

CS&A J3819 x x x x Rejects Only

CSAA Insurance Company (Auto Only) C1090 x x x x Rejects Only

Cumberland Insurance Group (Auto Only) C1091 x x x x Rejects Only

Cure Auto Insurance For NJ Auto (Auto Only) C1092 x x x x Rejects Only

CUSIG (Credit Union Self-Insured Group of California) J4010 x x x x x

CW Montgomery County (Carl Warren) * Paper Only x

Cypress Insurance Company (Member of BHHC) 20044 x x x x x x x x x x x x x

Dahl's Foods (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

DaimlerChrysler Corporation 41556 x x x x Rejects Only

Dakota Fire - WC ONLY (Except CA, NM, NV) 21415 x x x x x

Dakota Fire (Auto Only) C1029 x x x x x x

Dallas County Community College District 41556 x x x x Rejects Only

Dallas Independent School District J1494 x x x x x

Danaher Corporation J1051 x x x x x

Darigold J1936 x x x x x

Davis Mech Systems 41556 x x x x Rejects Only

Dawson ISD J3929 x x x x x

Daylight Transport 41556 x x x x Rejects Only

DBi Services LLC J3761 x x x x x

De Bartolos, Inc J1058 x x x x x

Definiti J2336 x x x x x

Del Mar Thoroughbred Club J3813 x x x x x

Del Taco, LLC J1681 x x x x x

Delaware Racing Association And Delaware Management Company, LLC J3806 x x x x x

Dell, Inc. J1983 x x x x

Page 9 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Denver Public Schools 41556 x x x x Rejects Only

Department of Water and Power of the City of Los Angeles (LADWP) J1514 x x x x x

Depositors Ins Co J1550 x x x x

Desert Hospital District 41556 x x x x Rejects Only

Desert Princess 41556 x x x x Rejects Only

Diamond Farming Company 41556 x x x x Rejects Only

Diploma Joint Insurance Fund (SEL) (WC Only) J3934 x x x x Rejects Only

Directory Distributing Assoc. J1059 x x x x x

Discount Tire J1611 x x x x x

Discover Re (Burger King) J1060 x x x x x

Discovery Hy-Vee (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Disneyland Resorts (Bunch) J1933 x x x x Rejects Only

Douglas County 41556 x x x x Rejects Only

Drybar Holdings J4012 x x x x x

Dunn-Edwards Corporation J1061 x x x x x

Durango Coffee Co. 41556 x x x x Rejects Only

Durham County, Nc J1994 x x x x x

Dustrol (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Dynamex, Inc. J1062 x x x x x

Eagle Claims J1934 x x x x x

Eagle Pass ISD 41556 x x x x Rejects Only

Eastern Alliance (EA) J2143 x x x x Rejects Only

EastGUARD Insurance Company - Guard DBA J1453 x x x x x

Eastman Kodak Company J1903 x x x x x

Eberle Vivian J2199 x x x x Rejects Only

Echo Pacific Develop 41556 x x x x Rejects Only

EDIC BB Everest Denali Insurance Company # 205 J4013 x x x x x

Edinburg Consolidated Independent School District 41556 x x x x Rejects Only

Edwards Claim Administration (SEE TAB) J1204 x x x x x

El Paso Community College (TX Jur) A0106 x x x x x

El Paso ISD J3727 x x x x x

El Paso Water Util TX Jur J1017 x x x x x

El Pollo Loco J1737 x x x x x

ELC Electric Inc 41556 x x x x Rejects Only

Electric Insurance Company (Auto Only) C1093 x x x x x Rejects Only

Elite Comp 41556 x x x x Rejects Only

Elite Golf J3723 x x x x x

Embassy Of United Emirates J3347 x x x x Rejects Only

EMC Property and Casualty - WC ONLY - (Except CA, NM, NV) 21415 x x x x x

EMC Property and Casualty (Auto Only) C1029 x x x x x x

EMCASCO Insurance Co - WC ONLY (Except CA, NM, NV) 21407 x* x x x x

EMCASCO Insurance Co (Auto Only) C1029 x x x x x x

Emeritus Corporation J1679 x x x x x

Employer Insurance Group (EIG) J1232 x x x x x x x x

Employers Assurance Company J1232 x x x x x x x x

Employers Choice (ECN) J3771 x x x x Rejects Only

Employers Compensation Insurance Company J1232 x x x x x x x x

Employers Edge J3726 x x x x x

Employers General Insurance Group J1696 x x x x x

Employers Insurance (BUNCH) J1912 x x x x Rejects Only

Employers Mutual Casualty - WC ONLY - (Except CA, NM, NV) 21415 x x x x x

Employers Mutual Casualty (Auto Only) C1029 x x x x x x

Employers Preferred Insurance Company J1232 x x x x x x x x

Encompass (Subsidiary of Allstate) C1049 x x x x x

Encompass Specialty Surgery Network J2369 x x x x x

Envirosource J1063 x x x x x

Envision Radiology, LLC 41556 x x x x Rejects Only

EPIC BB Everest Premier Insurance Co # 206 J4014 x x x x x

Eplica, Inc. 41556 x x x x Rejects Only

Equian J2090 x x x x x

Page 10 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Ergon, Inc. J1952 x x x x x

Erickson-Hall Constr 41556 x x x x Rejects Only

Erie Insurance J1734 x x x x x

ERMC J1022 x x x x x

ERS J3780 x x x x x

ESIS TP043 x x x x Rejects Only

ESIS - First American Insurance Co J1064 x x x x x

ESIS - Lockheed Martin Corporation J1454 x x x x x

ESIS Auto (Auto Only) C1080 x x x x Rejects Only

Evolution Insurance Company J1065 x x x x x

Express, LLC J3739 x x x x x

ExxonMobil Corporation J1606 x x x x x

F&G Guaranty Ins Co/Main Street Program Colorado 41556 x x x x Rejects Only

Factory 2 U J1019 x x x x x

Fairchild Fasteners J1624 x x x x x

Fairfax County Government J1884 x x x x x

Fairmont Specialty Insurance Company - TX J1697 x x x x x

Fairview Health Services J1618 x x x x x

Family Health & Housing 41556 x x x x Rejects Only

FAMSA, Inc. J1807 x x x x x

Farm Bureau Mutual Insurance Company (MN Only) J1853 x x x x x

Farmers \ Civic Property and Casualty Company J1687 x x x x x

Farmers \ Exact Property and Casualty Company J1703 x x x x x

Farmers \ Fire Insurance Exchange J1706 x x x x x

Farmers \ Mid-Century Insurance Company J1710 x x x x Rejects Only

Farmers \ Neighborhood Spirit Property and Casualty Company J1701 x x x x x

Farmers \ Truck Insurance Exchange J1713 x x x x x

Farmers Insurance (Auto Only) C1025 x x x x x

Farmers Insurance Exchange J1563 x x x x x

Farmers of Flemington J3298 x x x x Rejects Only

Farmland Mutual Ins Co J1551 x x x x x

FCCI J1830 x x x x x

FCS Administrators (WC Only) J3933 x x x x Rejects Only

Federated Claims Service Corp. J1297 x x x x x

Federated Department Stores, Inc J1297 x x x x x

Federated Linen & Uniform 41556 x x x x Rejects Only

Federated Mutual Insurance Company 13935 x x x x x

Federated Rural Electric (Tx) 11118 x x x x x x x x x x x

Federated Services Insurance Company 28304 x x x x x

FFVA Mutual Insurance J1909 x x x x Rejects Only

Fidelity Mohawk J3299 x x x x Rejects Only

Fireman's Fund Insurance Company – dates of injury 1/1/2013 – 12/31/2017 21873 x x x x xFireman's Fund Insurance Company – dates of injury on or after 1/1/18 (dba Allianz

Global Corporate & Specialty) J2332 x x x x x

Firemen's Insurance Company * Paper Only x

First Health PPO C1074 x x x x Rejects Only

First Keystone Risk Retention Group (Auto Only) C1084 x x x x Rejects Only

First Patriot Insurance Company J3324 x x x x x

First Responder Joint Insurance Fund (WC Only) J3935 x x x x Rejects Only

Firstcomp J1011 x x x x Rejects Only

FKI Industries, Inc. J1047 x x x x x

Florida Fruit and Vegetable Association J1910 x x x x Rejects Only

Florida Insurance Alliance J3306 x x x x x

Florists Insurance Company J1417 x x x x x

Florists Mutual Insurance Company J1299 x x x x Rejects Only

Florists Mutual Insurance Company J1417 x x x x x

Flour Bluff ISD J3895 x x x x Rejects Only

FMI J3296 x x x x Rejects Only

Food Giant J3774 x x x x x

Foot Locker J2158 x x x x x

Ford Motor Company W/C Admin. J3793 x x x x Rejects Only

Page 11 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Forestry Mutual - At - South Carolina J3824 x x x x Rejects Only

Forestry Mutual Insurance Company J2153 x x x x Rejects Only

Forestry Mutual Insurance Small J3825 x x x x Rejects Only

Foss Maritime J3784 x x x x x

Franciscan Alliance J1883 x x x x x

Franciscan Sisters Of Chicago Service Corporation (FSCSC) J3345 x x x x x

Franco Construction 41556 x x x x Rejects Only

Frankenmuth Mutual J1440 x x x x x

Franklin Mutual J3297 x x x x Rejects Only

Fresno County Office of Education 41556 x x x x Rejects Only

Fresno County Self Insurance Group 41556 x x x x Rejects Only

Friedkin Companies, Inc J1984 x x x x

Fullerton Union High School District (CA) J1633 x x x x x

Futurecomp J3353 x x x x Rejects Only

GAB Robbins, Inc. TP117 x x x x x x x

GAB Robins (For Van Tuyl Companies ONLY) TP117 x x x x x x x

Gainsco (Auto Only) C1085 x x x x Rejects Only

Gallagher Bassett TP057 x x x x x

Gallagher Bassett - Former Chubb Services Claims J1561 x x x x x

Garden Grove Unified School District J1519 x x x x x

Garden Regional Hospital & Med Center, Inc. 41556 x x x x Rejects Only

Gates Corp DBA Gates Rubber Co J1066 x x x x x

Gates O'Doherty 41556 x x x x Rejects Only

Gates O'Doherty G&G 41556 x x x x Rejects OnlyGateway Insurance Company | Global Liberty Insurance Company of New York (Auto

Only) C1075 x x x x x

Gateway Trans., Inc. 41556 x x x x Rejects Only

GE Auto J1557 x x x x x

Geico (also AR, AZ, CO, GA, IA, KS, MS, MT, ND, NE, OH, PA, SC, SD, UT, WA, WY) J1747 x x x x x x x x x x x Rejects Only

Geico (Auto Only) J2030 x x x x Rejects Only

General Parts International J1678 x x x x x

Genesis Construction 41556 x x x x Rejects Only

Genex Care for Ohio J1895 x x x x x

GEO J1461 x x x x x

Georgia Casualty & Surety Co J1304 x x x x x

Georgie's Inc. J2137 x x x x x

Gillette Childrens Specialty Healthcare J1927 x x x x x

Glendale Elementary School District #40 41556 x x x x Rejects Only

Golden Corral Corporation J1067 x x x x x

Golden Eagle J1430 x x x x Rejects Only

Good2go Insurance (aka Personal Service Insurance) (Auto Only) C1094 x x x x Rejects Only

Goodfellow Top Grade Construction LLC (WC Only) J3906 x x x x Rejects Only

Goodrich J1462 x x x x x

Goodwill Industries J1621 x x x x x

Gordmans (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Grand River Insurance (WC Only) J1566 x x x x x

Grange WC 14060 x x x x x

Graphic Arts Mutual 25984 x x x x x

Great American Alliance Ins Co. 26832 x x x x x

Great American Assurance Co. 26344 x x x x x

Great American Ins. Co. 16691 x x x x x

Great American Ins. Co. of N.Y. 22136 x x x x x

Great Divide Insurance 25224 x x x x x

Great West Casualty J1820 x x x x Rejects Only

Green Diamond WA J1642 x x x x x

Greene Rad Maloney 41556 x x x x Rejects Only

Greer Constructon CO 41556 x x x x Rejects Only

Greif Brothers Corporation 41556 x x x x Rejects Only

Greve Clifford Wengel & Paras 41556 x x x x Rejects Only

Grimmway Enterprises, Inc. 41556 x x x x Rejects Only

Grinnell Reinsurance Company J1571 x x x x x x x

Page 12 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Grinnell Select J1541 x x x x x x

Grundfos Manufacturing Corporation 41556 x x x x Rejects Only

GS Metals 41556 x x x x Rejects Only

Gse Lining Technology, Inc. J1068 x x x x x

Guaranty Fund Management Services (WC Only) J3866 x x x x Rejects Only

Guard J1453 x x x x x

GuideOne Elite Insurance J1590 x x x x x

GuideOne Mutual Insurance J1574 x x x x x

Guidewell Mutual Holding J2345 x x x x Rejects Only

Guy Yocomo Construction (WC Only) J3927 x x x x Rejects Only

H & R Block J1672 x x x x x

Hamilton Mutual - WC - (Except CA, NM, NV) 21415 x x x x x

Hamilton Mutual (Auto Only) C1029 x x x x x x

Hannaford J1463 x x x x x

Hanover Insurance Company J1693 x x x x x

Hanover Lloyd's Insurance Company J1588 x x x x x

Harbor Freight Tools J2159 x x x x x

Harris J3790 x x x x Rejects Only

Hartford Dealership Advantage Program - WC 41556 x x x x Rejects Only

Harvard Maintenance J2388 x x x x Rejects Only

Hastings College of the Law 41556 x x x x Rejects Only

Hawaii Employers’ Mutual Insurance Co., Inc J3907 x x x x Rejects Only

Hawkeye J1426 x x x x Rejects Only

Hayhoe Construction 41556 x x x x Rejects Only

HCA-Hosptial Corporation of America J1450 x x x x x

Healthcare Risk Management Solutions (Corvel) J3300 x x x x x

HealthPartners 44547 x x x x x x

Healthsmart J1481 x x x x x

Healthsmart Casualty Claims Solutions J3313 x x x x x

Heartland Employment Services, LLC 41556 x x x x Rejects Only

Heartland Express J1677 x x x x x

Hebrew Homes Health Network, Inc. J4015 x x x x x x

Helmsman Management Services 33600 x x x x x

Help At Home Holdings J1985 x x x x x

Helpside, Inc. J2378 x x x x x

Hemet Unified School District (CA) J1654 x x x x x

Hereford ISD J2342 x x x x x

Heritage Group J1069 x x x x x

Highland Golf 41556 x x x x Rejects Only

Hillshire Brands J1959 x x x x x

Hilmar Cheese Company J1833 x x x x x

HMS Vineyards J3924 x x x x x

HMSHost J1612 x x x x x

Hoag Memorial Hospital Presbyterian J4038 x x x x x

Hogan Motor Leasing 41556 x x x x Rejects Only

Hogan Personell 41556 x x x x Rejects Only

Holly Farms Corp. J1070 x x x x x

Home Sweet Home 41556 x x x x Rejects Only

Horizon Casualty J4007 x x x x x Rejects Only

Horizon Casualty Services J4007 x x x x Rejects Only

Hortica Florist Mutual Insurance 13978 x x x x x x x x x x x

Hortica Florist Mutual Insurance J1417 x x x x x

Houchens Food Group J3775 x x x x x

Houchens Industries, Inc. J3776 x x x x x

Household Merch Nni J1071 x x x x x

Housing Authority El Paso (TX) A0107 x x x x x

Houston Hunters Patrol, Inc J1020 x x x x x

Houston ISD J1999 x x x x Rejects Only

Howard County Government (MD) J1888 x x x x x

Hughes Tool Company J1072 x x x x x

Page 13 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Husqvarna North America J2171 x x x x x

Hutchinson Technology J1626 x x x x x x

Hy-Vee (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Ichahn Automotive Group (Pep Boys & AutoPlus) J3747 x x x x x

ICW (Insurance Co of the West) 27847 x x x x x

IDS Property Casualty (Auto Only) C1099 x x x x Rejects Only

IDS Property Casualty (Auto Only) J2038 x x x x Rejects Only

Illinois Casualty J1575 x x x x x

Illinois EMCASCO - (Except CA, NM, NV) 21415 x x x x x

Illinois EMCASCO (Auto Only) C1029 x x x x x x

Illinois State Toll Highway Authority (IL, IN, WI only) J3344 x x x x x

Imperial Irrigation District 41556 x x x x Rejects Only

IMT (WC Only) J3930 x x x x Rejects Only

Inconen Corporation 41556 x x x x Rejects Only

Indiana Insurance J1425 x x x x Rejects Only

Ingles Markets J1907 x x x x x

Injury Care Services J3826 x x x x Rejects Only

Injury Management Organization (IMO) J3798 x x x x x

Inland Valley Hospice 41556 x x x x Rejects Only

Innovative Claim Solutions (ICS) - Rancho Cordova J1599 x x x x x

Innovative Claim Solutions (ICS) - San Ramon J1601 x x x x x

Innovative Risk Management (IRM) J2152 x x x x Rejects Only

Insilco Corp J1073 x x x x x

Integrity Mutual Insurance Company (WC ONLY) 14303 x x x x x

Intercare J1542 x x x x Rejects Only

Intercare - Sussex J1957 x x x x x

Intercare - Sussex J1957 x x x x x

Intergovernmental Risk Management Agency (IRMA) J3352 x x x x x

Interinsurance Exchange of the Automobile Club J1810 x x x x x

IPMG Claims Management Services (Insurance Program Managers Group) J1887 x x x x x

Irex Corporation J1074 x x x x x

Ironworking Contract I.P. J1075 x x x x x

Island Insurance Companies J3794 x x x x Rejects Only

iSurity J1911 x x x x

J B Hunt Transport Inc. A0138 x x x x x

J&L Risk Mgmt Consultants, Inc. J3827 x x x x Rejects Only

J.H. Mccormack Const 41556 x x x x Rejects Only

JD Mechanical 41556 x x x x Rejects Only

Jefferson County Commission (Al) J3331 x x x x x

Jefferson County Texas 41556 x x x x Rejects Only

JI Specialty Services J1006 x x x x Rejects Only

John Muir Health 41556 x x x x Rejects Only

Johnston Schools (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Jones Truck Lines,Inc. J1076 x x x x x

JSL J3783 x x x x x

Judson ISD 41556 x x x x Rejects Only

Juvenile Jail Facility Managem J1077 x x x x x

JWF Speciality (WC Only) J3848 x x x x Rejects Only

JWF Specialty J3800 x x x x Rejects Only

Kautz Vinyards 41556 x x x x Rejects Only

KCI Holdings USA J1078 x x x x x

Keenan and Associates (See note for exclusions) J1498 x x x x x

Kelley Amerit Holdings, Llc J3343 x x x x x

Kellogg Companies J1803 x x x x x

Ken Davis Industries Inc. J1079 x x x x x

Kentucky Employers Mutual Insurance - KEMI J3680 x x x x Rejects Only

Kern Medical Surgery Center J3335 x x x x x

Key Risk Management Services LLC J1521 x x x x x

Kikkoman Foods Inc (WC Only) J3925 x x x x x

King County Workmans Comp J4016 x x x x x x

King Pak Potato Company LLC 41556 x x x x Rejects Only

Page 14 of 38



All

States 837P 837I

WORK

COMP AUTO 835

King Ranch 41556 x x x x Rejects Only

Knoxville Utilities Board (Tn) J3330 x x x x x

Koch Foods, Inc J1986 x x x x

Kroger Co. J2327 x x x x x x x x x x x

KTA Construction (COSD2) 41556 x x x x Rejects Only

L. Arrowhead C. Club 41556 x x x x Rejects Only

LA Metro J2374 x x x x Rejects Only

Laclede Chain 41556 x x x x Rejects Only

Laclede Steel 41556 x x x x Rejects Only

Lake Elsinore School District 41556 x x x x Rejects Only

Lamar Consolidated ISD 41556 x x x x Rejects Only

Lamesa ISD 41556 x x x x Rejects Only

Landin J3808 x x x x Rejects Only

Landmark Golf Co 41556 x x x x Rejects Only

Landmark Grad&Paving 41556 x x x x Rejects Only

Landry's J1889 x x x x x

Landstar Bco Wc Program J1080 x x x x x

Lane County 41556 x x x x Rejects Only

Larimer County - WC 41556 x x x x Rejects Only

Las Vegas Sands Corp J4017 x x x x x

Lauridsen Group (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

LB Auto/Pacific Part 41556 x x x x Rejects Only

LB Auto/Pacific Supp 41556 x x x x Rejects Only

LCTA Workers' Comp J1998 x x x x x

Le Mars Insurance Company J3842 x x x x Rejects Only

League of Minnesota Cities Insurance Trust J1527 x x x x x

Lekos Electric 41556 x x x x Rejects Only

Levin Enterprises, Inc. 41556 x x x x Rejects Only

LFP Corporation J1650 x x x x x

Liberty Mutual 33600 x x x x x

Liberty Mutual - Auto Only C1058 x x x x x

Liberty Mutual Middle Markets 33600 x x x x x

Liberty Northwest 33600 x x x x x

Liberty Wausau 33600 x x x x x

Lineage Logistics Holdings, LLC J2172 x x x x x

Link Snacks (Jacks Links) J2133 x x x x Rejects Only

Lion Farms J3802 x x x x Rejects Only

Lion Raisins J3803 x x x x Rejects Only

Lithia Motors, Inc. J3730 x x x x x

Livingston ISD 41556 x x x x Rejects Only

Lk Arrowhead Co Club 41556 x x x x Rejects Only

Lodi Memorial Hospital 41556 x x x x Rejects Only

Long Beach Unified School District J1515 x x x x x

Longs Drugs J1464 x x x x x

Louisiana State University J1953 x x x x x

Louisiana Workers' Compensation Corporation (LWCC) J1547 x x x x x

Lowe's J1465 x x x x x x x x x x x

Lsg Sky Chefs International J1081 x x x x x

Luba Casualty Insurance Company J1341 x x x x x x

Lubbock ISD J3731 x x x x x

Lumbermen's Underwriting Alliance J1899 x x x x x x

Lynwood Unified School District (CA) J1669 x x x x x

LYNX J1949 x x x x x

M&S Blue and Gold Fleet J3782 x x x x x

Macys (Daly City) (except ID, SD, MT, VT, WY, Guam) J1345 x x x x x

Macys (Newport Beach) (except ID, SD, MT) J1346 x x x x x

Macys Corporate Services Inc (except ID, SD, MT, VT, WY) J1347 x x x x x

Madera Community Hospital 41556 x x x x Rejects Only

Magna Carta J2173 x x x x x

Major League Baseball 8 J1082 x x x x x

Page 15 of 38



All

States 837P 837I

WORK

COMP AUTO 835

ManageAbility - Auto C1063 x x x x x

ManageAbility - WC J3767 x x x x x

Manufacturers Alliance Insurance Company 41556 x x x x Rejects Only

Mapfre (Auto Only) J2044 x x x x Rejects Only

MAPFRE Insurance (Auto Only) C1086 x x x x Rejects Only

Marcotte & Hearne 41556 x x x x Rejects Only

Maricopa County Community College District 41556 x x x x Rejects Only

Marine Repair S J3787 x x x x x

Mariposa County 41556 x x x x Rejects Only

Marriott J1431 x x x Rejects Only

Maryland Uninsured Employer's Fund J3744 x x x x x

Massachusetts Bay Insurance Company J1689 x x x x x

Matagorda County 41556 x x x x Rejects Only

Matheson Trucking J1736 x x x x x

Mathis ISD (WC Only) J3871 x x x x x

Matrix Absence Management TP075 x x x x x

Maverick Transportation LLC J3355 x x x x x

Maxim Crane Works J1083 x x x x x

May Department Stores (except ID, SD, MT, VT, WY) J1347 x x x x x

May Trucking J2348 x x x x Rejects Only

Mayo Clinic/Recovery and Claims Services 41193 x x x x x

Mc Donald'S-Mcopco J1084 x x x x x

MDSI Phys Group INC 41556 x x x x Rejects Only

Meadowbrook Insurance Group J1478 x x x x x Rejects Only

Meadowood Resort Llc J3814 x x x x x

Medical Ben Admin 41556 x x x x Rejects Only

MEDRISK J1956 x x x x x

Meemic 11983 x x x x x

Meijer Stores J1930 x x x x x

Meijer Stores J1930 x x x x x

Member Select Insurance Company 11983 x x x x x

MEMIC Casualty Company JP-14164 x x x x x

MEMIC Indemnity Company 11030 x x x x x

Memorial Health Services 41556 x x x x Rejects Only

Memorial Hermann TPA J3781 x x x x Rejects Only

Merchants Insurance J4008 x x x x x x Rejects Only

Merchants Insurance Group (Auto Only) C1095 x x x x Rejects Only

Mercury (Auto Only) C1087 x x x x Rejects Only

Mercury Insurance (Auto Only) J2047 x x x x Rejects Only

Meridian Construction Program 41556 x x x x Rejects Only

Meridian Management Services LLC J2379 x x x x x

Meritage Corporation 41556 x x x x Rejects Only

Mesa County Colorado 41556 x x x x Rejects Only

Mesa County Valley School District 51 41556 x x x x Rejects Only

Metis Services J3857 x x x x Rejects Only

MetLife (Auto Only) C1100 x x x x Rejects Only

MetLife (Auto Only) J2048 x x x x Rejects Only

Metropolitan Council - CORVEL (WC & Auto) J1355 x x x x x

Mettler-Toledo (except ND, WA, WY) J3315 x x x x x

Mexicana Airlines 41556 x x x x Rejects Only

Miami-Dade County (Fl) J3329 x x x x x

Michael Hogan Assoc 41556 x x x x Rejects Only

Michigan Millers Mutual J1988 x x x x x

Middle Tennessee Medical Center J3779 x x x x x

Middlesex Insurance Company J1417 x x x x x

Midwest Builders J3939 x x x x x x

Midwest Drywall (via EMC Risk Services) J1119 x x x x x x

Midwest Family Advantage Insurance Co J3748 x x x x x

Midwest Family Mutual (Auto Only) - CORVEL (Auto Only) C1051 x x x x x x

Midwest Family Mutual Insurance Co (Work Comp Only) J1685 x x x x x x

Page 16 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Midwest Insurance 10895 x x x x Rejects Only

Millard Refrigerated J1482 x x x x x

Millennium Risk Services J2324 x x x x

Minnesota Counties Ins Trust (MCIT) J1351 x x x x x

Minnesota Department of Labor & Industry – Claims Services & Investigations Unit J1436 x x x x x

Minnesota WC Plan J1417 x x x x x

Minnesota Workers Compensation Assigned Risk Plan (aka Superior Point) J1553 x x x x x

Mission Aviation Fellowship 41556 x x x x Rejects Only

Mission Lodge Sanitarium 41556 x x x x Rejects Only

Mississippi Department of Transportation J2372 x x x x x

Mississippi Department Of Corrections J3328 x x x x x

Mississippi School Boards WC Trust J2373 x x x x x

Missoula Cart Co, In 41556 x x x x Rejects Only

Missouri Employers Mutual J3815 x x x x x

Mitchell Energy & Devel J1085 x x x x x

Mitsui Sumitomo Insurance Group - Toyota Claims Only J1692 x x x x x

Mitsui Sumitomo Insurance USA Inc. - Toyota Claim Only J1694 x x x x x

MMIC J1622 x x x x x

Modesto Irrigation District 41556 x x x x Rejects Only

Monrovia Unified School District(Athens) J3303 x x x x Rejects Only

Montana State Fund - WC J2893 x x x x x

Montgomery J1424 x x x x Rejects Only

Montgomery County Self-Insurance Program (MD) J1890 x x x x x

Montgomery County Texas A0179 x x x x x

Monument Administrators - Cornerstone Comp J1530 x x x x x

Monument Administrators - Elite Country Club J1530 x x x x x

Morongo Basin Transit Authority (CA) J1651 x x x x x

Morris Material Handling J1086 x x x x x

Morrison Health Care, Inc. J1087 x x x x x

Motion Picture & Television Fund 41556 x x x x Rejects Only

Mt. Sinai Hospital - Ex-Medical J3795 x x x x x

MTS J1641 x x x x x

Munford, Inc. J1088 x x x x x

Municipal Pooling Authority J2141 x x x x Rejects Only

Murphy & Bean J2380 x x x x Rejects Only

Musco (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Nap Tools (via EMC Risk Services) J1120 x x x x x x

National American Insurance Co (NAICO) J1695 x x x x x x x x x

National Casualty Company J1551 x x x x x

National Comp Administrators J3828 x x x x Rejects Only

National Farmers Union Property and Casualty Company - QBE DBA J1484 x x x x x x x x x x x

National Jewish Health 41556 x x x x Rejects Only

National Liability and Fire Insurance Company (DOI before 7/1/2014) 20044 x x x x x x x x x x x x x

National Liability and Fire Insurance Company (DOI on or after 7/1/2014) J1453 x x x x x

National Loss Prevention, Inc J1021 x x x x x

National Senior Campuses - Erickson Senior Living J2174 x x x x x

Nationwide - Auto Only C1062 x x x x

Nationwide - Previously Harleysville Insurance Company - CORVEL (WC & Auto) J1595 x x x x Rejects Only

Nationwide Affinity Ins Co Of America (NAICOA) J1552 x x x x x

Nationwide Agribusiness Companies J1551 x x x x x

Nationwide Agribusiness Ins Co J1551 x x x x x

Nationwide Ins Co Of America (NICOA) J1552 x x x x x

Nationwide Insurance Companies J1552 x x x x x

Nationwide Mutual Fire Co J1552 x x x x x

Nationwide Mutual Insurance Company J1552 x x x x x

Nationwide National Casualty Company J4036 x x x x x

Nationwide Property And Casualty Ins Co J1552 x x x x x

NBC Universal J1359 x x x Rejects Only

NCH Healthcare Inc. J3912 x x x x Rejects Only

Page 17 of 38



All

States 837P 837I

WORK

COMP AUTO 835

NCLM - North Carolina League of Municipalities J1772 x x x x x

Neffsville Mutual Insurance Company J3325 x x x x x

Network Adjusters J3904 x x x x Rejects Only

New Jersey Manufacturing 12122 x x x x x

New Jersey Manufacturing - Auto Only C1048 x x x x x

New Koosharem Corporation/Select Staffing (DOI after 7/31/2014) J1875 x x x x x

New Mexico Mutual J2147 x x x x Rejects Only

New York Black Car Fund (NYBCF) J3309 x x x x x

Newport News Shipbuilding Workers Compensation J3308 x x x x Rejects Only

Next Level Administration J2331 x x x x x

Nike, Inc J2175 x x x x x

NJ Property-Liability Insurance Guaranty Assoc. (NJPLIGA) J3926 x x x x x

Nonprofit Insurance Trust J1845 x x x x x

Nordstrom, Inc. J1360 x x x Rejects Only

Norfolk & Dedham Group (Auto Only) C1096 x x x x Rejects Only

Norfolk Public Schools (VA) J3740 x x x x x

NorGUARD Insurance Company - Guard DBA J1453 x x x x x

North Bay Schools Insurance Authority (NBSIA) J1549 x x x x x

North Carolina Farm Bureau J1825 x x x x x

North Carolina Guarantee Insurance Association J1906 x x x x x

North Clackamas School District #12 41556 x x x x Rejects Only

North County Transit District 41556 x x x x Rejects Only

North Dakota Workforce Safety & Insurance (Conduent - Formerly Bunch

CareSolutions) J1435 x x x x x

North East Independent School District (NEISD) J1872 x x x x Rejects Only

North River Insurance Company 31348 x x x x x x x x

Northern Claims Management J1923 x x x x Rejects Only

Northern Colorado School Districts Workers' Compensation Pool 41556 x x x x Rejects Only

Northern Kentucky University J1943 x x x x x

Norwalk La Mirada Unified School District J2186 x x x x x

Norwood J1089 x x x x x

Nova Dealership Advantage Program - WC 41556 x x x x Rejects Only

Nova Elite Comp Program 41556 x x x x Rejects Only

Nova Metals Advantage Plus Program - WC 41556 x x x x Rejects Only

Nova Pro Risk Solutions J1056 x x x x x

Nova Saiph Re (WC Only) J3881 x x x x x

Nuevo Engineering 41556 x x x x Rejects Only

NYSIF 45052 x x x x Rejects Only

Oak River Insurance Company (Member of BHHC) 20044 x x x x x x x x x x x x x

Occusystems J2294 x x x x Rejects Only

Oceans Acquisition, Inc. J3754 x x x x x

Ohio Casualty Group 24074 x x x x x

Ohio Farmers J3319 x x x x x

Old Guard J3321 x x x x x

Old Guard Fire Insurance Company J3327 x x x x x

Old Republic Insurance Co 24147 x x x x x

Omaha National J3805 x x x x Rejects Only

One Beacon 20621 x x x x x x x x x x x x

One Call Physical Therapy (Formerly Align Networks) J1716 x x x x Rejects Only

Orange County Fire Authority J1876 x x x x x

Orchard Supply Company (Bunch CareSolutions) J1962 x x x x x

Orchard Supply Company (Bunch CareSolutions) J1962 x x x x x

Oregon State Accident Insurance Fund (SAIF) Corporation J1720 x x x x x

O'Reilly Auto Parts J1670 x x x x x

Orica, Inc. J1090 x x x x x

OSI Group, LLC J1904 x x x x x

Outrigger Lodging 41556 x x x x Rejects Only

Overhill Farms, Inc. 41556 x x x x Rejects Only

Pacific Blue (PACBLU) J3801 x x x x Rejects Only

Pacific Coast Building Products J1808 x x x x x

Pacific Compensation Insurance Company J1913 x x x x Rejects Only

Pacific Dental Services J1806 x x x x x

Pacific Gas & Electric -115 J1916 x x x x Rejects Only

Pacific Hydrotech Co 41556 x x x x Rejects Only

Pacific Lumber Company (Marathon) 41556 x x x x Rejects Only

Pacific Specialty Insurance 41556 x x x x Rejects Only

Page 18 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Pacific Sunwear J1805 x x x x x

Pajaro Vly Comnty Health Trust 41556 x x x x Rejects Only

Paladin ISL J1827 x x x x x x x

Paladin Managed Care Services, Inc. J1475 x x x x x

Palmdale School District J2187 x x x x x

Palo Alto Medical Foundation 41556 x x x x Rejects Only

Papa John's International Inc J1091 x x x x x

Paradigm J1001 x x x x x

Park District Risk Management Association (PDRMA) J1365 x x x x x

Parkdale Mills J3829 x x x x Rejects Only

Parker Services J1417 x x x x x

Parker Services LLC J1417 x x x x x

Pas Coffee Roasters 41556 x x x x Rejects Only

Pasco County BOCC J3913 x x x x x

Patriot General Insurance Company J1417 x x x x x

Patterson Bro Light. 41556 x x x x Rejects Only

Peace Health J4029 x x x x

Pediatric Services Holding Corp - Psa Healthcare J1989 x x x x

Peerless J1423 x x x x Rejects Only

Peg Discover Re J1092 x x x x x

Peg Discover Re( Foood Merchant) J1054 x x x x x

Pegasus Risk Management CA J1924 x x x x Rejects Only

Pegi-Family Dining J1093 x x x x x

Peninsula Indemnity Company J3893 x x x x Rejects Only

Penn Millers Insurance Co J1573 x x x x x x

Penn National Insurance (Auto Only) C1076 x x x x x

Penn National Insurance (WC Only) J3903 x x x x x x x x

Pennsylvania Manufacturers' Association Insurance Company 41556 x x x x Rejects Only

Pennsylvania Manufacturers Indemnity Company 41556 x x x x Rejects Only

Pennsylvania Manufacturing Associates J1439 x x x x x

People 2.0 J1466 x x x x x

Performance Contracting Inc J1940 x x x x x

Petaluma Valley Hospital 41556 x x x x Rejects Only

Pflugerville ISD 41556 x x x x Rejects Only

Pharmacist Mutual Insurance Co. J1570 x x x x x Rejects Only

Pharmacist Mutual Insurance Co. J3734 x x x x

Phh Fleetamerica J1094 x x x x x

Pie Insurance Services Inc. J3755 x x x x x

Pier 1 Inc. USA J1369 x x x Rejects Only

Pierce County WA J3762 x x x x x

Pima County 41556 x x x x Rejects Only

Plainview ISD 41556 x x x x Rejects Only

Plano Independent School District J2381 x x x x x

Plott Health Care 41556 x x x x Rejects Only

Plymouth Rock (Auto Only) J3938 x x x x Rejects Only

Poly-America 41556 x x x x Rejects Only

Ponderosa Landscape 41556 x x x x Rejects Only

Port of Oakland (CA) J1627 x x x x x

Ports America (National) J2146 x x x x Rejects Only

Prairie Meadows (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Preferred Employers J1095 x x x x x

Preferred Employers Group J1096 x x x x x

Preferred Employers Insurance Company (PEI) J1496 x x x x x

Preferred Mutual (WC Only) J3864 x x x x Rejects Only

Premier Group Insurance J3334 x x x x x

Previsor Insurance J4018 x x x x x

Prime Healthcare J1673 x x x x x

Prime Property & Casualty (Auto Only) C1081 x x x Rejects Only

Prince George's County Government (MD) J1891 x x x x x

Professional Claims Management J1821 x x x Rejects Only

Progressive J1748 x x x x x

Prospect Medical Holdings J2339 x x x x Rejects Only

Page 19 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Protective Insurance Co J1568 x x x x x

Prudential Overall Supply - AZ, CA 41556 x x x x Rejects Only

Public Alliance Insurance Coverage Fund (PAIC Jif) (WC Only) J3936 x x x x Rejects Only

Publix Super Markets, Inc. J1897 x x x x x

Puget Sound Educational Services District (Psesd) J3314 x x x x x

Puget Sound Workers' Compensation Trust J3791 x x x x Rejects Only

Pure Insurance (Auto Only) C1088 x x x x Rejects Only

QBE - General Casualty - Eden Prairie J1485 x x x x x x x x x x x

QBE - General Casualty - Farmers Union J1483 x x x x x x x x x x x

QBE - General Casualty - Freeport J1486 x x x x x x x x x x x

QBE - General Casualty - Indianapolis J1487 x x x x x x x x x x x

QBE - General Casualty - Simsbury J1488 x x x x x x x x x x x

QBE - General Casualty - Sun Prairie J1489 x x x x x x x x x x x

QBE - General Casualty - West Des Moines J1490 x x x x x x x x x x x

QBE - General Casualty Co of Wisconsin J1484 x x x x x x x x x x x

Quality Care Conv 41556 x x x x Rejects Only

Quality Health M. G. 41556 x x x x Rejects Only

Queen of Angels - Hollywood 41556 x x x x Rejects Only

Raley's Family of Fine Stores J1522 x x x x x

Ralph Lauren J1938 x x x x x

RAM Mutual Insurance Company J1894 x x x x Rejects Only

Rampart Insurance Company 38512 x x x x x

Ramsey County (MN) J1663 x x x x x

Rancho Santiago Community College District (CA) J1635 x x x x x

RCH Protective - SNCC 41556 x x x x Rejects Only

Recology J1675 x x x x x

Recreational Equipment Inc. J3763 x x x x x

Red Oak Independent School District A0205 x x x x x

Redwood Fire and Casualty Insurance Company (Member of BHHC) 20044 x x x x x x x x x x x x x

Reedy Creek Improvement District (WC Only) J3914 x x x x Rejects Only

Regent Insurance Company - QBE DBA J1484 x x x x x x x x x x x

Regis Brands J1467 x x x x x

Regis Corporation - WC ONLY J2198 x x x x x x x x x x Rejects Only

Rehab Center of Beverly Hills 41556 x x x x Rejects Only

Reny Company J2328 x x x x Rejects Only

Republic Franklin Insurance 12475 x x x x x

Republic Indemnity Company of America J1008 x x x x Rejects Only

Republic Western Ins. Co J1597 x x x x x x

Rescare, Inc. J1376 x x x Rejects Only

Residential Services Group J1097 x x x x x

Resolute Forest Products J1954 x x x x x

Restaurant Reinsurance Limited J1098 x x x x x

Restoration Prof 41556 x x x x Rejects Only

Retail Business Services (RBS) J3733 x x x x x x x x

Retailer's Casualty J1437 x x x x x

Retailer's First J1437 x x x x x

Retro Insulation INC J3870 x x x x x

Return to Work J1202 x x x x x

RevMed J1848 x x x x x

Rexnord J2176 x x x x x

Rhone-Poulenc,Inc. J1099 x x x x x

Rick Concrete Const. 41556 x x x x Rejects Only

Rieth-Riley Construction Compa J1100 x x x x x

Riley County Police (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Risk Administration Services J1828 x x x x Rejects Only

Risk Enterprise Management (REM) J1491 x x x x x x

Risk Management Solutions (RMS) (WC Only) J3873 x x x x x

Risk Transfer Technologies, Inc. J1101 x x x x x

Rite Aid Corporation J3724 x x x x x

Riverport Insurance (MN School Board Association) J1546 x x x x x

Riverport Insurance Company (Agricultural ONLY) * Paper Only x

Robstown ISD 41556 x x x x Rejects Only

Rockwall ISD 41556 x x x x Rejects Only

Rockwood Casualty Insurance J1906 x x x x x

Page 20 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Rose Garden Guest Ho 41556 x x x x Rejects Only

Roseburg Forest Products J3751 x x x x x

Rosewoood Equipment 41556 x x x x Rejects Only

Rossi Concrete, Inc 41556 x x x x Rejects Only

Roth Staffing Companies * Paper Only x

RSC Insurance Services, Ltd. J1102 x x x x x

Rural Special District Insurance Program 41556 x x x x Rejects Only

Rutgers Casualty Insurance For (Auto Only) C1101 x x x x Rejects Only

SA Recycling, LLC J1728 x x x x x

Safe TPA J3770 x x x x Rejects Only

SafeCo Insurance 24740 x x x x x

Safeco Insurance (Auto Only) C1053 x x x x x

Safeshore - STA J3785 x x x x x

Safety Group J3777 x x x x x

Safety National J2157 x x x x x x

Safety-Kleen Corporation J1103 x x x x x

Salt Lake City Corporation 41556 x x x x Rejects Only

Salt Lake City Corporation J1730 x x x x x

Sam Kane Beef Processors, Inc. 41556 x x x x Rejects Only

San Diego Community College District (CA) J1638 x x x x x

San Diego Hospice and The Institute for Palliative Medicine 41556 x x x x Rejects Only

San Diego Metropolitan Transit System 41556 x x x x Rejects Only

San Diego Metropolitan Transit System (SCHIP Liability) 41556 x x x x Rejects Only

San Diego Transit Corp. 41556 x x x x Rejects Only

San Diego Trolley, Inc. 41556 x x x x Rejects Only

San Diego/Imperial Schools JPA (CA) J1656 x x x x Rejects Only

San Francisco Municipal Transportation Agency (SFMTA) J1886 x x x x x

San Joaquin County 41556 x x x x Rejects Only

Santa Clara Co Office Of Educ 41556 x x x x Rejects Only

Santa Clara Valley Tansportation Authority J1518 x x x x x

Saratoga County Self-Insurance Plan J2188 x x x x x

Savage Services J3752 x x x x x

Save Mart J2346 x x x x x

SCHB J3830 x x x x Rejects Only

Schlumberger Technology J1104 x x x x x

Schneider Gain 41556 x x x x Rejects Only

Schnuck Market, Inc J1560 x x x x x

Schools Insurance Authority (SIA) J2325 x x x x Rejects Only

Scotts Miracle-Gro Company J1049 x x x x x

Scottsdale Insurance Co E&S (Auto Only) C1079 x x x x x x

Seabright (SBIC) J1499 x x x x x

SECURA Insurance A Mutual Company J1379 x x x x Rejects Only

Sedgwick - 3M Company - WC J2392 x x x x x

Sedgwick - Abercrombie & Fitch - WC J2393 x x x x x

Sedgwick - ABRH, LLC. - WC J2394 x x x x x

Sedgwick - Absher Construction Company - WC J2395 x x x x x

Sedgwick - Academy Express, LLC - WC J2396 x x x x x

Sedgwick - Academy Sports plus Outdoors - WC J2397 x x x x x

Sedgwick - AccentCare, Inc - WC J2398 x x x x x

Sedgwick - Accenture LLP - WC J2399 x x x x x

Sedgwick - Ace Cash Express, Inc. - WC J2400 x x x x x

Sedgwick - Ace Hardware - WC J2401 x x x x x

Sedgwick - Acloche - WC J2402 x x x x x

Sedgwick - ADS Waste Holdings, Inc. - WC J2403 x x x x x

Sedgwick - Advance Auto Parts - WC J2404 x x x x x

Sedgwick - AdvanSix Inc. - WC J2405 x x x x x

Sedgwick - Advantage Sales & Marketing Inc. - WC J2406 x x x x x

Sedgwick - Advantage Solutions - WC J2407 x x x x x

Sedgwick - AECOM - WC J2408 x x x x x

Sedgwick - Afognak Native Corp - WC J2409 x x x x x

Sedgwick - Agilent Technologies, Inc. - WC J2410 x x x x x

Sedgwick - Air Transport Services Group, Inc - WC J2411 x x x x x

Sedgwick - Airbnb Incorporated - WC J2412 x x x x x

Sedgwick - Aircraft Braking System Corp - WC J2413 x x x x x

Sedgwick - Albertsons Companies WC Self-Admin - WC J2414 x x x x x

Sedgwick - Albertsons LLC - WC J2415 x x x x Rejects Only

Sedgwick - All Risk Usl And H J3696 x x x x

Sedgwick - Allegheny Technologies, Inc - WC J2416 x x x x x

Sedgwick - Allianz of America, Inc. - WC J2418 x x x x x

Sedgwick - Allison Transmission, Inc. - WC J2419 x x x x x

Sedgwick - Allstate Corp - TPA Program, The - WC J2420 x x x x x

Sedgwick - Ally Financial Inc - WC J2421 x x x x x

Sedgwick - AltaMed Health Services Corporation - WC J2422 x x x x x

Page 21 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Altres Inc. - WC J2423 x x x x x

Sedgwick - Amazon.Com, Inc. - WC J2424 x x x x x

Sedgwick - American Airlines Group - WC J2425 x x x x x

Sedgwick - American Axle and Manufacturing - WC J2426 x x x x x

Sedgwick - American Baptist Homes Of The West (1580) - WC J2427 x x x x x

Sedgwick - American Blue Ribbon Holdings, L.L.C. - WC J2428 x x x x x

Sedgwick - American Chemical Society - WC J2429 x x x x x

Sedgwick - American Express - WC J2430 x x x x x

Sedgwick - American Family Mutual Insurance Co SI - WC J2431 x x x x x

Sedgwick - American Honda Motor Co., Inc. - WC J2432 x x x x x

Sedgwick - American Lumber Underwriters - WC J2433 x x x x x

Sedgwick - American National Red Cross - WC J2434 x x x x x

Sedgwick - American States Water Company - WC J2435 x x x x x

Sedgwick - Americare Systems, Inc. - WC J2436 x x x x x

Sedgwick - Americold Logistics LLC - WC J2437 x x x x x

Sedgwick - AmerisourceBergen Corporation - WC J2439 x x x x x

Sedgwick - Ameriwood Industries - WC J2440 x x x x x

Sedgwick - Ametek, Inc - WC J2441 x x x x x

Sedgwick - Anheuser-Busch Companies, LLC - WC J2442 x x x x x

Sedgwick - Anschutz Corporation, The - WC J2443 x x x x x

Sedgwick - Anvil International, LLC - WC J2444 x x x x x

Sedgwick - Aon Corporation - WC J2445 x x x x x

Sedgwick - Apex Tool Group LLC - WC J2446 x x x x x

Sedgwick - Apogee Enterprises Inc. - WC J2447 x x x x x

Sedgwick - Apollo Education Group, Inc - WC J2448 x x x x x

Sedgwick - Apple Inc. - WC J2449 x x x x x

Sedgwick - Applied Risk Services, Inc - WC J2450 x x x x x

Sedgwick - Applied Underwriters Inc - WC J2451 x x x x x

Sedgwick - Aptim Holding Corp. - WC J2452 x x x x x

Sedgwick - Aptiv U.S. Services, General Partnership - WC J2453 x x x x x

Sedgwick - Arakelian Enterprises (DO NOT USE for Athens Ins) - WC J2454 x x x x x

Sedgwick - Aramark - WC J2455 x x x x x

Sedgwick - Aramark Monopolistic Oversight - WC J2456 x x x x x

Sedgwick - Arby's Restaurant Group - WC J2457 x x x x x

Sedgwick - Arcadis US, Inc. - WC J2458 x x x x x

Sedgwick - Armstrong Flooring, Inc - WC J2459 x x x x x

Sedgwick - Armstrong World Industries - WC J2460 x x x x x

Sedgwick - Arrow Electronics, Inc - WC J2461 x x x x x

Sedgwick - Ascena Retail Group - Canada - WC J2462 x x x x x

Sedgwick - Ascena Retail Group, Inc. - WC J2463 x x x x x

Sedgwick - Ascension Health - WC J2464 x x x x x

Sedgwick - Aspire Casualty, LTD - WC J2465 x x x x x

Sedgwick - Asplundh Tree Expert Company - WC J2466 x x x x x

Sedgwick - Associated Wholesale Grocers, Inc (AWG) - WC J2467 x x x x x

Sedgwick - AT&T Services, Inc. - WC J2468 x x x x x

Sedgwick - Atlas General Insurance - WC J2469 x x x x x

Sedgwick - Aureon HR - WC J2470 x x x x x

Sedgwick - Automotive Management Services, Inc - WC J2471 x x x x x

Sedgwick - Autozone, Inc. - WC J2472 x x x x x

Sedgwick - Auxiliary Organizations WC Plan - WC J2473 x x x x x

Sedgwick - Avaya Inc. - WC J2474 x x x x x

Sedgwick - AVI Foodsystems, Inc. - WC J2475 x x x x x

Sedgwick - Baldwin Wallace University - WC J2476 x x x x x

Sedgwick - Banfield Pet Hospital - WC J2477 x x x x x

Sedgwick - Barnhart Crane and Rigging Company - WC J2478 x x x x x

Sedgwick - Barton Malow Practice Program - WC J2479 x x x x x

Sedgwick - Barton Malow RoCCIP - WC J2480 x x x x x

Sedgwick - Battelle Energy Alliance, LLC - WC J2481 x x x x x

Sedgwick - Battelle Memorial Institute - WC J2482 x x x x x

Sedgwick - Bay Club Company, LLC, The - WC J2483 x x x x x

Sedgwick - Bayhealth Medical Center, Inc. OCIP - WC J2484 x x x x x

Sedgwick - Beall's - WC J2485 x x x x x

Sedgwick - Beaumont Health Systems - WC J2486 x x x x x

Sedgwick - Becton, Dickinson and Company - WC J2487 x x x x x

Sedgwick - Bellevue School District #405 - WC J2488 x x x x x

Sedgwick - Berkley Life Sciences - WC J2489 x x x x x

Sedgwick - Berkley Technology Underwriters - WC J2490 x x x x x

Sedgwick - Bertelsmann Inc. - WC J2491 x x x x x

Sedgwick - Best Buy Co., Inc. - WC J2492 x x x x x

Sedgwick - Bethany Methodist Corp. - WC J2493 x x x x x

Sedgwick - Bethesda - WC J2494 x x x x x

Sedgwick - Big Lots - WC J2495 x x x x x

Sedgwick - Bikeshare Holdings LLC - WC J2496 x x x x x

Page 22 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Biogen, Inc. - WC J2497 x x x x x

Sedgwick - BJC Healthcare OCIP - WC J2498 x x x x x

Sedgwick - BJ's Wholesale Club, Inc. - WC J2499 x x x x x

Sedgwick - Blue Shield of California - WC J2500 x x x x x

Sedgwick - BluePearl Veterinary Partners - WC J2501 x x x x x

Sedgwick - BlueScope Steel North America - WC J2502 x x x x x

Sedgwick - BMW (US) HOLDINGS CORP. - WC J2503 x x x x x

Sedgwick - BOARD OF EDUCATION U-46 - WC J2504 x x x x x

Sedgwick - Bob Evans Restaurants, LLC - WC J2505 x x x x x

Sedgwick - Boeing Company, The - WC J2506 x x x x x

Sedgwick - Boler Company, The - WC J2507 x x x x x

Sedgwick - Boston Medical Center - WC J2508 x x x x x

Sedgwick - BP America, Inc. - WC J2509 x x x x x

Sedgwick - BPAA Program - WC J2510 x x x x x

Sedgwick - Bradken Inc. - WC J2511 x x x x x

Sedgwick - Bravo Brio Restaurant Group, Inc. - WC J2512 x x x x x

Sedgwick - Brenntag North America, Inc. - WC J2513 x x x x x

Sedgwick - Bridgestone Americas, Inc. - WC J2514 x x x x x

Sedgwick - Bridgestone APM Company - WC J2515 x x x x x

Sedgwick - British Airways, PLC - WC J2516 x x x x x

Sedgwick - Brooklyn Bureau Of Community Service - WC J2517 x x x x x

Sedgwick - Brooks Brothers Group, Incorporated - WC J2518 x x x x x

Sedgwick - Brookstone Inc - WC J2519 x x x x x

Sedgwick - Brown And Caldwell - WC J2520 x x x x x

Sedgwick - Buffalo Wild Wings, Inc. et al - WC J2522 x x x x x

Sedgwick - Build Group, Inc. - WC J2523 x x x x x

Sedgwick - Burger King Worldwide Holdings, Inc. - WC J2525 x x x x x

Sedgwick - Butterball, L.L.C. - WC J2526 x x x x x

Sedgwick - California State University - WC J2527 x x x x x

Sedgwick - California Truckers Safety Association - WC J2528 x x x x x

Sedgwick - Cardenas Markets LLC - WC J2529 x x x x x

Sedgwick - Cardinal Health - WC J2530 x x x x x

Sedgwick - Cardinal Logistics Management Corp - WC J2531 x x x x x

Sedgwick - Cargill, Inc. - WC J2532 x x x x x

Sedgwick - Carleton College - WC J2533 x x x x x

Sedgwick - Carter Lumber - WC J2535 x x x x x

Sedgwick - Cascade Corporation (2186) - WC J2536 x x x x x

Sedgwick - Case Farms Processing, Inc. - WC J2537 x x x x x

Sedgwick - Cast & Crew Entertainment Services LLC - WC J2538 x x x x x

Sedgwick - Castle & Cooke - Insured - WC J2539 x x x x x

Sedgwick - Catalent - WC J2540 x x x x x

Sedgwick - Catholic Health Initiatives - WC J2541 x x x x x

Sedgwick - CEC Entertainment, Inc. - WC J2542 x x x x x

Sedgwick - Cedar Fair, L.P. - WC J2543 x x x x x

Sedgwick - Centers For Dialysis Care, Inc. - WC J2544 x x x x x

Sedgwick - Centurylink, Inc - WC J2545 x x x x x

Sedgwick - Cenveo Inc. - WC J2546 x x x x x

Sedgwick - Certified Coatings Company - WC J2547 x x x x x

Sedgwick - CF Industries - WC J2548 x x x x x

Sedgwick - Champlain Enterprises, LLC - WC J2549 x x x x x

Sedgwick - Change Healthcare Holdings, LLC - WC J2550 x x x x x

Sedgwick - Charles Schwab Corporation, The - WC J2551 x x x x x

Sedgwick - Chesapeake Energy Corporation - WC J2552 x x x x x

Sedgwick - Chesapeake Tunnel Joint Venture - WC J2553 x x x x x

Sedgwick - Chewy - WC J2554 x x x x x

Sedgwick - Chicago Transit Authority - WC J2555 x x x x x

Sedgwick - Chick-Fil-A - WC J2556 x x x x x

Sedgwick - Children's Health System of Texas - WC J2557 x x x x x

Sedgwick - Children's Hosp Med Ctre of Akron OCIP - WC J2558 x x x x x

Sedgwick - Childrens National Medical Center J3697 x x x x x x

Sedgwick - Chiquita Brands International, Inc. - WC J2559 x x x x x

Sedgwick - Chrysler Group LLC - WC J2560 x x x x x

Sedgwick - Chubb Group Of Insurance Companies - WC J2561 x x x x x

Sedgwick - Cigna Corporation - WC J2562 x x x x x

Sedgwick - Cintas Corporation - WC J2563 x x x x x

Sedgwick - Cisco Systems, Inc. - WC J2564 x x x x x

Sedgwick - City of Beachwood Ohio - WC J2565 x x x x x

Sedgwick - City of Bellevue - WC J2566 x x x x x

Sedgwick - City of Charlotte - WC J2567 x x x x x

Sedgwick - City of Gahanna - WC J2569 x x x x x

Sedgwick - City of Hialeah - WC J2570 x x x x x

Sedgwick - City of Hilliard - WC J2571 x x x x x

Sedgwick - City of Memphis - WC J2572 x x x x x

Page 23 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - City Of Santa Clara - WC J2574 x x x x x

Sedgwick - City of Santa Cruz - WC J2575 x x x x x

Sedgwick - City Of South Lake Tahoe - WC J2576 x x x x x

Sedgwick - City of Wadsworth - WC J2577 x x x x x

Sedgwick - Clean Harbor Environmental Services Incorporated (Auto) J3698 x x x x x x

Sedgwick - Clean Harbor Environmental Services Incorporated (Work Comp) J3698 x x x x x

Sedgwick - Cleveland Construction Incorporated - WC J2578 x x x x x

Sedgwick - CLIC W/C Program - WC J2579 x x x x x

Sedgwick - Cliffs Natural Resources - WC J2580 x x x x x

Sedgwick - Coach USA, Inc - WC J2581 x x x x x

Sedgwick - Coach, Inc. - WC J2582 x x x x x

Sedgwick - Coinmach Service Corporation - WC J2583 x x x x x

Sedgwick - Colgate-Palmolive Corporate - WC J2584 x x x x x

Sedgwick - College of Wooster - WC J2585 x x x x x

Sedgwick - Colonial Group, Inc/Everest - WC J2586 x x x x x

Sedgwick - Colonial Pipeline Company - WC J2587 x x x x x

Sedgwick - Color Spot Nurseries Inc - WC J2588 x x x x x

Sedgwick - Columbia Association - WC J2589 x x x x x

Sedgwick - Columbus Mckinnon Corporation - WC J2590 x x x x x

Sedgwick - Columbus State Community College - WC J2591 x x x x x

Sedgwick - CommScope, Inc - WC J2592 x x x x x

Sedgwick - Community Memorial Health System, Corp - WC J2593 x x x x x

Sedgwick - Companion Property and Casualty - WC J2594 x x x x x

Sedgwick - Compass Group - WC J2595 x x x x x

Sedgwick - Con Edison - WC J2596 x x x x x

Sedgwick - ConAgra Brands, Inc. - WC J2597 x x x x x

Sedgwick - Conduent Incorporated - WC J2598 x x x x x

Sedgwick - Connect 202 Partners, LLC - WC J2599 x x x x x

Sedgwick - Constellium US Holdings, I, LLC - WC J2600 x x x x x

Sedgwick - Continental Tire, The Americas, LLC - WC J2601 x x x x x

Sedgwick - ContiTech USA, Inc. - WC J2602 x x x x x

Sedgwick - COP/CPB of The Church of Jesus Christ of LDS - WC J2603 x x x x x

Sedgwick - Corelogic, Inc - WC J2604 x x x x x

Sedgwick - Cornerstone Affiliates - WC J2605 x x x x x

Sedgwick - Corporation of the Catholic Archbishop of Seattle - WC J2606 x x x x x

Sedgwick - Cottage Health - WC J2607 x x x x x

Sedgwick - County of Maui Risk Management Division - WC J2608 x x x x x

Sedgwick - County of Santa Cruz - WC J2609 x x x x x

Sedgwick - Covenant Health - WC J2610 x x x x x

Sedgwick - Crane Company - WC J2611 x x x x x

Sedgwick - Crane Electronics - WC J2612 x x x x x

Sedgwick - Crate & Barrel Holdings, Inc. - WC J2613 x x x x x

Sedgwick - Creighton University - WC J2614 x x x x x

Sedgwick - CSC Serviceworks - WC J2615 x x x x x

Sedgwick - CTI Foods Holding Co., LLC - WC J2616 x x x x x

Sedgwick - Cumberland County Schools - WC J2617 x x x x x

Sedgwick - Cummins Inc. - WC J2618 x x x x x

Sedgwick - Cunningham Lindsey - WC J2619 x x x x x

Sedgwick - CVS Pharmacy, Inc. - WC J2620 x x x x x

Sedgwick - CYRO Industries - WC J2621 x x x x x

Sedgwick - Daily Services LLC J3699 x x x

Sedgwick - Daimler Trucks, North America LLC - WC J2622 x x x x x

Sedgwick - Damco USA, Inc - WC J2623 x x x x x

Sedgwick - Dameron Hospital Association - WC J2624 x x x x x

Sedgwick - Dana Incorporated - WC J2625 x x x x x

Sedgwick - Danaher Corporation - WC J2626 x x x x x

Sedgwick - Davita, Inc. - WC J2627 x x x x x

Sedgwick - Day One Insurance - WC J2628 x x x x x

Sedgwick - Dean Foods Company (Auto) J3700 x x x x x x

Sedgwick - Dean Foods Company (Work Comp) J3700 x x x x x

Sedgwick - Del Monte Foods - WC J2629 x x x x x

Sedgwick - Delaware County - WC J2631 x x x x x

Sedgwick - Delivery Service Providers - WC J2632 x x x x x

Sedgwick - Delphi (1856) - WC J2633 x x x x x

Sedgwick - Delta Air Lines, Inc. - WC J2634 x x x x x

Sedgwick - Dentists Insurance Company, The - WC J2635 x x x x x

Sedgwick - Desco Corporation - WC J2636 x x x x x

Sedgwick - Diamond Resorts International - WC J2637 x x x x x

Sedgwick - Dignity Health - WC J2638 x x x x x

Sedgwick - Dimension Development Two, LLC - WC J2639 x x x x x

Sedgwick - Dole Food Company, Inc - WC J2640 x x x x x

Sedgwick - Dole Packaged Foods, LLC - WC J2641 x x x x x

Sedgwick - Dollar Tree Stores, Inc - WC J2642 x x x x x

Page 24 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Domino's Pizza, LLC - WC J2643 x x x x x

Sedgwick - DPWN Holdings, Inc. - WC J2644 x x x x x

Sedgwick - Dr Pepper Snapple Group, Inc. - WC J2645 x x x x x

Sedgwick - DTE Electric Company OCIP - WC J2646 x x x x x

Sedgwick - Duke Energy Corporation - WC J2647 x x x x x

Sedgwick - Duracell Company, The - WC J2648 x x x x x

Sedgwick - E.S. Wagner Company - WC J2649 x x x x x

Sedgwick - East Penn Manufacturing Co., Inc. - WC J2650 x x x x x

Sedgwick - Eat'n Park Hospitality Group, Inc. - WC J2651 x x x x x

Sedgwick - Eaton Corporation - WC J2652 x x x x x

Sedgwick - eBay Inc. - WC J2653 x x x x x

Sedgwick - Ecology Auto Parts, Inc. - WC J2654 x x x x x

Sedgwick - Edward C. Levy - WC J2655 x x x x x

Sedgwick - Edward Don And Company - WC J2656 x x x x x

Sedgwick - Eileen Fisher Incorporated - WC J2657 x x x x x

Sedgwick - Eisenhower Medical Center - WC J2658 x x x x x

Sedgwick - Elite Distributors Insurance Company - WC J2659 x x x x x

Sedgwick - Emcor Group, Inc. - WC J2660 x x x x x

Sedgwick - Emergency Medical Services Corporation - WC J2661 x x x x x

Sedgwick - Empire Southwest, LLC - WC J2662 x x x x x

Sedgwick - Employers Mutual Casualty Company - WC J2663 x x x x x

Sedgwick - Endo International Plc (Auto) J3701 x x x x x x

Sedgwick - Endo International Plc (Work Comp) J3718 x x x x x

Sedgwick - Energy Northwest - WC J2664 x x x x x

Sedgwick - EnPro Industries, Inc. - WC J2665 x x x x x

Sedgwick - Enterprise Services LLC - WC J2666 x x x x x

Sedgwick - Entertainment Employees WC Program, Inc - WC J2667 x x x x x

Sedgwick - Episcopal Retirement Homes, Inc. - WC J2668 x x x x x

Sedgwick - Eramet Marietta - WC J2669 x x x x x

Sedgwick - Ervin Industries, Inc. - WC J2670 x x x x x

Sedgwick - ESCO Corporation - WC J2671 x x x x x

Sedgwick - Esurance - WC J2672 x x x x x

Sedgwick - Everest Casualty Facility - WC J2673 x x x x x

Sedgwick - Everest Dimension Development - WC J2674 x x x x x

Sedgwick - Everest Energy - WC J2675 x x x x x

Sedgwick - Everest Environmental - WC J2676 x x x x x

Sedgwick - Everest Insured Programs - WC J2677 x x x x x

Sedgwick - Everest National Ins Co - CA1 - WC J2678 x x x x x

Sedgwick - Everest Risk Management - WC J2679 x x x x x

Sedgwick - Everest Southern Company - WC J2680 x x x x x

Sedgwick - Evolution Insurance Company, Ltd - WC J2681 x x x x x

Sedgwick - Evraz - WC J2682 x x x x x

Sedgwick - Express Services, Inc. - WC J2683 x x x x x

Sedgwick - Extra Space Storage, Inc - WC J2684 x x x x x

Sedgwick - Fabcon, Inc - WC J2685 x x x x x

Sedgwick - Family Dollar Stores, Inc. - WC J2686 x x x x x

Sedgwick - Fannie Mae - WC J2687 x x x x x

Sedgwick - Farmer Brothers Company - WC J2688 x x x x x

Sedgwick - Farmers Group Incorporated - WC J2689 x x x x x

Sedgwick - FCA US LLC - WC J2690 x x x x x

Sedgwick - Federal Express Corporation - WC J2691 x x x x x

Sedgwick - Fedex Freight Corporation - WC J2692 x x x x x

Sedgwick - FedEx Ground Package System, Inc - WC J2693 x x x x x

Sedgwick - FedEx Supply Chain Distribution System - WC J2694 x x x x x

Sedgwick - Fidelity National Financial, Inc. - WC J2695 x x x x x

Sedgwick - Fidelity National Information Services - WC J2696 x x x x x

Sedgwick - Firelands Regional Medical Center - WC J2697 x x x x x

Sedgwick - First American Title Insurance Company - WC J2698 x x x x x

Sedgwick - First Data Corporation - WC J2699 x x x x x

Sedgwick - First Energy - WC J2700 x x x x x

Sedgwick - Fisher Foods Marketing, Inc. - WC J2701 x x x x x

Sedgwick - Five Rivers Cattle Feeding LLC - WC J2702 x x x x x

Sedgwick - Fives North American Combustion, Inc. - WC J2703 x x x x x

Sedgwick - Flatiron Dragados Sukut Joint Venture - WC J2704 x x x x x

Sedgwick - Flatiron-Skanska-Stacy & Witbeck CCIP - WC J2705 x x x x x

Sedgwick - Fleet Wholesale Supply Co., Inc. - WC J2706 x x x x x

Sedgwick - Fluor Corporation - WC J2707 x x x x x

Sedgwick - Follett Corporation - WC J2708 x x x x x

Sedgwick - Food Products of California WC Program - WC J2709 x x x x x

Sedgwick - Foodservice Risk Management, Inc. - WC J2710 x x x x x

Sedgwick - Foothill DeAnza CCD - WC J2711 x x x x x

Sedgwick - Forest Hills Local School District - WC J2712 x x x x x

Sedgwick - Fort Worth Transportation Authority - WC J2713 x x x x x

Page 25 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Fortive Corporation - WC J2714 x x x x x

Sedgwick - Fortune Brands Home And Security - WC J2715 x x x x x

Sedgwick - Franklin County Board of Commissioners - WC J2716 x x x x x

Sedgwick - Fred Weber, Inc. - WC J2717 x x x x x

Sedgwick - Fred's, Inc. - WC J2718 x x x x x

Sedgwick - Freeman Companies - WC J2719 x x x x x

Sedgwick - Freeport McMoRan Incorporated - WC J2720 x x x x x

Sedgwick - Frisch's Restaurants, Inc. - WC J2721 x x x x x

Sedgwick - Frontdoor Incorporated (Auto) J3719 x x x x x x

Sedgwick - Frontdoor Incorporated (Work Comp) J3702 x x x x x

Sedgwick - Fry's Electronics Incorporated - WC J2722 x x x x x

Sedgwick - Ft. Lauderdale Airport Hunt-Moss CCIP - WC J2723 x x x x x

Sedgwick - Fulmer Supermarkets, Inc. - WC J2724 x x x x x

Sedgwick - Galderma - WC J2725 x x x x x

Sedgwick - Gamestop Inc. - WC J2726 x x x x x

Sedgwick - GATX Corporation - WC J2727 x x x x x

Sedgwick - GCP Applied Technologies Inc. - WC J2728 x x x x x

Sedgwick - GE Appliances - WC J2729 x x x x x

Sedgwick - GENCO Distribution System, Inc - WC J2730 x x x x x

Sedgwick - General Electric - WC J2731 x x x x x

Sedgwick - General Motors Company - WC J2732 x x x x x

Sedgwick - Geo Group, Inc., The - WC J2733 x x x x x

Sedgwick - Germain Automotive Partnership - WC J2734 x x x x x

Sedgwick - Gilead Sciences Inc - WC J2735 x x x x x

Sedgwick - Global Medical Response Inc - (Work Comp) J3703 x x x x x

Sedgwick - Global Medical Response Inc (Auto) J3703 x x x x x x

Sedgwick - Golden Entertainment Incorporated J3704 x x x x

Sedgwick - Grace Pacific, LLC - WC J2736 x x x x x

Sedgwick - Graceworks Lutheran Services - WC J2737 x x x x x

Sedgwick - Graham Packaging Company Inc - WC J2738 x x x x x

Sedgwick - Grange Mutual Casualty Company - WC J2739 x x x x x

Sedgwick - Gray Incorporated (Auto) J3705 x x x x x x

Sedgwick - Gray Incorporated (Work Comp) J3705 x x x x x

Sedgwick - Great American Ins. Alternative Markets - WC J2740 x x x x x

Sedgwick - Gulf Oil Limited Partnership (Auto) J3706 x x x x x x

Sedgwick - Gulf Oil Limited Partnership (Work Comp) J3706 x x x x x

Sedgwick - Gurney's Inn Resort & Spa Ltd. - WC J2741 x x x x x

Sedgwick - Hajoca Corporation - WC J2742 x x x x x

Sedgwick - Hallcon (Auto) J3707 x x x x x x

Sedgwick - Hallcon (Work Comp) J3707 x x x x x

Sedgwick - Hanesbrands Inc. - WC J2743 x x x x x

Sedgwick - Hanover Insurance Group, Inc., The - WC J2744 x x x x x

Sedgwick - Harlandale ISD - WC J2745 x x x x x

Sedgwick - Harris Teeter Supermarkets, Inc. - WC J2746 x x x x x

Sedgwick - Harvard Services Group/Maintenance - WC J2748 x x x x x

Sedgwick - Hawaiian Airlines Incorporated J3708 x x x x x

Sedgwick - HCAA Tampa International Airport OCIP - WC J2749 x x x x x

Sedgwick - HEALTH CARE FACILITIES OF MO - WC J2750 x x x x x

Sedgwick - Health Concepts Ltd Workers Compensation - WC J2751 x x x x x

Sedgwick - Heartland Coca-Cola Bottling Company LLC - WC J2753 x x x x x

Sedgwick - Heartland Express, Inc. - WC J2754 x x x x x

Sedgwick - HellermannTyton Corporation - WC J2755 x x x x x

Sedgwick - Helmerich & Payne, Inc. - WC J2756 x x x x x

Sedgwick - Hendrick Automotive Group - WC J2758 x x x x x

Sedgwick - Heraeus - WC J2759 x x x x x

Sedgwick - Hersha Group LLC J3709 x x x x x x

Sedgwick - Hershey Company, The - WC J2760 x x x x x

Sedgwick - Hershey Entertainment & Resorts Company - WC J2761 x x x x x

Sedgwick - Hertz Corporation - WC J2762 x x x x x

Sedgwick - Hewlett Packard Enterprise Company - WC J2763 x x x x x

Sedgwick - Hillenbrand, Inc. - WC J2764 x x x x x

Sedgwick - Hilliard City School District - WC J2765 x x x x x

Sedgwick - Hilton Grand Vacation Inc. - WC J2766 x x x x x

Sedgwick - Hilton Los Angeles/Universal City - WC J2767 x x x x x

Sedgwick - Hilton Worldwide Inc. - WC J2768 x x x x x

Sedgwick - Hire Dynamics LLC - WC J2769 x x x x x

Sedgwick - Hispanic Food Holdings, LLC - WC J2770 x x x x x

Sedgwick - Hobby Lobby Stores, Inc. - WC J2771 x x x x x

Sedgwick - Home Care Quality Authority - WC J2772 x x x x x

Sedgwick - Homeland Acquisition Corp - WC J2773 x x x x x

Sedgwick - Honda Engineering North America, Inc. - WC J2774 x x x x x

Sedgwick - Honda Logistics North America - WC J2775 x x x x x

Sedgwick - Honda Manufacturing of Alabama, LLC - WC J2776 x x x x x

Page 26 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Honda North America, Inc. - WC J2777 x x x x x

Sedgwick - Honda of America Mfg., Inc. - WC J2778 x x x x x

Sedgwick - Honeywell Federal Manufacturing & Techno - WC J2779 x x x x x

Sedgwick - Honeywell International Inc. - WC J2780 x x x x x

Sedgwick - HP Inc. - WC J2781 x x x x x

Sedgwick - H-P Products, Inc. - WC J2782 x x x x x

Sedgwick - HumanGood - WC J2783 x x x x x

Sedgwick - Huntington Bancshares Incorporated - WC J2784 x x x x x

Sedgwick - Huntington Hospital - WC J2785 x x x x x

Sedgwick - Hyde Park Restaurant Systems, Inc. - WC J2786 x x x x x

Sedgwick - Ias Logistics DFW dba Pinnacle Logistic (Auto) J3710 x x x x x x

Sedgwick - Ias Logistics DFW dba Pinnacle Logistic (Work Comp) J3710 x x x x x

Sedgwick - Iberdrola dba Avangrid - WC J2787 x x x x x

Sedgwick - Ilitch Holdings, Inc. - WC J2788 x x x x x

Sedgwick - Indiana University Health Incorporated - WC J2789 x x x x x

Sedgwick - Infineon Technologies Americas Corp - WC J2790 x x x x x

Sedgwick - Insperity Services, L.P. - WC J2791 x x x x x

Sedgwick - Inspira Health Network, Inc. OCIP - WC J2792 x x x x x

Sedgwick - Installed Building Products Incorporated (Auto) J3720 x x x x x x

Sedgwick - Installed Building Products Incorporated (Work Comp) J3720 x x x x x

Sedgwick - Intel Corporation - WC J2793 x x x x x

Sedgwick - Interface Inc - WC J2794 x x x x x

Sedgwick - International Paper Company - WC J2795 x x x x x

Sedgwick - International Rectifier Corporation - WC J2796 x x x x x

Sedgwick - International Technical Coatings, Inc. - WC J2797 x x x x x

Sedgwick - Irvine Company - WC J2798 x x x x x

Sedgwick - Island Energy Services - WC J2799 x x x x x

Sedgwick - J.Crew Group, Inc. - WC J2800 x x x x x

Sedgwick - J.G. Boswell Company - WC J3294 x x x x x

Sedgwick - J.R. Simplot Company - WC J3295 x x x x x

Sedgwick - Jackson Health Systems OCIP - WC J2801 x x x x x

Sedgwick - JBS USA, LLC - WC J2802 x x x x x

Sedgwick - JEG's Automotive - WC J2803 x x x x x

Sedgwick - JetBlue Airways Corporation - WC J2804 x x x x x

Sedgwick - JM Family Enterprises, Inc. - WC J2805 x x x x x

Sedgwick - John Carroll University - WC J2806 x x x x x

Sedgwick - Johnson Controls International PLC - WC J2807 x x x x x

Sedgwick - Joliet Junior College - WC J2808 x x x x x

Sedgwick - JP Morgan Chase Bank, NA. - WC J2809 x x x x x

Sedgwick - Just Rite Acoustics, Inc. - WC J2810 x x x x x

Sedgwick - Kaiser Foundation Health Plan - WC J2811 x x x x x

Sedgwick - Kennedy Health System, Inc. OCIP - WC J2812 x x x x x

Sedgwick - Kenyon College - WC J2813 x x x x x

Sedgwick - Key Corp - WC J2814 x x x x x

Sedgwick - Key Technology, Inc. - WC J2815 x x x x x

Sedgwick - Keysight Technologies, Inc - WC J2816 x x x x x

Sedgwick - Keystone Foods LLC - WC J2817 x x x x x

Sedgwick - Kimco Staffing Services, Inc. - WC J2818 x x x x x

Sedgwick - KinderCare Education - WC J2819 x x x x x

Sedgwick - Kindred Healthcare - WC J2820 x x x x x

Sedgwick - Kindred Healthcare TXNS - WC J2821 x x x x x

Sedgwick - Kinetic Concepts, Inc. - WC J2822 x x x x x

Sedgwick - Kirlin Group, The - WC J2823 x x x x x

Sedgwick - Knowledge Universe - WC J2824 x x x x x

Sedgwick - Kohl's Department Stores Inc. - WC J2825 x x x x x

Sedgwick - KPMG, LLP - WC J2826 x x x x x

Sedgwick - Kroger Co., The - WC J2827 x x x x x

Sedgwick - Lafarge Holcim - WC J2828 x x x x x

Sedgwick - Lamb Weston Holdings - WC J2829 x x x x x

Sedgwick - Lancaster Colony Corporation - WC J2831 x x x x x

Sedgwick - Land O' Lakes, Inc. - WC J2832 x x x x x

Sedgwick - Landmark Media Enterprises, LLC - WC J2833 x x x x x

Sedgwick - LandTek Group, The - WC J2834 x x x x x

Sedgwick - Lapp Insulators, LLC - WC J2835 x x x x x

Sedgwick - Laurel Health Care Company - WC J2836 x x x x x

Sedgwick - Lawa People Mover Fluor J3711 x x x x x x

Sedgwick - Lawrence Livermore National Laboratory - WC J2837 x x x x x

Sedgwick - Lear Corporation - WC J2838 x x x x x

Sedgwick - Ledcor Contractors Group, Inc. - WC J2839 x x x x x

Sedgwick - Legacy Health - WC J2840 x x x x x

Sedgwick - Les Schwab - WC J2841 x x x x x

Sedgwick - Liberty Coca-Cola Beverages, LLC - WC J2842 x x x x x

Sedgwick - Liberty Property Trust OCIP - LPT - WC J2843 x x x x x

Page 27 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Lighthouse Indemnity LLC - WC J2844 x x x x x

Sedgwick - Lincoln Electric Holdings, Inc. - WC J2845 x x x x x

Sedgwick - Liqui-Box Corporation - WC J2846 x x x x x

Sedgwick - Liquid Environmental Solutions - WC J2847 x x x x x

Sedgwick - Little Company Of Mary Hospital & Health - WC J2848 x x x x x

Sedgwick - LOR, Inc. - WC J2849 x x x x x

Sedgwick - Los Angeles Unified School District - WC J2850 x x x x x

Sedgwick - Louisiana Office of Risk Management - WC J2851 x x x x x

Sedgwick - Lowe's Companies, Inc - WC J2852 x x x x x

Sedgwick - LTI, Inc./Milky Way - WC J2853 x x x x x

Sedgwick - Lubrizol Corporation, The - WC J2854 x x x x x

Sedgwick - Lucent Insurance LTD Captive - WC J2855 x x x x x

Sedgwick - Luxottica US Holdings Corp - WC J2856 x x x x x

Sedgwick - LVMH Moet Hennessy Louis Vuitton Inc. - WC J2857 x x x x x

Sedgwick - Lyca Tel LLC - WC J2858 x x x x x

Sedgwick - MacAljon / SCL, Inc. - WC J2859 x x x x x

Sedgwick - Macys Incorporated - WC J2860 x x x x x

Sedgwick - Major League Baseball - WC J2861 x x x x x

Sedgwick - Malcolm Drilling Company Incorporated - WC J2862 x x x x x

Sedgwick - Management & Training Corporation - WC J2863 x x x x x

Sedgwick - Manhattan Beer Distributors - WC J2864 x x x x x

Sedgwick - Manhattan Construction Company IAH CCIP - WC J2865 x x x x x

Sedgwick - Martin Marietta Materials, Inc. - WC J2866 x x x x x

Sedgwick - Masco Cabinetry Middlefield LLC - WC J2867 x x x x x

Sedgwick - Mass Mutual Life Insurance Co and subs. - WC J2868 x x x x x

Sedgwick - Mayfield City School District - WC J2869 x x x x x

Sedgwick - McCarthy Museum of Fine Arts CCIP - WC J2870 x x x x x

Sedgwick - McGraw Hill Financial Inc. - WC J2871 x x x x x

Sedgwick - McKesson Corporation - WC J2872 x x x x x

Sedgwick - Mcmaster-Carr Supply Company - WC J2873 x x x x x

Sedgwick - Meadwestvaco Corporation - WC J2874 x x x x x

Sedgwick - Medical Solutions, L.L.C. - WC J2875 x x x x x

Sedgwick - Medina County - WC J2876 x x x x x

Sedgwick - Mentor Network, The - WC J2877 x x x x x

Sedgwick - MERCHANTS OF VIRGINIA, G.S.I.A. - WC J2878 x x x x x

Sedgwick - Mercy Health Services - WC J2879 x x x x x

Sedgwick - Methode Electronics, Inc. - WC J2880 x x x x x

Sedgwick - Metropolitan Museum of Art, The - WC J2881 x x x x x

Sedgwick - Metrovest Hospitality, LLC - WC J2882 x x x x x

Sedgwick - MHE US Holdings, LLC - WC J2883 x x x x x

Sedgwick - Miba Bearings US, LLC - WC J2884 x x x x x

Sedgwick - Michels Corporation - WC J2885 x x x x x

Sedgwick - Michigan Clubs Self-Insurance - WC J2886 x x x x x

Sedgwick - Mid-America Conversion Services, LLC - WC J2887 x x x x x

Sedgwick - Mid-Coast Transit Constructors CCIP - WC J2888 x x x x x

Sedgwick - Miller & Long Co., Inc. - WC J2889 x x x x x

Sedgwick - Minneapolis Public School-SSD1 - WC J2890 x x x x x

Sedgwick - Mohegan Tribal Gaming Authority - WC J2891 x x x x x

Sedgwick - Monsanto Company - WC J2892 x x x x x

Sedgwick - Moss & Associates, LLC. - WC J2894 x x x x x

Sedgwick - Motivate LLC J3712 x x x x

Sedgwick - Motorist Mutual Insurance Company - WC J2895 x x x x x

Sedgwick - Mueller Industries, Inc. - WC J2896 x x x x x

Sedgwick - Mueller Water Products, Inc - WC J2897 x x x x x

Sedgwick - Myers Industries, Inc - WC J2898 x x x x x

Sedgwick - NASB Workers Compensation Pool - WC J2899 x x x x x

Sedgwick - National Construction Rentals, Inc. - WC J2900 x x x x x

Sedgwick - National DCP, LLC - WC J2901 x x x x x

Sedgwick - National Express LLC - WC J2902 x x x x x

Sedgwick - National Football League - WC J2903 x x x x x

Sedgwick - National Grid USA - WC J2904 x x x x x

Sedgwick - National Gypsum - WC J2905 x x x x x

Sedgwick - National Home Health Care Corp. - WC J2906 x x x x x

Sedgwick - Navistar, Inc - WC J2907 x x x x x

Sedgwick - NBTY, Inc. - WC J2908 x x x x x

Sedgwick - NC Department of Public Instruction - WC J2909 x x x x x

Sedgwick - NCACC Worker's Compensation Pool - WC J2910 x x x x x

Sedgwick - NDS Insurance, Ltd. SPC - WC J2911 x x x x x

Sedgwick - Nebraska Medicine - WC J2912 x x x x x

Sedgwick - Nebraska Methodist Health System - WC J2913 x x x x x

Sedgwick - Nestle Holdings, Inc. - WC J2914 x x x x x

Sedgwick - Nestle Waters, Inc. - WC J2915 x x x x x

Sedgwick - Nevada C4 Report - WC J2916 x x x x x

Page 28 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - New Albertson's Inc - WC J2917 x x x x x

Sedgwick - New York & Company - WC J2918 x x x x x

Sedgwick - New York Blower Company, The - WC J2919 x x x x x

Sedgwick - Newman Technology, Inc. - WC J2920 x x x x x

Sedgwick - Nexteer Automotive Corporation - WC J2921 x x x x x

Sedgwick - Nibbi Brothers General Contractors - WC J2922 x x x x x

Sedgwick - Nike IncWHQ Expansion Phase Zero OCIP - WC J2923 x x x x x

Sedgwick - North America Central School Bus - WC J2924 x x x x x

Sedgwick - Northgate Market J3713 x x x x x

Sedgwick - Northrop Grumman Corporation - OCIP - WC J2926 x x x x x

Sedgwick - Northrop Grumman Corporation - WC J2925 x x x x x

Sedgwick - Northside Independent School District - WC J2927 x x x x x

Sedgwick - Northwestern Energy - WC J2928 x x x x x

Sedgwick - Northwestern Medicine - WC J2929 x x x x x

Sedgwick - Novaria Holdings LLC Dba Novaria Group J3714 x x x x x

Sedgwick - Novo Nordisk OCIP - WC J2930 x x x x x

Sedgwick - Nucor Corporation - WC J2931 x x x x x

Sedgwick - Ocean State Job Lot - WC J2932 x x x x x

Sedgwick - OCLC, Inc. - WC J2933 x x x x x

Sedgwick - Office Depot - WC J2934 x x x x x

Sedgwick - Ohio Masonic Home, The - WC J2935 x x x x x

Sedgwick - O'Melveny & Myers, LLP - WC J2936 x x x x x

Sedgwick - OPI Contractors - WC J2937 x x x x x

Sedgwick - Option Care - WC J2938 x x x x x

Sedgwick - Orbital ATK, Inc. - WC J2939 x x x x x

Sedgwick - Oregon Zurich - Bundled - WC J2940 x x x x x

Sedgwick - Owner Operators, Inc - WC J2941 x x x x x

Sedgwick - PACCAR Inc - WC J2942 x x x x x

Sedgwick - Pacific Union Conf of 7th-Day Adventists - WC J2943 x x x x x

Sedgwick - Pacific Woodtech Corporation - WC J2944 x x x x x

Sedgwick - Packaging Corporation of America - WC J2945 x x x x x

Sedgwick - Pactiv Corporation - WC J2946 x x x x x

Sedgwick - Papillon Airways, Inc. - WC J2947 x x x x x

Sedgwick - Paramedics Logistics Operating Company - WC J2948 x x x x x

Sedgwick - Park Hotels and Resorts Inc. - WC J2949 x x x x x

Sedgwick - Parking Spot, The - WC J2950 x x x x x

Sedgwick - Pathway Insurance Company - WC J2951 x x x x x

Sedgwick - Pennsylvania State University, The - WC J2952 x x x x x

Sedgwick - Penske Automotive Group - WC J2953 x x x x x

Sedgwick - Penske Corporation - WC J2954 x x x x x

Sedgwick - Peoria School District #150 - WC J2955 x x x x x

Sedgwick - Pepsi Bottling Ventures, LLC. - WC J2956 x x x x x

Sedgwick - Pepsi Cola National Brand Beverages, Ltd - WC J2957 x x x x x

Sedgwick - PepsiCo - WC J2958 x x x x x

Sedgwick - Perdue - WC J2959 x x x x x

Sedgwick - Pestsure Association - WC J2960 x x x x x

Sedgwick - Petco Animal Supplies Inc. - WC J2961 x x x x x

Sedgwick - Peter Kiewit Sons, Inc. - WC J2962 x x x x x

Sedgwick - Peter Pan Seafoods, Inc. - WC J2963 x x x x x

Sedgwick - Peter Piper Pizza - WC J2964 x x x x x

Sedgwick - Petersen Dean Incorporated - WC J2965 x x x x x

Sedgwick - Petsmart, Inc. - WC J2966 x x x x x

Sedgwick - Pfizer Inc - WC J2967 x x x x x

Sedgwick - Pickerington Board of Education - WC J2968 x x x x x

Sedgwick - PIER 1 - WC J2969 x x x x x

Sedgwick - Pilgrim's - WC J2970 x x x x x

Sedgwick - Pilgrim's Stand Alone - WC J2971 x x x x x

Sedgwick - Pilkington North America, Inc. - WC J2972 x x x x x

Sedgwick - Pinnacle West Capital Corporation - WC J2973 x x x x x

Sedgwick - Pitney Bowes, Inc. - WC J2974 x x x x x

Sedgwick - Plains All American Pipeline - WC J2975 x x x x x

Sedgwick - Plaskolite, Inc. - WC J2976 x x x x x

Sedgwick - Pohaku Pa'a, LLC - WC J2977 x x x x x

Sedgwick - Polaris Industries - WC J2978 x x x x x

Sedgwick - PowerTeam Services LLC - WC J2979 x x x x x

Sedgwick - Prairie Band Casino and Resort - WC J2980 x x x x x

Sedgwick - Precision Castparts Corp. - WC J2981 x x x x x

Sedgwick - Premier Group Insurance - WC J2982 x x x x x

Sedgwick - Prince Resorts Hawaii, Inc. - WC J2983 x x x x x

Sedgwick - Pritchard Industries Incorporated J3715 x x x x x x

Sedgwick - Procter & Gamble Company, The - WC J2984 x x x x x

Sedgwick - Providence Health & Services - WC J2985 x x x x x

Sedgwick - PSEG - WC J2987 x x x x x

Page 29 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Public Storage - WC J2988 x x x x x

Sedgwick - PURE Insurance Company - WC J2989 x x x x x

Sedgwick - Pyramid Masonry Contractors, Inc - WC J2990 x x x x x

Sedgwick - QBE - Program Business - WC J2991 x x x x x

Sedgwick - QBE Americas, Inc. - WC J2992 x x x x x

Sedgwick - QBE Holdings, Inc - WC J2993 x x x x x

Sedgwick - R.J. Corman Railroad Group, LLC - WC J2994 x x x x x

Sedgwick - RBS Citizens NA - WC J2995 x x x x x

Sedgwick - Recreational Equipment Inc. - WC J2996 x x x x x

Sedgwick - Regis Corporation - WC J2997 x x x x x

Sedgwick - Regis Franchise Files - WC J2998 x x x x x

Sedgwick - Rent-A-Center - WC J2999 x x x x x

Sedgwick - Republic National Distributing Company - WC J3000 x x x x x

Sedgwick - Research Corporation of the UH - WC J3001 x x x x x

Sedgwick - Resideo Technologies Incorporated (Auto) J3693 x x x x x x

Sedgwick - Resideo Technologies Incorporated (Work Comp) J3693 x x x x x

Sedgwick - Retailers Insurance Company - WC J3002 x x x x x

Sedgwick - Revolution Insurance, Ltd. - WC J3003 x x x x x

Sedgwick - Reyes Holdings, L.L.C. - WC J3004 x x x x x

Sedgwick - Reynolds Packaging Inc. - WC J3005 x x x x x

Sedgwick - Rochling Glastic Composites - WC J3007 x x x x x

Sedgwick - Rockefeller University - WC J3008 x x x x x

Sedgwick - Rogue Fitness - WC J3009 x x x x x

Sedgwick - Rollins, Inc - WC J3010 x x x x x

Sedgwick - Ross Stores, Inc. - WC J3011 x x x x x

Sedgwick - Roth Staffing Companies - WC J3012 x x x x x

Sedgwick - Roto-Rooter Services Company - WC J3013 x x x x x

Sedgwick - Rush Enterprises - WC J3014 x x x x x

Sedgwick - Rush Oak Park Hospital - WC J3015 x x x x x

Sedgwick - Rush University Medical Center - WC J3016 x x x x x

Sedgwick - S&P Global Inc. - WC J3017 x x x x x

Sedgwick - S. A. Comunale Company, Inc. - WC J3018 x x x x x

Sedgwick - SABIC Innovative Plastics US LLC - WC J3019 x x x x x

Sedgwick - Safelite Group, Inc - WC J3020 x x x x x

Sedgwick - Safety National - Guaranteed Cost - WC J3021 x x x x x

Sedgwick - Safeway, Inc - WC J3022 x x x x x

Sedgwick - Salmon Companies - WC J3023 x x x x x

Sedgwick - Salo, Inc. - WC J3024 x x x x x

Sedgwick - Salvation Army, The - WC J3025 x x x x x

Sedgwick - San Mateo County CCD - WC J3027 x x x x x

Sedgwick - Sandridge Food Corporation - WC J3028 x x x x x

Sedgwick - Santee Cooper - WC J3029 x x x x x

Sedgwick - Saputo Cheese USA, Inc. - WC J3030 x x x x x

Sedgwick - Saulsbury Industries, Inc - WC J3031 x x x x x

Sedgwick - Savannah River Nuclear Solutions LLC - WC J3032 x x x x x

Sedgwick - Schertz-Cibolo-Universal City ISD - WC J3033 x x x x x

Sedgwick - Schlage Lock Company LLC - WC J3034 x x x x x

Sedgwick - Schneider Enterprise Resources, Inc. - WC J3035 x x x x x

Sedgwick - School Board of Brevard County, The - WC J3036 x x x x x

Sedgwick - School Systems of Virginia, GSIA - WC J3037 x x x x x

Sedgwick - Schwan Food Company, The - WC J3038 x x x x x

Sedgwick - Scripps Health - WC J3039 x x x x x

Sedgwick - Sears Holdings Corporation - WC J3040 x x x x x

Sedgwick - Sears Hometown and Outlet Stores - WC J3041 x x x x x

Sedgwick - Seattle Goodwill Industries - WC J3042 x x x x x

Sedgwick - Securitas Security Services USA, Inc. - WC J3043 x x x x x

Sedgwick - Seneca Foods Corporation - WC J3044 x x x x x

Sedgwick - Sensient Technologies Corporation - WC J3045 x x x x x

Sedgwick - Sheppard, Mullin, Richter & Hampton LLP - WC J3046 x x x x x

Sedgwick - Siemens Medical Solutions USA, Inc. - WC J3047 x x x x x

Sedgwick - Simmons Foods - WC J3048 x x x x x

Sedgwick - Simon Roofing and Sheet Metal - WC J3049 x x x x x

Sedgwick - Sizemore, Inc. - WC J3050 x x x x x

Sedgwick - Sky Zone LLC - WC J3051 x x x x x

Sedgwick - SkyWest Airlines, Inc. - WC J3052 x x x x x

Sedgwick - Smart & Final - WC J3053 x x x x x

Sedgwick - Smart & Final Starr GC - WC J3054 x x x x x

Sedgwick - Sonepar USA Holdings, Inc - WC J3055 x x x x x

Sedgwick - Sonic Automotive, Inc. - WC J3056 x x x x x

Sedgwick - Southern Company - WC J3058 x x x x x

Sedgwick - Southern Glazer's Wine & Spirits - WC J3059 x x x x x

Sedgwick - SP+ - WC J3060 x x x x x

Sedgwick - Spartanburg Steel Products, Inc - WC J3061 x x x x x

Page 30 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Spokane Public School District #81 - WC J3062 x x x x x

Sedgwick - SPS TECHNOLOGIES - WC J3063 x x x x x

Sedgwick - SPX Corporation - WC J3064 x x x x x

Sedgwick - SPX FLOW Inc. - WC J3065 x x x x x

Sedgwick - SSW Holding Company, Inc. - WC J3066 x x x x x

Sedgwick - St. Joseph Health - WC J3067 x x x x x

Sedgwick - St. Joseph's Healthcare System - WC J3068 x x x x x

Sedgwick - St. Jude Children's Research Hospital - WC J3069 x x x x x

Sedgwick - Stanford University Hospital And Clinics - WC J3070 x x x x x

Sedgwick - Stanley Black & Decker - WC J3071 x x x x x

Sedgwick - Starbucks Coffee Company - WC J3072 x x x x x

Sedgwick - Starr Aviation Agency Incorporated - WC J3073 x x x x x

Sedgwick - Starr Aviation Pre-award 1 - WC J3074 x x x x x




Sedgwick - Starr Companies - WC J3078 x x x x x

Sedgwick - Starr Restaurant Organization, LP - WC J3079 x x x x x

Sedgwick - State of Iowa - WC J3080 x x x x x

Sedgwick - State of Oregon Bankrupt Employers - WC J3081 x x x x x

Sedgwick - State of Oregon DBCS Decertified SIGS - WC J3082 x x x x x

Sedgwick - State of Oregon/DCBS, Non-Complying Empl - WC J3083 x x x x x

Sedgwick - Stater Bros Markets - WC J3084 x x x x x

Sedgwick - Ste. Michelle Wine Estates - WC J3085 x x x x x

Sedgwick - Steelcase, Inc. - WC J3086 x x x x x

Sedgwick - Stericycle - WC J3087 x x x x x

Sedgwick - STM Industries Inc - WC J3088 x x x x x

Sedgwick - Strategic Petroleum Reserve - WC J3089 x x x x x

Sedgwick - Stryker Corporation - WC J3090 x x x x x

Sedgwick - Style Crest Enterprises, Inc. - WC J3091 x x x x x

Sedgwick - Subaru of Indiana - WC J3092 x x x x x

Sedgwick - Suez Water Technologies & Solutions - WC J3093 x x x x x

Sedgwick - Suffolk Public Schools - WC J3094 x x x x x

Sedgwick - Sugar Creek Packing Company - WC J3095 x x x x x

Sedgwick - Sun Coast Resources Inc. - WC J3096 x x x x x

Sedgwick - Sunrise Senior Living, LLC. - WC J3097 x x x x x

Sedgwick - Swagelok Company - WC J3098 x x x x x

Sedgwick - Swisher International Group Inc. - WC J3099 x x x x x

Sedgwick - Symantec Corporation - WC J3100 x x x x x

Sedgwick - Talen Energy Corporation - WC J3101 x x x x x

Sedgwick - Tapestry, Inc. - WC J3103 x x x x x

Sedgwick - Target Corporation - WC J3104 x x x x x

Sedgwick - TBC Corporation - WC J3105 x x x x x

Sedgwick - TE Connectivity - WC J3106 x x x x x

Sedgwick - Tempo aka Alight Solutions - WC J3107 x x x x x

Sedgwick - Tenet Healthcare Corporation - WC J3108 x x x x x

Sedgwick - Tenneco, Inc - WC J3109 x x x x x

Sedgwick - Tennessee Valley Authority J3716 x x x x x

Sedgwick - Terumo Medical Corporation - WC J3110 x x x x x

Sedgwick - Tesco Corporation - WC J3111 x x x x x

Sedgwick - Texas Roadhouse - WC J3112 x x x x x

Sedgwick - Thyssenkrupp Elevator Corporation - WC J3113 x x x x x

Sedgwick - TI Automotive Systems LLC - WC J3114 x x x x x

Sedgwick - Titan America LLC (Auto) J3721 x x x x x

Sedgwick - Titan America LLC (Work Comp) J3721 x x x x x

Sedgwick - Titan Insurance, Ltd. - WC J3115 x x x x x

Sedgwick - T-Mobile, USA Inc. - WC J3116 x x x x x

Sedgwick - TNC (US) Holdings, Inc. - WC J3117 x x x x x

Sedgwick - Town Pump, Inc. - WC J3118 x x x x x

Sedgwick - Toyota - WC J3119 x x x x x

Sedgwick - Trader Joe's Company - WC J3120 x x x x x

Sedgwick - Trans World Entertainment Corporation - WC J3121 x x x x x

Sedgwick - Transdev - WC J3122 x x x x x

Sedgwick - Triangle Services, Inc - WC J3123 x x x x x

Sedgwick - Trilogy Health Services, LLC - WC J3124 x x x x x

Sedgwick - Trimble Navigation - WC J3125 x x x x x

Sedgwick - Trump Organization, The - WC J3126 x x x x x

Sedgwick - TSG, Inc. - WC J3127 x x x x x

Sedgwick - Tullier's Law Louisiana ORM - WC J3128 x x x x x

Sedgwick - Twin America - WC J3129 x x x x x

Page 31 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - TWR Enterprises, Inc - WC J3130 x x x x x

Sedgwick - Tyco - WC J3131 x x x x x

Sedgwick - U S Concrete Incorporated - WC J3132 x x x x x

Sedgwick - Union Metal Corporation - WC J3134 x x x x x

Sedgwick - United Continental Holdings Incorporated - WC J3135 x x x x x

Sedgwick - UNITED CONTRACTORS OF VIRGINIA, G.S.I.A. - WC J3136 x x x x x

Sedgwick - United Ground Express - WC J3137 x x x x x

Sedgwick - UnitedHealth Group - WC J3138 x x x x x

Sedgwick - Universal Health Services, Inc - WC J3139 x x x x x

Sedgwick - University Health System, Inc - WC J3140 x x x x x

Sedgwick - University of California - WC J3141 x x x x x

Sedgwick - University Of Minnesota (1546) - WC J3142 x x x x x

Sedgwick - University of Pennsylvania OCIP - WC J3143 x x x x x

Sedgwick - URM Stores, Inc. - WC J3144 x x x x x

Sedgwick - URS Energy and Construction, Inc. - WC J3145 x x x x x

Sedgwick - US Foods - WC J3146 x x x x x

Sedgwick - US Oncology Network, The - WC J3147 x x x x x

Sedgwick - Vallarta Supermarkets - WC J3148 x x x x x

Sedgwick - Valley Presbyterian Hospital - WC J3149 x x x x x

Sedgwick - Vallourec Star - WC J3150 x x x x x

Sedgwick - Vanliner Insurance Company - WC J3151 x x x x x

Sedgwick - Varian Medical Systems, Inc. - WC J3152 x x x x x

Sedgwick - Veolia North America - WC J3153 x x x x x

Sedgwick - Verity Health System Corp - WC J3155 x x x x x

Sedgwick - Verizon Communications - WC J3156 x x x x x

Sedgwick - Verizon Wireless - WC J3157 x x x x x

Sedgwick - Verso Paper Holdings LLC - WC J3158 x x x x x

Sedgwick - Veterinary Health Group - WC J3159 x x x x x

Sedgwick - Veterinary Services Mars - WC J3160 x x x x x

Sedgwick - VHS of Michigan, Inc. - WC J3161 x x x x x

Sedgwick - Viacom Inc. - WC J3162 x x x x x

Sedgwick - Village at Marymount, The - WC J3163 x x x x x

Sedgwick - Vista Outdoor Inc. - WC J3164 x x x x x

Sedgwick - Von Maur - WC J3165 x x x x x

Sedgwick - Vosco Forestry/Everest - WC J3166 x x x x x

Sedgwick - W. R. GRACE & CO. - WC J3167 x x x x x

Sedgwick - Walgreen Co. - WC J3168 x x x x x

Sedgwick - Walla Walla University - WC J3169 x x x x x

Sedgwick - Ward Trucking, LLC - WC J3170 x x x x x

Sedgwick - Waste Pro USA - WC J3171 x x x x x

Sedgwick - Wayne County - WC J3172 x x x x x

Sedgwick - Webster Industries Inc. - WC J3173 x x x x x

Sedgwick - Welbilt Incorporated (Auto) J3717 x x x x x x

Sedgwick - Welbilt Incorporated (Work Comp) J3717 x x x x x

Sedgwick - Wells' Enterprises, Inc. - WC J3174 x x x x x

Sedgwick - Wells Fargo - WC J3175 x x x x x

Sedgwick - Wendy's - WC J3176 x x x x x

Sedgwick - West Virginia Insurance Commission - WC J3177 x x x x x

Sedgwick - Western Digital Corporation - WC J3178 x x x x x

Sedgwick - Western Southern Life Insurance Company - WC J3179 x x x x x

Sedgwick - Western Union Company, The - WC J3180 x x x x x

Sedgwick - WestRock Company - WC J3181 x x x x x

Sedgwick - Weyerhaeuser Company - WC J3182 x x x x x

Sedgwick - Whataburger LLC - WC J3183 x x x x x

Sedgwick - Williams-Sonoma, Inc - WC J3184 x x x x x

Page 32 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sedgwick - Wind River Environmental LLC - WC J3185 x x x x x

Sedgwick - Windsor House, Inc. - WC J3186 x x x x x

Sedgwick - Windstream Communications, Inc. - WC J3187 x x x x x

Sedgwick - Winn-Dixie Stores, Inc. - WC J3188 x x x x x

Sedgwick - WKI Holding Company, Inc. - WC J3189 x x x x x

Sedgwick - WOOD PRODUCTS OF VIRGINIA, G.S.I.A. - WC J3191 x x x x x

Sedgwick - Woodside Hotel and Resorts Group Service - WC J3192 x x x x x

Sedgwick - Worldwide Flight Services - WC J3193 x x x x x

Sedgwick - Wynn Boston Harbor OCIP - WC J3194 x x x x x

Sedgwick - Xerox Business Services/ACS - WC J3195 x x x x x

Sedgwick - Xerox Corporation - WC J3196 x x x x x

Sedgwick - XL Catlin Construction - WC J3197 x x x x x

Sedgwick - Xl Construction - WC J3198 x x x x

Sedgwick - XPO Logistics, Inc. - WC J3199 x x x x x

Sedgwick - YRC Worldwide - WC J3200 x x x x x

Sedgwick - YRC Worldwide Canada (CAN PD) - WC J3201 x x x x x

Sedgwick - Zachry Construction Corporation - WC J3202 x x x x x

Sedgwick / Cargill, Inc. J1661 x x x x x

Sedgwick CMS TP097 x x x x Rejects Only

Seeno Construction (Chartis) 41556 x x x x Rejects Only

Seeno Homes 41556 x x x x Rejects Only

Sela Health Care 41556 x x x x Rejects Only

Select Energy Services J1937 x x x x x

Select Services J3831 x x x x Rejects Only

Select Staffing (Koosharem, Real Time Staffing, Remedy, Select/Remedy & Westaff J1446 x x x x x

Selective 12572 x x x x x

Selective Insurance C1077 x x x x x x

Self Insured Fund For FL Florists And Nurseries J1417 x x x x x

Self-Insured Fund – MA J1417 x x x x x

Self-Insured Schools of California (SISC) J1520 x x x x x

Self-Insured Security Fund (SISF Metro) J2382 x x x x x

Self-Insured Security Fund (SISF Tri-Star) J2383 x x x x x

Selman Breitman 41556 x x x x Rejects Only

Seminole Tribe of Florida J2384 x x x x x

Sempra Energy/Employee Care Services J1915 x x x x Rejects Only

Sentry Casualty Company J1417 x x x x x

Sentry Insurance J1417 x x x x x

Sentry Insurance A Mutual Company J1417 x x x x x

Sentry Select Insurance Company J1417 x x x x x

Service Lloyds Insurance Co J1593 x x x x x

SFM Mutual Insurance Company (Except CA) J1553 x x x x x

SFN Group (Spherion, Technisource, Tatum, The Mergis Group, SourceRight Solutions,

& Today's Office Professionals J1456 x x x x x

Shamrock Foods J2338 x x x x Rejects Only

Sharyland Independent School District 41556 x x x x Rejects Only

Shaws/StarMarket J1468 x x x x x

Sheboygan Falls Insurance Company J3897 x x x x Rejects Only

Sierra Nevada Memorial 41556 x x x x Rejects Only

Signal Insurance J3792 x x x x Rejects Only

Sika Corporation J3338 x x x x x

Silberberger Engn 41556 x x x x Rejects Only

Silverado Senior Living J2177 x x x x x

SISCO (RCM&D Self Insured Services Company, Cost Containment Services) J1898 x x x x x

SKB Corporation 41556 x x x x Rejects Only

SKF USA Inc J2178 x x x x x

Smart and Final J1824 x x x x Rejects Only

Page 33 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Snap-On Incorporated J1105 x x x x x

Society Insurance J2139 x x x x Rejects Only

Solvay America Inc J1106 x x x x x

Sonic Automotive Inc. J1381 x x x Rejects Only

Sonoma Valley Healthcare District 41556 x x x x Rejects Only

Sonoma Valley Hlth 41556 x x x x Rejects Only

South Coast Area Transit (CA) J1731 x x x x x

Southeast Leasing (legal name is Packard Claims Administration, Inc.) J1865 x x x x x x x x x x

Southern California Edison J1817 x x x x x

Southern Mutual Insurance Company J3876 x x x x Rejects Only

Southern Textile Recycling, Inc. (CA) J1648 x x x x x

Southwest Airlines (SWA) J1233 x x x x x

Southwest Gas Corporation 41556 x x x x Rejects Only

Southwest Key J3745 x x x x x

Space Exploration Technologies Corp J1990 x x x x

Sparta Insurance Company J4034 x x x x x

Special Funds J2003 x x x x Rejects Only

Specialty Coffee 41556 x x x x Rejects Only

SPNet - Integra Group J4041 x x x x x

Spooner's Woodworks 41556 x x x x Rejects Only

Springs – Ga J3832 x x x x Rejects Only

Sprouts Farmers Market, Inc. J1850 x x x x x

Spruce Grove Inc J3749 x x x x x

St Paul Insurance J1926 x x x Rejects Only

St. Rose Hospital 41556 x x x x Rejects Only

Standard & Preferred Insurance Company J4039 x x x x x

Standard Forwarding (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Standard Fruit & Veg 41556 x x x x Rejects Only

Stanley Steemer International Inc J1939 x x x x x

Stanley Works, Inc. J1385 x x x Rejects Only

Stant Corporation J1107 x x x x x

Star Transport LLC J3809 x x x x Rejects Only

State Auto Mutual Insurance Company J1966 x x x x x

State Auto Mutual Insurance Company J1966 x x x x x

State Compensation Insurance Fund (SCIF) 35076 x x x x x

State Farm - Auto Only J1548 x x x x Rejects Only

State Farm - WC Only J3349 x x x x x

State Fund Mutual J1553 x x x x x

State of Minnesota - DOER J1555 x x x x x

State of North Carolina J1659 x x x x x

State of Rhode Island J1234 x x x x x

State of Wyoming J2179 x x x x x

State Of Wyoming J3357 x x x x Rejects Only

State Office of Risk Management J1418 x x x x x Rejects Only

Statewide Insurance Fund (WC Only) J3937 x x x x Rejects Only

Sti Holdings, Inc. J3323 x x x x x

Stimson Lumber Company - MT, OR, WA 41556 x x x x Rejects Only

Stonington C. Club 41556 x x x x Rejects Only

Style Crest Enterprise J3880 x x x x x

Summit Health Ltd J1108 x x x x x

Summit Holdings J1437 x x x x x

Sun Mar Healthcare J1610 x x x x x

Sunrise Country Club 41556 x x x x Rejects Only

Superior Access Ins Services 41556 x x x x Rejects Only

Superior Industries International, Inc. 41556 x x x x Rejects Only

Superior Point (aka Minnesota Workers Compensation Assigned Risk Plan) J1553 x x x x x

Superior Ready Mix 41556 x x x x Rejects Only

Sussex Insurance Company (formerly Companion Property & Casualty Insurance) J1829 x x x x x

Page 34 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Sutter Health J1512 x x x x x

Swift Transportation J1109 x x x x x

Syngenta Corporation J1972 x x x x x

Sysco Corporation J3316 x x x x x

T.H.E. Insurance J1791 x x x x x

Tailored Brands Inc. J3764 x x x x x

Takeda America Holdings, Inc. J1991 x x x x

Tan Medical Group 41556 x x x x Rejects Only

Tankstar USA, Inc. J2180 x x x x x

Tawa Services, Inc. J3750 x x x x x

TD Tile 41556 x x x x Rejects Only

Technology Insurance Co J1855 x x x x x x

Techsource J3310 x x x x x

Texas A&M A0235 x x x x x

Texas Association of School Boards A0234 x x x x x

Texas Builders Insurance Co J1581 x x x x x

Texas Children's J3333 x x x x x

Texas Hospital Insurance (WC Only) J3869 x x x x Rejects Only

Texas Mutual Insurance 22945 x x x x x

Texas Mutual League (TML) (SEE TAB) - Employees of IEBP Only A0245 x x x x x

Texas Political Subdivisions JSIF J1921 x x x x Rejects Only

Texas Roadhouse, Inc. J1676 x x x x x

Texas Small Business Pool J1110 x x x x x

TFA Selective Workers Comp Group J3778 x x x x x

The American Equity Underwriters, Inc (AEU) J4019 x x x x x x

The Atlas Group of Companies (Auto Only) C1075 x x x x x

The Auto Club Group 11983 x x x x x

The Charlotte-Mecklenburg Hospital Authority J3833 x x x x Rejects Only

The Cheesecake Factory J2181 x x x x x

The De Moya Group, Inc. J4040 x x x x

The Gap, Inc. J1671 x x x x x

The Hartford J1422 x x x x x

The Jones Financial Companies, LLP J1846 x x x x x

The Main Street America Group / Austin Mutual J1834 x x x x x

The Main Street America Group / Grain Dealers Mutual J1835 x x x x x

The Main Street America Group / Great Lakes Casualty J1836 x x x x x

The Main Street America Group / Main Street America Assurance J1837 x x x x x

The Main Street America Group / MSA Insurance Protection J1838 x x x x x

The Main Street America Group / MSAIC Surplus/Non-Admitted J1839 x x x x x

The Main Street America Group / NGM J1840 x x x x x

The Main Street America Group / Old Dominion Insurance Company J1841 x x x x x

The Main Street America Group / Spring Valley Mutual J1842 x x x x x

The Men's Wearhouse, Inc J1615 x x x x x

The Mentor Network (Bunch CareSolutions) J1963 x x x x x x x x x x x x x x x x

The Mentor Network (Bunch CareSolutions) J1963 x x x x x x x x x x x x x x x x

The Odom Corporation J3816 x x x x x

The Parts House Acquisition J4020 x x x x x

The Salvation Army J1472 x x x x x

The Scotts Company J1111 x x x x x

The Vitamin Shoppe J3337 x x x x x

The Zenith 13269 x x x x x

The Zenith - YMCA San Diego (WC Only) J3922 x x x x x

Therapy Direct Network J1831 x x x x x

Third Coast Underwriters (3CU) J2148 x x x x Rejects Only

Thomas McGee J1746 x x x x Rejects Only

Thomas Staffing Services, Inc/Venturi Staffing 41556 x x x x Rejects Only

THREE J3769 x x x x x

Tiffany & Co J3736 x x x x x

Tilly's, Inc. J2183 x x x x x

Page 35 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Toll Brothers J3746 x x x x x

TOPA Insurance Company J1537 x x x x x

Topanga Roscoe Corp. 41556 x x x x Rejects Only

Total Petroleum, Inc. J1112 x x x x x

Tower Energy Group J1604 x x x x x

Town of Colma (CA) J1668 x x x x x

Town Of Hempstead (NY) J3810 x x x x x

Town Of Oyster Bay (NY) J3796 x x x x x

Tractor Supply Company J1505 x x x x x

Travelers 19046 x x x x x

Triangle Insurance J1996 x x x x x

Tri-City Healthcare District 41556 x x x x Rejects Only

Tri-City Healthcare District J1905 x x x x x

Tri-City Linen Suppl 41556 x x x x Rejects Only

Tricity Uniform 41556 x x x x Rejects Only

Tri-County Schools Insurance Group JPA (WC Only) J3879 x x x x x

Trillium Staffing Solutions J1674 x x x x x

Trimet J3772 x x x x x

Trindel Insurance Fund J1971 x x x x Rejects Only

Triple A 11983 x x x x x

Tri-State Insurance Company * Paper Only x

Tucson Unified School Dist WC 41556 x x x x Rejects Only

Tyson Foods Inc. J1732 x x x x x x x

UDR, Inc. J3741 x x x x x

UMR Risk Management (previously POMCO) J2004 x x x x Rejects Only

Underwriters Safety and Claims TP108 x x x x x

Unigard Insurance Company - QBE DBA J1484 x x x x x x x x x x x

Union Construction Workers' Comp Program J1629 x x x x x x

Union Insurance Company * Paper Only x

Union Insurance Company of Providence - (Except CA, NM, NV) 25844 x x x x x

Union Insurance Company of Providence (Auto Only) C1029 x x x x x x

United Continental J2330 x x x x Rejects Only

United Convalescent 41556 x x x x Rejects Only

United Dominion Realty Trust J1048 x x x x x

United Fire J1401 x x x x x

United Fire Group (aka Mercer Insurance) (Auto Only) C1102 x x x x Rejects Only

United Health Services, Inc. dba Pruitt Health J3753 x x x x x

United Heartland J1859 x x x x x

United States Cold Storage J1113 x x x x x

United States Fire Insurance Company 31348 x x x x x x x x

United Wisconsin Insurance Company J1235 x x x x x Rejects Only

University of Colorado 41556 x x x x Rejects Only

University of Kentucky Health Services J1941 x x x x x

University of Texas at Austin (IMO) J2387 x x x x Rejects Only

US Foodservice, Inc. J1114 x x x x x

US Mobile Wireless 41556 x x x x Rejects Only

US National Resources (Aigrm) J1115 x x x x x

US Sugar Corporation J1950 x x x x x

USAA (Auto Only) J1822 x x x x x

Utica - Auto Only C1027 x x x x x

Utica Mutual Insurance Co 25976 x x x x x

Utica National Insurance Co of Texas 43478 x x x x x

V&M Restoration 41556 x x x x Rejects Only

Vacorp J3807 x x x x x

Valenzuela Eng. Inc 41556 x x x x Rejects Only

Valitas Health Services, Inc. dba Corizon Health J3742 x x x x x

Valley Casework Inc 41556 x x x x Rejects Only

Valley Harvesting & Packing, Inc. 41556 x x x x Rejects Only

Page 36 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Valley Health Care Management Services, LLC 41556 x x x x Rejects Only

Valley Health System 41556 x x x x Rejects Only

Valley Memorial Hospital 41556 x x x x Rejects Only

Valley Mills ISD J1873 x x x x Rejects Only

Van Diest (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Velocity Vehicle Group (Corvel) Doi > 4/15/2012 Or Later J1992 x x x x

Venture Pac Develop 41556 x x x x Rejects Only

Vermeer (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Vertical Concrete 41556 x x x x Rejects Only

Vicorp Restaurants, Inc. J1116 x x x x x

Victor Plastics (via EMC Risk Services) (Except CA, NM, NV) J1118 x x x x x

Victoria ISD 41556 x x x x Rejects Only

Virginia Beach City Public Schools (VA ONLY) J2165 x x x x

Virginia International Terminals J3786 x x x x x

Virginia Risk Sharing (VRSA) (WC Only) J3928 x x x x x Rejects Only

Virginia Surety Company, Inc. J1404 x x x x Rejects Only

Vista Hills C Club 41556 x x x x Rejects Only

VML Insurance Programs J3354 x x x x Rejects Only

Vons / Safeway J1750 x x x x x x x x x x

Vought Aircraft Industries J1405 x x x Rejects Only

Vulcan Materials J1993 x x x x

W Co Radiology Cntr 41556 x x x x Rejects Only

Wadena (WC Only) J3931 x x x x x

Wake County J3834 x x x x Rejects Only

Walker, Hunter & Assoc., Inc - Springs J3835 x x x x Rejects Only

Walker, Hunter & Assoc., Inc - Timber Fund J3836 x x x x Rejects Only

Wal-Mart J1004 x x x x Rejects Only

Warner Brothers J2385 x x x x Rejects Only

Washington County 41556 x x x x Rejects Only

Washington Gas J3865 x x x x Rejects Only

Washington Hospital 41556 x x x x Rejects Only

Watkins Manufacturing Corporation 41556 x x x x Rejects Only

WATTSHealth Foundation, Inc. (SNCC) 41556 x x x x Rejects Only

Wawona Packing 41556 x x x x Rejects Only

WE Energies J1406 x x x x x

Wegmans (WC Only) J3845 x x x x Rejects Only

Werner Enterprises J1856 x x x x Rejects Only

Wesco Insurance Company J1857 x x x x x x Rejects Only

Weslaco Independent School District 41556 x x x x Rejects Only

West Bend - NSI J3348 x x x x x

West Bend Mutual Insurance J2088 x x x x Rejects Only

West Coast Hospitals, Inc. 41556 x x x x Rejects Only

West Oso ISD 41556 x x x x Rejects Only

West Texas Rural Counties Association Preferred Risk Pool - WC 41556 x x x x Rejects Only

Westamerica/Phil Long Dealerships 41556 x x x x Rejects Only

Western Agricultural Insurance Company J3738 x x x x x

Western National Assurance J1569 x x x x x

Western National Insurance \ Pioneer Specialties J1586 x x x x x

Western National Insurance Group J1495 x x x x x

Westfield Insurance J1858 x x x x Rejects Only

Westfield National J3322 x x x x x

WestGUARD Insurance Company - Guard DBA J1453 x x x x x

Willamette View 41556 x x x x Rejects Only

Williams & Sonoma J1473 x x x x x

Williamson County Government (TN Only) J2386 x x x x

Wilmer-Hutchins ISD/Dallas ISD 41556 x x x x Rejects Only

Wilson Mutual Insurance (All States EXCEPT WI/MN) J1893 x x x x x

Wilson Mutual Insurance (MN/WI ONLY) J1407 x x x x x x

Page 37 of 38



All

States 837P 837I

WORK

COMP AUTO 835

Woodland Park West 41556 x x x x Rejects Only

Work First Casualty Company J4035 x x x x x

Workers Compensation And Employer Liability J3722 x x x x x

Worldcom Inc J1874 x x x x Rejects Only

Worthington Industries J3757 x x x x x

Wyman-Gordon Companies J1117 x x x x x

Xcel Energy J1628 x x x x x

xl Environmental, Inc. J1055 x x x x x

Xylem Inc. J3765 x x x x x

YMCA 41556 x x x x Rejects Only

York Claim Services J1421 x x x x Rejects Only

Zachry Construction J1409 x x x x x x x x x Rejects Only

Zipcar J3797 x x x x Rejects Only

Z-Nat Insurance (Zenith National) 30120 x x x x x

Zoe Holding Company Inc. J3766 x x x x x

Zoetis, Inc. J2184 x x x x x

Zurich Farmers J1015 x x x x x x x x x x x x x x x

Zurich Insurance N.A. 16535 x x x x x x x x x x x x x x x

Page 38 of 38

WORKERS' COMPENSATION / AUTO PAYER LIST 05/15/2020 …...WORKERS' COMPENSATION / AUTO PAYER LIST 05/15/2020 Payer ID TX MN CA IL LA NJ NY OR WI NC NM OK TN VA All States 837P 837I

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