Compensation Agency Page 1 Insurance Company Listing

7/8/2021 Workers’ Disability Compensation Agency Page 1 Insurance Company Listing

A.I.U. Insurance Company Acuity, A Mutual Insurance Company AIG Domestic Claims 2800 S. Taylor Drive P.O. Box 25908 P.O. Box 58 Shawnee Mission, KS 66225 Sheboygan, WI 53081 NAIC Number: 193990012 NAIC Number: 141840289

Acadia Insurance Company Affiliated F M Insurance Company P.O. Box 1594 Allendale Park Des Moines, IA 50306 P.O. Box 7500 NAIC Number: 313250098 Johnston, RI 02919 NAIC Number: 100140065 Acceptance Insurance Company 535 W. Broadway AIG Property Casualty Company P.O. Box 1574 AIG Domestic Claims Council Bluffs, IA 51502-1574 P.O. Box 25908 NAIC Number: 379580329 Shawnee Mission, KS 66225 NAIC Number: 194020012 Accident Fund General Insurance Co. P.O. Box 40790 Alea North America Insurance Company Lansing, MI 48901 55 Capital Blvd. NAIC Number: 123040572 Rocky Hill, CT 06067 NAIC Number: 248991325 Accident Fund Insurance Co. of America P.O. Box 40790 All America Insurance Company Lansing , MI 48901 800 S. Washington Street NAIC Number: 101660572 Vanwert, OH 45891 NAIC Number: 202220036 Accident Fund National Insurance Co. P.O. Box 40790 Alliance Assurance Company, Ltd. Lansing, MI 48901 3600 Arco Corporate Drive NAIC Number: 123050572 Charlotte, NC 28273 NAIC Number: 202730553 Accredited Surety and Casualty Company, Inc. P.O. Box 140855 Allianz Insurance Company Orlando, FL 32814-0855 P.O. Box 970 NAIC Number: 263794234 O'Fallon, MO 63366 NAIC Number: 353000761 Ace American Insurance Company 1 Beaver Valley Road - 4E Allied Eastern Indemnity Company Wilmington, DE 19803 25 Race Avenue NAIC Number: 226670626 P.O. Box 83777 Lancaster, PA 17608-3777 Ace Fire Underwriters Insurance Company NAIC Number: 112422698 1 Beaver Valley Road - 4E Wilmington, DE 19803 Allied Insurance Company NAIC Number: 207020626 1 Beaver Valley Road - 4E Wilmington, DE 19803 Ace Property & Casualty Insurance Company NAIC Number: 365280626 1 Beaver Valley Road - 4E Wilmington, DE 19803 Allied Property & Casualty Insurance Company NAIC Number: 206990626 P.O Box 182079 Columbus, OH 43218-2079 ACIG Insurance Company NAIC Number: 425790140 2600 N Central Expy Ste 800 Richardson, TX 075080-2064 Allmerica Financial Benefits Insurance Company NAIC Number: 199840594 P.O. Box 15144 Worcester, MA 01615 NAIC Number: 418400088

7/8/2021 Workers’ Disability Compensation Agency Page 2 Insurance Company Listing

Allmerica Financial Alliance Insurance Company American Druggists Insurance Company P.O. Box 15144 c/o MI Property & Casualty Worcester, MA 01615 P.O. Box 531266 NAIC Number: 102120088 Livonia, MI 48153-1266 NAIC Number: 101540143 Allstate Indemnity Company 3075 Sanders Road, Suite H1A American Economy Insurance Company Northbrook, IL 60062-7127 2000 Westwood Drive NAIC Number: 192400008 P.O. Box 8016 Wausau, WI 54402-8016 Allstate Insurance Company NAIC Number: 196900163 3075 Sanders Road, Suite H1A Northbrook, IL 60062-7127 American European Insurance Company NAIC Number: 192320008 250 Main Street P.O. Box 903 Amco Insurance Company Buffalo, NY 14240-9974 P.O. Box 182079 NAIC Number: 233370226 Columbus, OH 43218-2079 NAIC Number: 191000140 American Family Home Insurance Company 555 College Road East American & Foreign Insurance Company Princeton, NJ 08543 3600 Arco Corporate Drive NAIC Number: 234500957 Charlotte, NC 28273 NAIC Number: 245890553 American Fire & Casualty Company 350 E 96th Street American Alternative Insurance Company Indianapolis, IN 46240 American RE Plaza NAIC Number: 240660148 555 College Road East Princeton, NJ 08543 American Guarantee & Liability Insurance Co. NAIC Number: 197200957 P.O. Box 968041 Schaumburg, IL 60196-8041 American Automobile Insurance Company NAIC Number: 262470212 P.O. Box 970 O'Fallon, MO 63366 American Hardware Mutual Insurance Company NAIC Number: 218490761 P.O. Box 435 Minneapolis, MN 55440 American Casualty Company of Reading, PA NAIC Number: 133310291 P.O. Box 8317 Chicago, IL 60680-8317 American Home Assurance Company NAIC Number: 204270218 AIG Domestic Claims P.O. Box 25908 American Commercial Liability Insurance Co. Shawnee Mission, KS 66225 c/o MI Property & Casualty NAIC Number: 193800012 P.O. Box 531266 Livonia, MI 48153-1266 American Insurance Company NAIC Number: 303920713 P.O. Box 970 O'Fallon, MO 63366 American Compensation Insurance Company NAIC Number: 218570761 P.O. Box 390327 Bloomington, MN 55439 American Interstate Insurance Company NAIC Number: 459344463 2301 Highway 190 West Deridder, LA 70634 American Continental Insurance Company NAIC Number: 318950680 P.O. Box 660456 Dallas, TX 75266-0456 American Manufacturers Mutual Insurance Co. NAIC Number: 122460164 c/o MI Property & Casualty Fund P.O. Box 531266 American Country Insurance Company Livonia, MI 48153-1266 150 N. W. Point Blvd., Suite 300 NAIC Number: 305620108 Elk Grove Village, IL 60007-1015 NAIC Number: 382370000

7/8/2021 Workers’ Disability Compensation Agency Page 3 Insurance Company Listing

American Modern Home Insurance Company American Zurich Insurance Company 555 College Road East P.O. Box 968041 Princeton, NJ 08543 Schaumburg, IL 60196-8041 NAIC Number: 234690957 NAIC Number: 401420212

American Motorists Insurance Company Amerisure Insurance Company c/o MI Property & Casualty Fund P.O. Box 1515 P.O. Box 531266 Canonsburg, PA 15317 Livonia, MI 48153-1266 NAIC Number: 194880124 NAIC Number: 229180108 Amerisure Mutual Insurance Company American Mutual Insurance Company of Boston P.O. Box 1515 100 Unicorn Park Drive Canonsburg, PA 15317 Woburn, MA 01801 NAIC Number: 233960124 NAIC Number: 195500015 Amerisure Partners Insurance Company American Mutual Liability Insurance Company P.O. Box 1515 100 Unicorn Park Drive Canonsburg, PA 15317 Woburn, MA 01801 NAIC Number: 110500124 NAIC Number: 195690015 AmGuard Insurance Company American Physicians Assurance Corporation P.O. Box A-H 1301 N. Hagadorn Wilkes-Barre, PA 18703 P.O. Box 1471 NAIC Number: 423900031 East Lansing, MI 48826 NAIC Number: 330060966 Ansur America Insurance Company One Mutual Avenue American Policyholders Insurance Co. Frankenmuth, MI 48787 100 Unicorn Park Drive NAIC Number: 109841309 Woburn, MA 01801 NAIC Number: 195770015 AP Specialty Insurance Corp. 1301 N. Hagadorn Road American Protection Insurance Company East Lansing, MI 48823-2320 c/o MI Property & Casualty Fund NAIC Number: 102290966 P.O. Box 531266 Livonia, MI 48153-1266 Arch Insurance Company NAIC Number: 189100108 P.O. Box 542033 Omaha, NE 68154 American Safety Casualty Insurance Company NAIC Number: 111500000 100 Galleria Pkwy SE, Ste. 700 Atlanta, GA 30339-5947 Argonaut Great Central Insurance Company NAIC Number: 399691346 P.O. Box 469012 San Antonio, TX 78246-9012 American Select Insurance Company NAIC Number: 198600457 One Park Circle P.O. Box 5005 Argonaut Insurance Company Westfield Center, OH 44251 P.O. Box 469012 NAIC Number: 199920228 San Antonio, TX 78246-9012 NAIC Number: 198010457 American States Insurance Company 2000 Westwood Drive Argonaut Midwest Insurance Company P.O. Box 8016 P.O. Box 469012 Wausau, WI 54402-8016 San Antonio, TX 78246-9012 NAIC Number: 197040163 NAIC Number: 198280457

American Universal Insurance Company Arrowood Indemnity Company c/o MI Property & Casualty 3600 Arco Corporate Drive P.O. Box 531266 Charlotte, NC 28273 Livonia, MI 48153-1266 NAIC Number: 246780553 NAIC Number: 197470021

7/8/2021 Workers’ Disability Compensation Agency Page 4 Insurance Company Listing

Ashmere Insurance Company Badger Mutual Insurance Company 401 E Las Olas Blvd, Ste. 1540 1635 W National Ave Fort Lauderdale, FL 33301 Milwaukee, WI 53204 NAIC Number: 403980000 NAIC Number: 134200000

Associated Indemnity Corporation Balboa Insurance Company P.O. Box 970 3349 Michelson Drive O'Fallon, MO 63366 Irvine, CA 92713 NAIC Number: 218650761 NAIC Number: 248130165

Assurance Company of America Bancinsure, Inc. P.O. Box 968041 5005 N. Lincoln Blvd. Schaumburg, IL 60196-8041 Oklahoma City, OK 73105 NAIC Number: 193050212 NAIC Number: 185380000

Assurance Corporation Bankers Standard Insurance Company 11405 North Community House Rd 1 Beaver Valley Road - 4E Charlotte, NC 28277 Wilmington, DE 19803 NAIC Number: 115513219 NAIC Number: 182790626

Athena Assurance Company Benchmark Insurance Company P.O. Box 660456 150 Lake St. West Dallas, TX 75266-0456 Wayzata, MN 55391 NAIC Number: 417690164 NAIC Number: 413940000

Atlantic Mutual Insurance Company Berkley Casualty Company c/o MI Property & Casualty 1250 E Diehl Rd., Ste 200 P.O. Box 531266 Naperville, IL 60563 Livonia, MI 48153-1266 NAIC Number: 159110098 NAIC Number: 198950024 Berkley National Insurance Company Atlantic Specialty Insurance Company 1250 E Diehl Rd., Ste 200 OneBeacon Insurance Group Naperville, IL 60563 605 Hwy 169 North Suite 800 NAIC Number: 389110098 Plymouth, MN 55441 NAIC Number: 271541129 Berkley Regional Insurance Company 1250 E Diehl Rd., Ste 200 Atlantic States Insurance Company Naperville, IL 60563 PO Box 302 NAIC Number: 295800098 Marietta, PA 17547 NAIC Number: 225860250 Berkshire Hathaway Direct Insurance Company P.O. Box 881716 Auto Owners Insurance Company San Francisco, CA 94188 Michigan Workers' Comp. Claims NAIC Number: 103910031 P.O. Box 30510 Lansing, MI 48909 Berkshire Hathaway Homestate Insurance Company NAIC Number: 189880280 P.O. Box 881716 San Francisco, CA 94188 Automobile Insurance Company of Hartford, CT NAIC Number: 200440031 P.O. Box 660456 Dallas, TX 75266-0456 Bitco General Insurance Corporation NAIC Number: 190620041 PO Box 1019 Youngwood, PA 15697-0919 Axa Corporate Solutions Insurance Company NAIC Number: 200950150 17 State Street New York, NY 10004-1501 Bitco National Insurance Company NAIC Number: 330220968 PO Box 1019 Youngwood, PA 15697-0919 NAIC Number: 201090150

7/8/2021 Workers’ Disability Compensation Agency Page 5 Insurance Company Listing

Bloomington Compensation Insurance Company Casualty Reciprocal Exchange PO Box 390327 c/o MI Property & Casualty Bloomington, MN 55439 P.O. Box 531266 NAIC Number: 123114463 Livonia, MI 48153-1266 NAIC Number: 212370056 Boston Insurance Company 1717 E. 9th Street Celina Mutual Insurance Company Cleveland, OH 44114 1 Insurance Square NAIC Number: 333330000 Celina, OH 45822 NAIC Number: 201760035 Boston Old Colony Insurance Company P.O. Box 8317 Centennial Insurance Company Chicago, IL 60680-8317 c/o MI Property & Casualty NAIC Number: 207610218 P.O. Box 531266 Livonia, MI 48153-1266 BrickStreet Mutual Insurance Co NAIC Number: 199090024 471 E. Broad Street, 14th Floor Columbus, OH 43215 Central Mutual Insurance Company NAIC Number: 123720291 800 S. Washington Street Vanwert, OH 45891 Brotherhood Mutual Insurance Company NAIC Number: 202300036 P.O. Box 2227 Fort Wayne, IN 46801 Central National Insurance Co. of Omaha NAIC Number: 135280000 105 S. 17th Street Omaha, NE 68102 Buckeye Union Insurance Company NAIC Number: 202490217 P.O. Box 8317 Chicago, IL 60680-8317 Century Indemnity Company NAIC Number: 207880218 1 Beaver Valley Road - 4E Wilmington, DE 19803 Camden Fire Insurance Association Co. of NJ NAIC Number: 207100626 OneBeacon Insurance Group 605 Hwy 169 North Suite 800 Charter Oak Fire Insurance Company Plymouth, MN 55441 P.O. Box 660456 NAIC Number: 219461129 Dallas, TX 75266-0456 NAIC Number: 256150041 Capitol Indemnity Corporation P.O. Box 5900 AIG Property Casualty Company Madison, WI 53705 AIG Domestic Claims NAIC Number: 104720501 P.O. Box 4230 Alpharetta, GA 30023-4230 Carolina Casualty Insurance Company NAIC Number: 194020012 1250 E Diehl Rd., Ste 200 Naperville, IL 60563 Cherokee Insurance Company NAIC Number: 105100098 34200 Mound Road Sterling Heights, MI 48310 Carriers Insurance Company NAIC Number: 106420000 c/o MI Property & Casualty P.O. Box 531266 Chrysler Insurance Company Livonia, MI 48153-1266 P.O. Box 9220 NAIC Number: 105290338 Farmington Hills, MI 48333-9220 NAIC Number: 104990240 Castlepoint National Insurance Company 59 Maiden Lane Floor 42 Chubb Indemnity Company New York, NY 10038 1 Beaver Valley Road - 4E NAIC Number: 401343703 Wilmington, DE 19803 NAIC Number: 127770038

7/8/2021 Workers’ Disability Compensation Agency Page 6 Insurance Company Listing

Chubb National Insurance Company Commerce & Industry Insurance Company 1 Beaver Valley Road - 4E AIG Domestic Claims Wilmington, DE 19803 P.O. Box 25908 NAIC Number: 100520038 Shawnee Mission, KS 66225 NAIC Number: 194100012 Church Mutual Insurance Company P.O. Box 342 Commercial Casualty Insurance Company Merrill, WI 54452 One California St, Suite 600 NAIC Number: 187670000 San Francisco, CA 94111 NAIC Number: 322800031 Cincinnati Casualty Company P.O. Box 145496 Commercial Insurance Company of Newark Cincinnati, OH 45250-5496 P.O. Box 8317 NAIC Number: 286650244 Chicago, IL 60680-8317 NAIC Number: 208180218 Cincinnati Indemnity Company P.O. Box 145496 Companion Commercial Insurance Company Cincinnati, OH 45250-5496 P.O. Box 100165 NAIC Number: 232800244 Columbia, SC 29202 NAIC Number: 107940661 Cincinnati Insurance Company P.O. Box 145496 Compass Insurance Company Cincinnati, OH 45250-5496 9277 Centre Pointe Drive, Suite 140 NAIC Number: 106770244 West Chester, OH 45069 NAIC Number: 219890143 Citizens Insurance Company of America P.O. Box 15144 CompWest Insurance Company Worcester, MA 01615 P.O. Box 40790 NAIC Number: 315340088 Lansing, MI 48901-7990 NAIC Number: 121770572 Citizens Insurance Company of Ohio P.O. Box 15144 Conifer Insurance Company Worcester, MA 01615 P.O. Box 3003 NAIC Number: 101760088 Birmingham, MI 48012 NAIC Number: 297344720 Citizens Insurance Company of the Midwest P.O. Box 15144 Connecticut Indemnity Company Worcester, MA 01615 3600 Arco Corporate Drive NAIC Number: 103950088 Charlotte, NC 28273 NAIC Number: 248720553 City Insurance Company c/o MI Property & Casualty Consolidated American Insurance Company P.O. Box 531266 P.O. Box 1 Livonia, MI 48153-1266 Columbia, SC 29202 NAIC Number: 225000095 NAIC Number: 249450168

Clarendon National Insurance Company Consolidated Insurance Company 411 5th Ave. FL 5 Commercial Claims New York, NY 10016-2221 PO Box 7205 NAIC Number: 205320517 London, KY 40742 NAIC Number: 226400111 Colonial American Casualty & Surety Company P.O. Box 968041 Consolidated Underwriters Schaumburg, IL 60196-8041 c/o MI Property & Casualty NAIC Number: 343470212 P.O. Box 531266 Livonia, MI 48153-1266 Colonial Penn Insurance Company NAIC Number: WC0080000 P.O. Box 1998 Valley Forge, PA 19482 NAIC Number: 347890239

7/8/2021 Workers’ Disability Compensation Agency Page 7 Insurance Company Listing

Continental Casualty Company Dorinco Reinsurance Company P.O. Box 8317 1320 Waldo Avenue, Suite 200 Chicago, IL 60680-8317 Midland, MI 48642 NAIC Number: 204430218 NAIC Number: 334990000

Continental Indemnity Company Eagle Pacific Insurance Company P.O. Box 3646 c/o MI Property & Casualty Fund Omaha, NE 68103 P.O. Box 531266 NAIC Number: 282584962 Livonia, MI 48153-1266 NAIC Number: 369860108 Continental Insurance Company P.O. Box 8317 Eagle Star Insurance Company Chicago, IL 60680-8317 111 John Street NAIC Number: 352890218 New York, NY 10038 NAIC Number: 222220000 Continental National American Casualty Co. P.O. Box 8317 Eastern Advantage Assurance Company Chicago, IL 60680-8317 25 Race Avenue NAIC Number: 204350218 P.O. Box 83777 Lancaster, PA 17608-3777 Continental National Indemnity Company NAIC Number: 130192698 P.O. Box 8317 Chicago, IL 60680-8317 Eastern Alliance Insurance Company NAIC Number: 282580218 25 Race Avenue P.O. Box 83777 Continental Western Insurance Company Lancaster, PA 17608-3777 P.O. Box 1594 NAIC Number: 107242698 Des Moines, IA 50306-1594 NAIC Number: 108040098 Eastguard Insurance Company 16 S. River Street Crum & Forster Indemnity Company Wilkes Barre, PA 18703 1 S Wacker Dr Ste 2380 NAIC Number: 147020031 Chicago, IL 60606-4617 NAIC Number: 313480158 Edison Insurance Company 222 Merchandise Mart Plaza Ste. 1450 CUMIS Insurance Society, Inc. Chicago, IL 60654 Workers' Compensation Claims NAIC Number: 242870000 P.O. Box 1221 Madison, WI 53701 Electric Insurance Company NAIC Number: 108470306 75 Sam Fonzo Dr. Beverly, MA 01915 Dakota Truck Underwriters NAIC Number: 212610057 300 Cherapa Place, Suite 401 Sioux Falls, SD 57103 Electric Mutual Liability Insurance Company NAIC Number: 349241124 75 Sam Fonzo Dr. Beverly, MA 01915 Depositors Insurance Company NAIC Number: 212880057 P.O. Box 182079 Columbus, OH 43218-2079 Emcasco Insurance Company NAIC Number: 425870140 P.O. Box 30546 Lansing, MI 48909 Discover Property & Casualty Insurance Co NAIC Number: 214070062 P.O. Box 660456 Dallas, TX 75266-0456 EMC Property & Casualty Company NAIC Number: 364630164 717 Mulberry Street Des Moines, IA 50309 Donegal Mutual Insurance Company NAIC Number: 251860062 PO Box 302 Marietta, PA 17547 NAIC Number: 136920250

7/8/2021 Workers’ Disability Compensation Agency Page 8 Insurance Company Listing

Employers Assurance Company Evergreen National Indemnity Company P.O. Box 32036 6140 Parkland Blvd. Lakeland, FL 33802-6671 Mayfield, OH 44124-6106 NAIC Number: 254023363 NAIC Number: 127503592

Employers Casualty Company Explore Insurance Company c/o MI Property & Casualty P.O. Box 509039 P.O. Box 531266 San Diego, CA 92150-9039 Livonia, MI 48153-1266 NAIC Number: 942784519 NAIC Number: 213690061 Fairfield Insurance Company Employers Compensation Insurance Company P.O. Box 881716 P.O. Box 32036 San Francisco, CA 94188 Lakeland, FL 33802-6671 NAIC Number: 447840031 NAIC Number: 115123363 Fairmont Insurance Company Employers Fire Insurance Company 250 Commercial Street Suite 5000 OneBeacon Insurance Group Manchester, NH 03101 605 Hwy 169 North Suite 800 NAIC Number: 188641111 Plymouth, MN 55441 NAIC Number: 206481129 Farm Bureau General Insurance Company Medical Maintenance Unit Employers Insurance Company of Nevada P.O. Box 30100 10375 Professional Circle Lansing, MI 48909 Reno, NV 6671 NAIC Number: 215470067 NAIC Number: 106403363 Farm Bureau Mutual Insurance Company Employers Insurance of Wausau Medical Maintenance Unit Commercial Claims P.O. Box 30100 PO Box 7205 Lansing, MI 48909 London, KY 40742 NAIC Number: 215550067 NAIC Number: 214580111 Farmers Automobile Insurance Association Employers Mutual Casualty Company 2505 Court Street P.O. Box 30546 Pekin, IL 61558-001 Lansing, MI 48909 NAIC Number: 242010153 NAIC Number: 214150062 Farmers Insurance Exchange Employers Preferred Insurance Company P.O. Box 108843 P.O. Box 32036 Oklahoma City, OK 73101 Lakeland, FL 33802-6671 NAIC Number: 216520069 NAIC Number: 103463363 Farmington Casualty Company Everest Denali Insurance Company P.O. Box 660456 477 Martinsville Rd, P.O. Box 830 Dallas, TX 75266-0456 Liberty Corner, NJ 07938-0830 NAIC Number: 414830041 NAIC Number: 160441120 Farmland Mutual Insurance Company Everest National Insurance Company P.O. Box 182079 P.O. Box 830 Columbus, OH 43218-2079 Liberty Corner, NJ 07938-0830 NAIC Number: 138380140 NAIC Number: 101201120 FCCI Insurance Company Everest Premier Insurance Company P.O. Box 58004 477 Martinsville Rd, P.O. Box 830 Sarasota, FL 34232-0800 Liberty Corner, NJ 07938-0830 NAIC Number: 101780474 NAIC Number: 160451120 Federal Insurance Company 1 Beaver Valley Road - 4E Wilmington, DE 19803 NAIC Number: 202810038

7/8/2021 Workers’ Disability Compensation Agency Page 9 Insurance Company Listing

Federal Kemper Insurance Company Firemans Fund Insurance Company of Wisconsin c/o MI Property & Casualty Fund P.O. Box 970 P.O. Box 531266 O'Fallon, MO 63366 Livonia, MI 48153-1266 NAIC Number: 372730761 NAIC Number: 305030108 Firemens Insurance Company of Newark, N.J. Federated Mutual Insurance Company P.O. Box 8317 P.O. Box 486 Chicago, IL 60680-8317 Owatonna, MN 55060-0486 NAIC Number: 208500218 NAIC Number: 139350007 Firemens Insurance Company of Washington, D.C. Federated Reserve Insurance Co P.O. Box 1594 121 East Park Square Des Moines, IA 50306-1594 Owatonna, MN 55060 NAIC Number: 217840098 NAIC Number: 160240007 First Dakota Indemnity Company Federated Rural Electric Insurance Corp. P.O. Box 89310 P.O. Box 15147 Sioux Falls, SD 57109 Lenexa, KS 66215 NAIC Number: 103511124 NAIC Number: 111180000 First Liberty Insurance Corporation Federated Service Insurance Company Commercial Claims P.O. Box 486 PO Box 7205 Owatonna, MN 55060-0486 London, KY 40742 NAIC Number: 283040007 NAIC Number: 335880111

Fidelity & Casualty Company of New York First National Insurance Company of America P.O. Box 8317 2000 Westwood Drive Chicago, IL 60680-8317 P.O. Box 8016 NAIC Number: 352700218 Wausau, WI 54402-8016 NAIC Number: 247240163 Fidelity & Deposit Company of Maryland P.O. Box 968041 Florists Mutual Insurance Company Schaumburg, IL 60196-8041 1 Horticultural Lane NAIC Number: 393060212 Edwardsville, IL 62025 NAIC Number: 139780349 Fidelity & Guaranty Insurance Company P.O. Box 660456 Foremost Insurance Company Gran Rapids, MI Dallas, TX 75266-0456 5665 N Kraft Lake Ave NAIC Number: 353860164 Caledonia, MI 49316 NAIC Number: 111850069 Fidelity & Guaranty Insurance Underwriters P.O. Box 660456 Foremost Property & Casualty Insurance Company Dallas, TX 75266-0456 5665 N Kraft Lake Ave NAIC Number: 258790164 Caledonia, MI 49316 NAIC Number: 118000069 Fire Insurance Exchange P.O. Box 3640 Foremost Signature Insurance Company Grand Rapids, MI 49501 P.O. Box 108843 NAIC Number: 216600069 Oklahoma City, OK 73101 NAIC Number: 415130069 Fire & Casualty Insurance Company of Ct 3600 Arco Corporate Drive Frankenmuth Mutual Insurance Company Charlotte, NC 28273 One Mutual Avenue NAIC Number: 248800553 Frankenmuth, MI 48787 NAIC Number: 139861309 Firemans Fund Insurance Company P.O. Box 970 Frank Winton Crum Insurance Company O'Fallon, MO 63366 100 S Missouri Ave NAIC Number: 218730761 Clearwater, FL 33756 NAIC Number: 116000000

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Freestone Insurance Company Glens Falls Insurance Company c/o MI Property & Casualty P.O. Box 8317 P.O. Box 531266 Chicago, IL 60680-8317 Livonia, MI 48153-1266 NAIC Number: 346220218 NAIC Number: 322711631 Globe Indemnity Company Fremont Casualty Insurance Company 3600 Arco Corporate Drive c/o MI Property & Casualty Charlotte, NC 28273 P.O. Box 531266 NAIC Number: 246000553 Livonia, MI 48153-1266 NAIC Number: 105450790 Grange Insurance Company of Michigan 400 Galleria Officentre, Suite 115 Fremont Compensation Insurance Company Southfield, MI 48034 c/o MI Property & Casualty NAIC Number: 111360267 P.O. Box 531266 Livonia, MI 48153-1266 Granite State Insurance Company NAIC Number: 377610790 AIG Domestic Claims P.O. Box 25908 Fremont Indemnity Company Shawnee Mission, KS 66225 c/o MI Property & Casualty NAIC Number: 238090012 P.O. Box 531266 Livonia, MI 48153-1266 Great American Alliance Insurance Company NAIC Number: 210400790 P.O. Box 5789 Cincinnati, OH 45201 Fremont Insurance Company NAIC Number: 268320084 933 E. Main Street Fremont, MI 49412 Great American Assurance Company NAIC Number: 139940000 P.O. Box 5789 Cincinnati, OH 45201 Frontier Insurance Company NAIC Number: 263440084 195 Lake Louise Marie Rd. Rock Hill, NY 12775 Great American Insurance Co of NY NAIC Number: 342660961 P.O. Box 5789 Cincinnati, OH 45201 Gateway Insurance Company NAIC Number: 221360084 1401 S. Brentwood Blvd., Ste. 1000 St.Louis, MO 63144 Great American Insurance Company NAIC Number: 283390000 P.O. Box 5789 Cincinnati, OH 45201 General Casualty Insurance Company NAIC Number: 166910084 P.O. Box 975 Sun Prairie, WI 53590 Great American Security Insurance Company NAIC Number: 188210796 P.O. Box 5789 Cincinnati, OH 45201 General Casualty Company of Wisconsin NAIC Number: 311350084 P.O. Box 975 Sun Prairie, WI 53590 Great American Spirit Insurance Company NAIC Number: 244140796 301 E 4th Street Cincinnati, OH 45202 General Insurance Company of America NAIC Number: 337230084 2000 Westwood Drive P.O. Box 8016 Great Divide Insurance Company Wausau, WI 54402-8016 600 East Las Colinas Blvd, Suite 1400 NAIC Number: 247320163 Irving, TX 75039 NAIC Number: 252240098 Genesis Insurance Company P.O. Box 881716 Great Midwest Insurance Company San Francisco, CA 94188 800 Gessner, Suite 600 NAIC Number: 389620031 Houston, TX 77024 NAIC Number: 186940000

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Great Northern Insurance Company Harco National Insurance Company 1 Beaver Valley Road - 4E P.O. Box 68309 Wilmington, DE 19803 Schaumburg, IL 60168 NAIC Number: 203030038 NAIC Number: 264330000

Great West Casualty Company Harleysville Insurance Company P.O. Box 94 P.O Box 182079 South Sioux City, NE 68776 Columbus, OH 43218-2079 NAIC Number: 113710150 NAIC Number: 235820140

Greater New York Mutual Insurance Company Harleysville Lake States Insurance Company 200 Madison Avenue P.O Box 182079 New York, NY 10016 Columbus, OH 43218-2079 NAIC Number: 221870222 NAIC Number: 145160140

Greenwich Insurance Company Harleysville Mutual Insurance Company 505 Eagleview Blvd. 355 Maple Avenue Exton, PA 19341-0636 P.O. Box 244 NAIC Number: 223221285 Harleysville, PA 19438-9950 NAIC Number: 141680253 Grocers Insurance Company 3600 Arco Corporate Drive Harleysville Preferred Insurance Company Charlotte, NC 28273 P.O Box 182079 NAIC Number: 405410553 Columbus, OH 43218-2079 NAIC Number: 356960140 Guarantee Insurance Company 2020 Capital Cir SE #310 Harleysville Worcester Insurance Company Tallahassee, FL 32301-5138 P.O Box 182079 NAIC Number: 113980000 Columbus, OH 43218-2079 NAIC Number: 261820140 Guideone Mutual Insurance Company 1025 Ashworth Road, Suite 101 Hartford Accident & Indemnity Company West DesMoines, IA 50265 P.O. Box 14170 NAIC Number: 150320303 Lexington, KY 40512 NAIC Number: 223570091 Gulf Insurance Company P.O. Box 660456 Hartford Casualty Insurance Company Dallas, TX 75266-0456 P.O. Box 14170 NAIC Number: 222170041 Lexington, KY 40512 NAIC Number: 294240091 Hamilton Mutual Insurance 717 Mulberry Street Hartford Fire Insurance Company Des Moines, IA 50309 P.O. Box 14170 NAIC Number: 141250062 Lexington, KY 40512 NAIC Number: 196820091 Hamilton Mutual Insurance Company John Keller, Asst. VP Hartford Insurance Company of Illinois 1520 Madison Road P.O. Box 14170 Cincinnati, OH 45206 Lexington, KY 40512 NAIC Number: 141250000 NAIC Number: 382880091

Hanover American Insurance Company Hartford Insurance Company of the Midwest P.O. Box 15144 P.O. Box 14170 Worcester, MA 01615 Lexington, KY 40512 NAIC Number: 360640088 NAIC Number: 374780091

Hanover Insurance Company Hartford Insurance Company of the Southeast P.O. Box 15144 P.O. Box 14170 Worcester, MA 01615 Lexington, KY 40512 NAIC Number: 222920088 NAIC Number: 382610091

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Hartford Underwriters Insurance Company Houston General Insurance Company P.O. Box 14170 OneBeacon Insurance Group Lexington, KY 40512 605 Hwy 169 North Suite 800 NAIC Number: 301040091 Plymouth, MN 55441 NAIC Number: 388491129 Hastings Mutual Insurance Company Peggy Surma Hudson Insurance Company 404 E. Woodlawn Avenue 1 S Wacker Dr Ste 2380 Hastings, MI 49058 Chicago, IL 60606-4617 NAIC Number: 141760000 NAIC Number: 250570158

Hawkeye Security Insurance Company Illinois Casualty Company P.O. Box 1848 225 20th Street Des Moines, IA 50306 Rock Island, IL 61201 NAIC Number: 217410072 NAIC Number: 155710000

HDI - Gerling America Insurcance Company Ideal Mutual Insurance Company 150 N. Wacker Drive c/o MI Property & Casualty 29th Floor P.O. Box 531266 Chicago, IL 60606 Livonia, MI 48153-1266 NAIC Number: 413430517 NAIC Number: 142300803

Highlands Insurance Company Illinois National Insurance Company P.O. Box 709 AIG Domestic Claims Mandeville, LA 70470 P.O. Box 25908 NAIC Number: 224891116 Shawnee Mission, KS 66225 NAIC Number: 238170012 HIH America Compensation & Liability Ins. Co. c/o MI Property & Casualty Imperial Casualty & Indemnity Company P.O. Box 531266 c/o MI Property & Casualty Livonia, MI 48153-1266 P.O. Box 531266 NAIC Number: 206561264 Livonia, MI 48153-1266 NAIC Number: 114870000 Home Indemnity Company c/o MI Property & Casualty Imperium Insurance Company P.O. Box 531266 600 Galleria Parkway Suite 770 Livonia, MI 48153-1266 Atlanta, GA 30339 NAIC Number: 225190095 NAIC Number: 354080000

Home Insurance Company Indemnity Insurance Company of North America c/o MI Property & Casualty 1 Beaver Valley Road - 4E P.O. Box 531266 Wilmington, DE 19803 Livonia, MI 48153-1266 NAIC Number: 435750626 NAIC Number: 225270095 Indiana Insurance Company Home Owners Insurance Company Commercial Claims Michigan Workers Comp. Claims PO Box 7205 P.O. Box 30510 London, KY 40742 Lansing, MI 48909 NAIC Number: 226590111 NAIC Number: 266380280 Indiana Lumbermens Mutual Insurance Company Housing Authority Property Insurance Company 3600 Woodview Trace 189 Commerce Court P.O. Box 68600 P.O. Box 189 Indianapolis, IN 46268 Cheshire, CT 06410-0189 NAIC Number: 142650246 NAIC Number: 100690000 Insurance Co. of the State of Pennsylvania AIG Domestic Claims P.O. Box 25908 Shawnee Mission, KS 66225 NAIC Number: 194290012

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Insurance Company of Greater New York Legion Insurance Company 200 Madison Avenue Attn: Dean Bender New York , NY 10016 P.O. Box 59239 NAIC Number: 221950222 Philadelphia, PA 19102 NAIC Number: 244221172 Insurance Company of North America 1 Beaver Valley Road - 4E Lexington Insurance Company Wilmington, DE 19803 AIG Domestic Claims NAIC Number: 227130626 P.O. Box 25908 Shawnee Mission, KS 66225 Insurance Company of the West NAIC Number: 194370012 P.O. Box 509039 San Diego, CA 92150-9039 Liberty Insurance Corporation NAIC Number: 278470922 Commercial Claims PO Box 7205 Insurance Corporation of America London, KY 40742 1301 N. Hagadorn NAIC Number: 424040111 P.O. Box 1471 East Lansing, MI 48826-1471 Liberty Mutual Fire Insurance Company NAIC Number: 109270966 Commercial Claims PO Box 7205 Intercontinental Insurance Company London, KY 40742 c/o MI Property & Casualty NAIC Number: 230350111 P.O. Box 531266 Livonia, MI 48153-1266 Liberty Mutual Insurance Company NAIC Number: 380910000 Commercial Claims PO Box 7205 International Insurance Company London, KY 40742 1 S Wacker Dr Ste 2380 NAIC Number: 230430111 Chicago, IL 60606-4617 NAIC Number: 210830158 Lincoln General Insurance Company P.O. Box 3709 Intrepid Insurance Company York, PA 17402 1250 E Diehl Rd., Ste 200 NAIC Number: 338551326 Naperville, IL 60563 NAIC Number: 107490098 LM Insurance Corporation Commercial Claims Ironshore Indemnity, Inc. PO Box 7205 P.O. Box 64035 London, KY 40742 St. Paul, MN 55164 NAIC Number: 336000111 NAIC Number: 236474509 LMI Insurance Company Kansas City Fire & Marine Insurance Company P.O. Box 27257 P.O. Box 8317 Raleigh, NC 27611 Chicago, IL 60680-8317 NAIC Number: 230860297 NAIC Number: 208850218 London Guarantee & Accident Company of NY Key Risk Insurance Company 25 Independence Boulevard 1250 E Diehl Rd., Ste 200 Warren, NJ 07059 Naperville, IL 60563 NAIC Number: 346490553 NAIC Number: 108850098 Lumber Mutual Insurance Company Lamorak Insurance Company P.O. Box 9165 OneBeacon Insurance Group Framingham, MA 01701-9165 605 Hwy 169 North Suite 800 NAIC Number: 144350946 Plymouth, MN 55441 NAIC Number: 206211129 Lumbermens Mutual Casualty Company c/o MI Property & Casualty Fund P.O. Box 531266 Livonia, MI 48153-1266 NAIC Number: 229770108

7/8/2021 Workers’ Disability Compensation Agency Page 14 Insurance Company Listing

Lumbermens Underwriting Alliance in Receivership Memic Indemnity Company 1905 N W Corporate Blvd P.O. Box 11409 Boca Raton, FL 33431-7303 Portland, ME 04104 NAIC Number: 231080000 NAIC Number: 110301332

M L B A Mutual Insurance Company Merchants Mutual Insurance Company P.O. Box 4067 250 Main Street East Lansing, MI 48826-4067 P.O. Box 903 NAIC Number: 301390000 Buffalo, NY 14240-9974 NAIC Number: 233290226 MAG Mutual Insurance Company P.O. Box 52979 Merchants Preferred Insurance Company Atlanta, GA 250 Main Street NAIC Number: 426170413 P.O. Box 903 Buffalo, NY 14240-9974 Manufacturers & Merchants Mutual Insurance Co NAIC Number: 129010226 P.O. Box 514 Concord, NH 03302 Meridian Citizens Mutual Insurance Co. NAIC Number: 231670116 P.O. Box 182822 Columbus, OH 43218 Manufacturers Alliance Insurance Co. NAIC Number: 105020175 P.O. Box 5231 Janesville, WI 53547-5231 Meridian Mutual Insurance Company NAIC Number: 368970767 P.O. Box 182822 Columbus, OH 43218 Manufacturing Technology Mutual Insurance NAIC Number: 233450175 Company P.O. Box 9150 Meridian Security Insurance Company Farmington Hills, MI 48333-9150 P.O. Box 182822 NAIC Number: 128240000 Columbus, OH 43218 NAIC Number: 233530175 Markel Insurance Company 4600 Cox Rd. MHA Insurance Company Glen Allen, VA 23060 3100 West Road, Building 1, Suite 200 NAIC Number: 389700785 East Lansing, MI 48823 NAIC Number: 331110000 Maryland Casualty Company P.O. Box 968041 MIC Property & Casualty Insurance Company Schaumburg, IL 60196-8041 Corporate Compliance Dept. NAIC Number: 193560212 3044 W. Grand Blvd. 482‑1x3301 Detroit, MI 48202 Massachusetts Bay Insurance Company NAIC Number: 386010079 P.O. Box 15144 Worcester, MA 01615 Michigan Commercial Insurance Mutual NAIC Number: 223060088 P.O. Box 19769 Sarasota, FL 34276-2769 Massachusetts Bonding & Insurance Company NAIC Number: 109980000 10 Post Office Square Boston, MA 00000 Michigan Insurance Company NAIC Number: Wc0050000 PO Box 302 Marietta, PA 17547 Medallion Insurance Company NAIC Number: 108570250 c/o MI Property & Casualty P.O. Box 531266 Michigan Millers Mutual Insurance Company Livonia, MI 48153-1266 Claims Department NAIC Number: 232800000 P.O. Box 30060 Lansing, MI 48909 Memic Casualty Company NAIC Number: 145080000 P.O. Box 11409 Portland, ME 04104 NAIC Number: 141641332

7/8/2021 Workers’ Disability Compensation Agency Page 15 Insurance Company Listing

Mid-Century Insurance Company Mitsui Sumitomo Insurance USA, Inc. P.O. Box 108843 P.O. Box 5435 Oklahoma City, OK 73101 Cincinnati, OH 45201-5435 NAIC Number: 216870069 NAIC Number: 225512978

Middlesex Insurance Company Monroe Guaranty Insurance Company P.O. Box 8032 9025 River Road Stevens Point, WI 54481 Suite 300 NAIC Number: 234340169 Indianapolis, IN 46240-6443 NAIC Number: 325060000 Middlesex Mutual Assurance Company 213 Court Street Motorists Mutual Insurance Company P.O. Box 891 471 E. Broad Street Middletown, CT 06457 Columbus, OH 43215 NAIC Number: 145320050 NAIC Number: 146210291

Midland Insurance Company N N Insurance Company c/o MI Property & Casualty P.O. Box 709 P.O. Box 531266 Mandeville, LA 70470 Livonia, MI 48153-1266 NAIC Number: 297851116 NAIC Number: 234930128 National American Insurance Company Midland National Insurance Company 1006 Manval Avenue 173 W. Madison Street P.O. Box Drawer 9 Chicago, IL 60602 Chandler, OK 74834 NAIC Number: Wc0090000 NAIC Number: 236630000

Midwest Employers Casualty Company National Ben Franklin Insurance Company 1250 E Diehl Rd., Ste 200 P.O. Box 8317 Naperville, IL 60563 Chicago, IL 60680-8317 NAIC Number: 236120098 NAIC Number: 208930218

Milford Casualty Insurance Company National Casualty Company 400 S Executive Drive, Suite 150 P.O Box 182079 Brookfield, WI 53005 Columbus, OH 43218-2079 NAIC Number: 266622538 NAIC Number: 119910140

Millers Mutual Insurance Association National Continental Insurance Company 111 E. Fourth Street P.O. Box 5070 P.O. Box 9006 Cleveland, OH 44101 Alton, IL 62002 NAIC Number: 102430155 NAIC Number: 145830855 National Farmers Union Property & Casualty Millers National Insurance Company OneBeacon Insurance Group 850 Warrenville Road 3rd Floor 605 Hwy 169 North Suite 800 Lisle, IL 60532 Plymouth, MN 55441 NAIC Number: 235660131 NAIC Number: 162171129

Mission Insurance Company National Farmers Union Standard Insurance Co. c/o MI Property & Casualty OneBeacon Insurance Group P.O. Box 531266 605 Hwy 169 North Suite 800 Livonia, MI 48153-1266 Plymouth, MN 55441 NAIC Number: 236040133 NAIC Number: 237521129

Mitsui Sumitomo Insurance Company of America National Fire Insurance Company of Hartford P.O. Box 5435 P.O. Box 8317 Cincinnati, OH 45201-5435 Chicago, IL 60680-8317 NAIC Number: 203622978 NAIC Number: 204780218

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National General Insurance Company Nationwide Mutual Fire Insurance Company Corporate Compliance Dept P.O Box 182079 3044 W. Grand Blvd. 482-1x3301 Columbus, OH 43218-2079 Detroit, MI 48202 NAIC Number: 237790140 NAIC Number: 237280079 Nationwide Mutual Insurance Company National Indemnity Company P.O Box 182079 P.O. Box 881716 Columbus, OH 43218-2079 San Francisco, CA 94188 NAIC Number: 237870140 NAIC Number: 200870031 Nationwide Property & Casualty Insurance National Interstate Insurance Company Company P.O. Box 5789 P.O Box 182079 Cincinnati, OH 45201 Columbus, OH 43218-2079 NAIC Number: 326200084 NAIC Number: 378770140

National Interstate Insurance Company of Hawaii Netherlands Insurance Company P.O. Box 5789 Commercial Claims Cincinnati, OH 45201 PO Box 7205 NAIC Number: 110510084 London, KY 40742 NAIC Number: 241710111 National Liability & Fire, Inc. 100 First Stamford Place 21st Century Insurance Company Stamford, CT 06911 5665 N Kraft Lake Ave NAIC Number: 200520031 Caledonia, MI 49316 NAIC Number: 238330069 National Mutual Insurance Company One Insurance Square New Hampshire Insurance Company Celina, OH 45822 AIG Domestic Claims NAIC Number: 201840035 P.O. Box 25908 Shawnee Mission, KS 66225 National Reinsurance Corporation NAIC Number: 238410012 P.O. Box 881716 San Francisco, CA 94188 New York Marine & General Insurance Company NAIC Number: 348350031 412 Mt. Kemble Ave Suite 300C Morristown, NJ 07960 National Specialty Insurance Company NAIC Number: 166080256 1900 L Don Dodson Drive Bedford, TX 76021 New York Underwriters Insurance Company NAIC Number: 226080093 P.O. Box 14170 Lexington, KY 40512 National Surety Corporation NAIC Number: 223730091 P.O. Box 970 O'Fallon, MO 63366 Newark Insurance Company NAIC Number: 218810761 3600 Arco Corporate Drive Charlotte, NC 28273 National Trust Insurance Company NAIC Number: 246430553 P.O. Box 58004 Sarasota, FL 34232-0800 NGM Insurance Company NAIC Number: 201410474 220 Salina Meadows, Suite 200 Syracuse, NY 13212 National Union Fire Insurance Company NAIC Number: 147880311 AIG Domestic Claims P.O. Box 25908 Niagara Fire Insurance Company Shawnee Mission, KS 66225 P.O. Box 8317 NAIC Number: 194450012 Chicago, IL 60680-8317 NAIC Number: 351060218 Nationwide Agribusiness Insurance Company P.O Box 182079 Columbus, OH 43218-2079 NAIC Number: 282230140

7/8/2021 Workers’ Disability Compensation Agency Page 17 Insurance Company Listing

Nipponkoa Insurance Company, LTD NorthStone Insurance Company 14 Wall Street, Suite 812 471 E. Broad Street, 14th Floor New York, NY 10005 Columbus, OH 43215 NAIC Number: 270732558 NAIC Number: 130450291

NLC Mutual Insurance Company Northwestern National Casualty Company 1301 Pennsylvania Avenue, NW P.O. Box 709 Washington, DC 20004 Mandeville, LA 70470 NAIC Number: 279050000 NAIC Number: 239061116

Nordia Insurance Company Northwestern National Insurance Company P.O. Box 886 9277 Centre Pointe Drive, Suite 140 Shelton, CT 06484 West Chester, OH 45069 NAIC Number: 261070000 NAIC Number: 239140143

NorGuard Insurance Company Nova Casualty Company P.O. Box A-H 2 Waterside Crossing, Suite 400 Wilkes-Barre, PA 18703 Windsor, CT 06095 NAIC Number: 314700031 NAIC Number: 425524257

North American Elite Insurance Company Nutmeg Insurance Company 650 Elm Street, Suite 600 P.O. Box 14170 Manchester, NH 03101 Lexington, KY 40512 NAIC Number: 297000181 NAIC Number: 396080091

North American Specialty Insurance Company Oak River Insurance Company 650 Elm Street, Suite 600 P.O. Box 881716 Manchester, NH 03101 San Fransicso, CA 94188 NAIC Number: 298740181 NAIC Number: 470762702

North Pointe Casualty Company OBI America Co. P.O. Box 975 OneBeacon Insurance Group Sun Prairie, WI 53590 605 Hwy 169 North Suite 800 NAIC Number: 394620796 Plymouth, MN 55441 NAIC Number: 156451129 North Pointe Insurance Company P.O. Box 975 OBI National Insurance Company Sun Prairie, WI 53590 OneBeacon Insurance Group NAIC Number: 277400796 605 Hwy 169 North Suite 800 Plymouth, MN 55441 North River Insurance Company NAIC Number: 141901129 1 S Wacker Dr Ste 2380 Chicago, IL 60606-4617 Occidental Fire & Casualty Company of NC NAIC Number: 211050158 John Mininger 702 Oberlin Road, Box 10800 Northbrook Indemnity Company Raleigh, NC 27605 1 Beaver Valley Road - 4E NAIC Number: 232480225 Wilmington, DE 19803 NAIC Number: 364550038 Ohio Casualty Insurance Company 350 E 96th Street Northern Assurance Company of America Indianapolis, IN 46240 OneBeacon Insurance Group NAIC Number: 240740148 605 Hwy 169 North Suite 800 Plymouth, MN 55441 Ohio Farmers Insurance Company NAIC Number: 383691129 P.O. Box 5005 Westfield Center, OH 44251 Northern Insurance Company of New York NAIC Number: 241040228 P.O. Box 968041 Schaumburg, IL 60196-8041 NAIC Number: 193720212

7/8/2021 Workers’ Disability Compensation Agency Page 18 Insurance Company Listing

Ohio Security Insurance Company Peerless Insurance Company 350 E 96th Street Commercial Claims Indianapolis, IN 46240 PO Box 7205 NAIC Number: 240820148 London, KY 40742 NAIC Number: 241980111 Old Republic General Insurance Corporation PO Box 1019 Penn Millers Insurance Company Youngwood, PA 15697-0919 72 N. Franklin Street NAIC Number: 241390150 Wilkes-Barre, PA 18773 NAIC Number: 149820125 Old Republic Insurance Company PO Box 1019 Pennsylvania General Insurance Company Youngwood, PA 15697-0919 OneBeacon Insurance Group NAIC Number: 241470150 605 Hwy 169 North Suite 800 Plymouth, MN 55441 OneBeacon Insurance Company NAIC Number: 219621129 OneBeacon Insurance Group 605 Hwy 169 North Suite 800 Pennsylvania Lumbermens Mutual Insurance Plymouth, MN 55441 1 Commerce Square NAIC Number: 219701129 2005 Market St., Ste. 1200 Philadelphia, PA 19103-7008 Pacific Employers Insurance Company NAIC Number: 149740000 1 Beaver Valley Road - 4E Wilmington, DE 19803 Pennsylvania Manufacturers Assn. Insurance Co NAIC Number: 227480626 P.O. Box 5231 Janesville, WI 53547-5231 Pacific Indemnity Company NAIC Number: 122620767 1 Beaver Valley Road - 4E Wilmington, DE 19803 Pennsylvania Manufacturers Indemnity Co. NAIC Number: 203460038 P.O. Box 5231 Janesville, WI 53547-5231 Pacific Insurance Company NAIC Number: 414240767 P.O. Box 8317 Chicago, IL 60680-8317 Pennsylvania National Mutual Casualty Ins. NAIC Number: 373380218 P.O. Box 2361 Harrisburg, PA 17105 Park Avenue Property & Casualty NAIC Number: 149900271 c/o MI Property & Casualty P.O. Box 531266 Petroleum Casualty Company Livonia, MI 48153-1266 P.O. Box 3342 NAIC Number: 287113499 Houston, TX 77253 NAIC Number: 122970000 Partners Mutual Insurance Company 20935 Swenson Pharmacists Mutual Insurance Company Waukesha, WI 53186 808 Hwy. 18 West NAIC Number: 134390000 P.O. Box 370 Algona, IA 50511 Patriot General Insurance Company NAIC Number: 137140775 P.O. Box 8032 Stevens Point, WI 54481 Phico Insurance Company NAIC Number: 234420169 5875 Castle Creek Pkwy N Dr. Ste. 300 P.O. Box 50465 Peerless Indemnity Insurance Company Indianapolis, IN 46250 Commercial Claims NAIC Number: 357180711 PO Box 7205 London, KY 40742 Phoenix Assurance Company of New York NAIC Nunber: 183330111 3600 Arco Corporate Drive Charlotte, NC 28273 NAIC Number: 352620553

7/8/2021 Workers’ Disability Compensation Agency Page 19 Insurance Company Listing

Phoenix Insurance Company Protective Insurance Company P.O. Box 660456 P.O. Box 7099 Dallas, TX 75266-0456 Indianapolis, IN 46207-7099 NAIC Number: 256230041 NAIC Number: 124160867

PinnaclePoint Insurance Company Providence Washington Insurance Company 471 E Broad St., 14th Floor 1275 Wampanoag Trail Columbus, OH 43215 Riverside, RI 02915 NAIC Number: 151370291 NAIC Number: 242950156

Pioneer State Mutual Insurance Company Prudential Commercial Insurance Company 1510 N. Elms Road P.O. Box 6426 Flint, MI 48532 Lawrenceville, NJ 08648 NAIC Number: 183090000 NAIC Number: 364390304

Plaza Insurance Company QBE Insurance Corporation P.O. Box 182822 P.O. Box 975 Columbus, OH 43218 Sun Prairie, WI 53590 NAIC Number: 309450175 NAIC Number: 392170796

Potomac Insurance Company of Illinois Rampart Insurance Company OneBeacon Insurance Group 20 Exchange Place, 11th Floor 605 Hwy 169 North Suite 800 New York, NY 10005 Plymouth, MN 55441 NAIC Number: 385120686 NAIC Number: 401341129 Ranger Insurance Company Praetorian Insurance Company 1 S Wacker Dr Ste 2380 P.O. Box 975 Chicago, IL 60606-4617 Sun Prairie, WI 53590 NAIC Number: 243840158 NAIC Number: 372570796 Redwood Fire & Casualty Insurance Co Preferred Professional Insurance Company P.O. Box 881716 P.O. Box 540658 San Francisco, CA 94188 Omaha, NE 68154 NAIC Number: 116730031 NAIC Number: 362340000 Regent Insurance Company Preserver Insurance Company P.O. Box 975 59 Maiden Lane Floor 42 Sun Prairie, WI 53590 New York, NY 10038 NAIC Number: 244490796 NAIC Number: 155863703 Reliance Insurance Company Princeton Insurance Company c/o MI Property & Casualty 746 Alexander Road P.O. Box 531266 Princeton, NJ 08543 Livonia, MI 48153-1266 NAIC Number: 422260924 NAIC Number: 244570159

Progressive Casualty Insurance Company Reliance National Indemnity Company P.O. Box 5070 c/o MI Property & Casualty Cleveland, OH 44101 P.O. Box 531266 NAIC Number: 242600155 Livonia, MI 48153-1266 NAIC Number: 244300159 Property & Casualty Insurance Company of Hartford Reliance National Insurance Company P.O. Box 14170 c/o MI Property & Casualty Lexington, KY 40512 P.O. Box 531266 NAIC Number: 346900091 Livonia, MI 48153-1266 NAIC Number: 405920159 Proselect Insurance Company 3100 West Road, Building 1, Suite 200 East Lansing, MI 48823 NAIC Number: 106381154

7/8/2021 Workers’ Disability Compensation Agency Page 20 Insurance Company Listing

Repwest Insurance Company Safety National Casualty Corporation 2721 N. Central Avenue 1832 Schuetz Road Phoenix, AZ 85004 St. Louis, MO 63146 NAIC Number: 310890574 NAIC Number: 151050074

Republic-Franklin Insurance Company Sagamore Insurance Company P.O. Box 6610 P.O. Box 7099 Utica, NY 13504-6610 Indianapolis, IN 46207-7099 NAIC Number: 124750201 NAIC Number: 404600867

Retailers Insurance Company SeaBright Insurance Company 603 S. Washington Avenue P.O. Box 91100 Lansing, MI 48933 Seattle, WA 98111 NAIC Number: 124710000 NAIC Number: 155630000

Riverport Insurance Company Secura Insurance Company 1250 E Diehl Rd., Ste 200 P.O. Box 819 Naperville, IL 60563 Appleton, WI 54912 NAIC Number: 366840098 NAIC Number: 225430096

RLI Insurance Company Secura Supreme Insurance Company 9025 N Lindbergh Drive P.O. Box 819 Peoria, IL 61615 Appleton, WI 54912 NAIC Number: 130560783 NAIC Number: 102390096

Rockwood Casualty Insurance Company Security Casualty Company P.O. Box 22146 222 S. Riverside Plaza Portland, OR 97269-2146 Chicago, IL 60606 NAIC Number: 355060457 NAIC Number: 249290000

Royal Insurance Company Security Insurance Company of Hartford 3600 Arco Corporate Drive 3600 Arco Corporate Drive Charlotte, NC 28273 Charlotte, NC 28273 NAIC Number: 269800553 NAIC Number: 249020553

Rural Trust Insurance Company Security National Insurance Company 6301 Ivy Lane Ste 506 2711 Centerville Road, Suite 400 Greenbelt, MD 20770 Wilmington, DE 19808 NAIC Number: 111340000 NAIC Number: 198792538

Sable Insurance Company Select Insurance Company 433 California Street, 11th Floor P.O. Box 660456 San Francisco, CA 94104 Dallas, TX 75266-0456 NAIC Number: 108230000 NAIC Number: 222330041

Safeco Insurance Company Selective Insurance Company of America 2000 Westwood Drive PO Box 7252 P.O. Box 8016 London, KY 40742 Wausau, WI 54402-8016 NAIC Number: 125720242 NAIC Number: 247400163 Selective Insurance Co of South Carolina Safeguard Insurance Company PO Box 7252 3600 Arco Corporate Drive London, KY 40742 Charlotte, NC 28273 NAIC Number: 192590242 NAIC Number: 246940553 Selective Insurance Co of the Southeast Safety First Insurance Company PO Box 7252 1832 Schuetz Road London, KY 40742 St. Louis, MO 63146 NAIC Number: 399260242 NAIC Number: 111230074

7/8/2021 Workers’ Disability Compensation Agency Page 21 Insurance Company Listing

Selective Way Insurance Company Sompo Japan Fire & Marine Insurance Company of PO Box 7252 America London, KY 40742 11405 North Community House Rd NAIC Number: 263010242 Hayes Building Suite 600 Charlotte, NC 28277 Seneca Insurance Company NAIC Number: 389973219 305 Madison Avenue Morristown, NJ 07962 Sompo America Insurance NAIC Number: 109361271 11405 North Community House Rd Hayes Building Suite 600 Sentinel Insurance Company, Ltd. Charlotte, NC 28277 P.O. Box 14170 NAIC Number: 111263219 Lexington, KY 40512 NAIC Number: 110000091 South Carolina Insurance Company P.O. Box 1 Sentry Casualty Company Columbia, SC 29202 P.O. Box 8032 NAIC Number: 249530168 Stevens Point, WI 54481 NAIC Number: 284600169 Southern Insurance Company 222 S 15th St Ste 1500 North Sentry Insurance Company Omaha, NE 68102 P.O. Box 8032 NAIC Number: 192163489 Stevens Point, WI 54481 NAIC Number: 249880169 Sparta Insurance Company 5 Batterson Park Road, 3rd Floor Sentry Select Insurance Company Farmington, CT 06032 P.O. Box 8032 NAIC Number: 206130000 Stevens Point, WI 54481 NAIC Number: 211800169 St. Paul Fire & Marine Insurance Company P.O. Box 660456 Sequoia Insurance Company Dallas, TX 75266-0456 10091 Park Run Drive, Suite 170 NAIC Number: 247670164 LasVegas, NV 89145 NAIC Number: 229850009 St. Paul Guardian Insurance Company P.O. Box 660456 Service American Indemnity Company Dallas, TX 75266-0456 6907 N Capital of Texas Hwy NAIC Number: 247750164 Austin, TX 78731 NAIC Number: 391520681 St. Paul Medical Liability Insurance Co. P.O. Box 660456 SFM Mutual Insurance Company Dallas, TX 75266-0456 3500 American Blvd. West, Suite 700 NAIC Number: 417500164 Bloomington, MN 55431 NAIC Number: 113470000 St. Paul Mercury Insurance Company P.O. Box 660456 Shelby Insurance Company Dallas, TX 75266-0456 Central Service Center NAIC Number: 247910164 175 Mansfield Avenue Shelby, OH 44875 St. Paul Property & Casualty Insurance Co. NAIC Number: 151560269 P.O. Box 660456 Dallas, TX 75266-0456 Sirius America Insurance Company NAIC Number: 415210164 140 Broadway 32nd Floor St. Paul Protective Insurance Company New York, NY 10005-1108 P.O. Box 660456 NAIC Number: 387764863 Dallas, TX 75266-0456 NAIC Number: 192240164 Society Insurance P.O. Box 1029 Fond Du Lac, WI 54936 NAIC Number: 152610000

7/8/2021 Workers’ Disability Compensation Agency Page 22 Insurance Company Listing

Standard Fire Insurance Company State National Insurance Company, Inc. P.O. Box 660456 1900 L Don Dodson Drive Dallas, TX 75266-0456 Bedford, TX 76021 NAIC Number: 190700041 N AIC Number: 128310093

Star Insurance Company Stonington Insurance Company c/o Meadowbrook Claims Service P.O. Box 975 26255 American Drive Sun Prairie, WI 53590 Southfield, MI 48034-6112 NAIC Number: 103400796 NAIC Number: 180230748 Strathmore Insurance Company StarNet Insurance Company 200 Madison Avenue 1250 E Diehl Rd., Ste 200 New York, NY 10016 Naperville, IL 60563 NAIC Number: 110240222 NAIC Number: 400450098 SummitPoint Insurance Co Starr Indemnity & Liability Co 471 E. Broad St., 14th Floor 399 Park Ave. 8th Floor Columbus, OH 43215 New York, NY 10022 NAIC Number: 151360291 NAIC Number: 383184670 Sun Insurance Office, Ltd. Starr Specialty Insurance Company 1 Beaver Valley Road - 4E 399 Park Ave. 8th Floor Wilmington, DE 19803 New York, NY 10022 NAIC Number: 203700038 NAIC Number: 161094670 Sussex Insurance Company StarStone National Insurance Co P.O. Box 100165 1111 Third Ave, Ste 1450 Columbia, SC 29202 Seattle, WA 98101 NAIC Number: 121570661 NAIC Number: 254964725 Synergy Insurance Company State Auto Property & Casualty Insurance Company 217 South Tryon Street P.O. Box 182822 Charlotte, NC 28202 Columbus, OH 43218 NAIC Number: 127730000 NAIC Number: 251270175 T H E Insurance Company State Automobile Mutual Insurance Company 10451 Gulf Blvd. P.O. Box 182822 Treasure Island, FL 33706 Columbus, OH 43218 NAIC Number: 128660000 NAIC Number: 251350175 Technology Insurance Company, Inc. State Farm Fire & Casualty Company P.O. Box 105074 Workers Compensation Claims Atlanta, GA 30348 P.O. Box 14015 NAIC Number: 423762538 Lexington, KY 40512-4015 NAIC Number: 251430176 TIG Insurance Company 250 Commercial Street Suite 5000 State Farm General Insurance Company Manchester, NH 03101 Workers Compensation Claims NAIC Number: 255341111 P.O. Box 14015 Lexington, KY 40512-4015 TIG Insurance Company of Michigan NAIC Number: 251510176 250 Commercial Street Suite 5000 Manchester, NH 03101 State Mutual Insurance Company NAIC Number: 255421111 P.O. Box 280 Lapeer, MI 48446 TIG Insurance Corporation of America NAIC Number: 152020000 250 Commercial Street Suite 5000 Manchester, NH 03101 NAIC Number: 255261111

7/8/2021 Workers’ Disability Compensation Agency Page 23 Insurance Company Listing

TIG Premier Insurance Company Transport Insurance Company 250 Commercial Street Suite 5000 11300 Highland Corporate Drive, Suite 103 Manchester, NH 03101 Cumberland, RI 02864 NAIC Number: 255181111 NAIC Number: 330140000

TNUS Insurance Company Transportation Insurance Company 200 W Madison St, Suite 1400 P.O. Box 8317 Chicago, IL 60606 Chicago, IL 60680-8317 NAIC Number: 323013098 NAIC Number: 204940218

Tokio Marine America Insurance Company Travelers Casualty & Surety Co. of America 200 W Madison St, Suite 1400 P.O. Box 660456 Chicago, IL 60606 Dallas, TX 75266-0456 NAIC Number: 109453098 NAIC Number: 311940041

Tokio Marine & Nichido Fire Insurance Company Travelers Casualty & Surety Company LTD P.O. Box 660456 200 W Madison St, Suite 1400 Dallas, TX 75266-0456 Chicago, IL 60606 NAIC Number: 190380041 NAIC Number: 129043098 Travelers Casualty Company of Connecticut Tower Insurance Company of New York P.O. Box 660456 59 Maiden Lane Floor 42 Dallas, TX 75266-0456 New York, NY 10038 NAIC Number: 361700041 NAIC Number: 443003703 Travelers Casualty Insurance Company of America Tower National Insurance Company P.O. Box 660456 59 Maiden Lane Floor 42 Dallas, TX 75266-0456 New York, NY 10038 NAIC Number: 190460041 NAIC Number: 437023703 Travelers Commercial Casualty Company Toyota Motor Insurance Company P.O. Box 660456 19001 S. Western Ave., FS 21 Dallas, TX 75266-0456 Torrance, CA 90509 NAIC Number: 402820041 NAIC Number: 376210372 Travelers Commercial Insurance Company Trans Pacific Insurance Company P.O. Box 660456 P.O. Box 483 Dallas, TX 75266-0456 Jersery City, NJ 07303 NAIC Number: 361370041 NAIC Number: 412383098 Travelers Indemnity Co. Of Connecticut Transcontinental Insurance Company P.O. Box 660456 P.O. Box 8317 Dallas, TX 75266-0456 Chicago, IL 60680-8317 NAIC Number: 256820041 NAIC Number: 204860218 Travelers Indemnity Company Transguard Insurance Company of America, Inc. P.O. Box 660456 215 Shurman Blvd., Suite 400 Dallas, TX 75266-0456 Naperville, IL 60563 NAIC Number: 256580041 NAIC Number: 288860000 Travelers Indemnity Company of America Transit Casualty Company P.O. Box 660456 c/o MI Property & Casualty Dallas, TX 75266-0456 P.O. Box 531266 NAIC Number: 256660041 Livonia, MI 48153-1266 NAIC Number: 129550337 Travelers Insurance Company P.O. Box 660456 Transport Indemnity Company Dallas, TX 75266-0456 2 Cross Roads of Commerce, Suite 700 NAIC Number: 393570041 Rolling Meadows, IL 60008 NAIC Number: 256070084

7/8/2021 Workers’ Disability Compensation Agency Page 24 Insurance Company Listing

Travelers Property Casualty Company of America United Security Insurance Company P.O. Box 660456 P.O. Box 1848 Dallas, TX 75266-0456 Des Moines, IA 50306 NAIC Number: 256740041 NAIC Number: 217760072

Triangle Insurance Company, Inc. United States Fidelity & Guaranty P.O. Box 1189 P.O. Box 660456 Enid, OK 73702 Dallas, TX 75266-0456 NAIC Number: 285350000 NAIC Number: 258870164

Tri State Insurance Company of Minnesota United States Fire Insurance Company 1250 E Diehl Rd., Ste 200 1 S Wacker Dr Ste 2380 Naperville, IL 60563 Chicago, IL 60606-4617 NAIC Number: 310030098 NAIC Number: 211130158

Truck Insurance Exchange United States Liability Insurance Company P.O. Box 108843 190 S. Warner Road Oklahoma City, OK 73101 Wayne, PA 19087 NAIC Number: 217090069 NAIC Number: 258950232

Trumbull Insurance Company United Wisconsin Insurance Company P.O. Box 14170 P.O. Box 40790 Lexington, KY 40512 Lansing, MI 48901 NAIC Number: 271200091 NAIC Number: 291570572

Twin City Fire Insurance Company Universal Underwriters Insurance Company P.O. Box 14170 P.O. Box 968041 Lexington, KY 40512 Schaumburg, IL 60196-8041 NAIC Number: 294590091 NAIC Number: 411810212

U S Specialty Insurance Company Utica Mutual Insurance Company 13403 Northwest Freeway P.O. Box 6610 Houston, TX 77040 Utica, NY 13504-6610 NAIC Number: 295990984 NAIC Number: 259760201

Ullico Casualty Company Valiant Insurance Company c/o MI Property & Casualty Fund P.O. Box 968041 P.O. Box 531266 Schaumburg, IL 60196-8041 Livonia, MI 48153-1266 NAIC Number: 266110212 NAIC Number: 378930781 Valley Forge Insurance Company Unigard Security Insurance Company P.O. Box 8317 15805 N.E. 24 Street Chicago, IL 60680-8317 Bellevue, WA 98008 NAIC Number: 205080218 NAIC Number: 257630356 Vanliner Insurance Company Union Insurance Company One United Drive 1250 E Diehl Rd., Ste 200 P.O. Box 26352 Naperville, IL 60563 Fenton, MO 63026 NAIC Number: 258440098 NAIC Number: 211720000

Union Insurance Company of Providence Vigilant Insurance Company 717 Mulberry Street 1 Beaver Valley Road - 4E Des Moines, IA 50309 Wilmington, DE 19803 NAIC Number: 214230062 NAIC Number: 203970038

United Pacific Insurance Company Virginia Surety Company, Inc. c/o MI Property & Casualty c/o AON Corporation P.O. Box 531266 175 W Jackson Livonia, MI 48153-1266 Chicago, IL 60604 NAIC Number: 244730159 NAIC Number: 408270317

7/8/2021 Workers’ Disability Compensation Agency Page 25 Insurance Company Listing

Wausau Business Insurance Company Westfield Insurance Company Commercial Claims P.O. Box 5005 PO Box 7205 Westfield Center, OH 44251 London, KY 40742 NAIC Number: 241120228 NAIC Number: 260690111 Westfield National Insurance Company Wausau Underwriters Insurance Company P.O. Box 5005 Commercial Claims Westfield Center, OH 44251 PO Box 7205 NAIC Number: 241200228 London, KY 40742 NAIC Number: 260420111 Westport Insurance Corporation 5200 Metcalf WCF National Insurance Company P.O. Box 2991 P.O. Box 571918 Overland Park, KS 66201 Salt Lake City, UT 84157-1918 NAIC Number: 398450181 NAIC Number: 405170000 Williamsburg National Insurance Company Wellfleet New York Insurance Company c/o Meadowbrook Claims Service P.O. Box 881716 26600 Telegraph Rd., Box 2054 San Francisco, CA 94188 Southfield, MI 48037 NAIC Number: 209310031 NAIC Number: 257800748

Wesco Insurance Company Work First Casualty Company 59 Maiden Lane 2636 Biehn Street New York, NY 10038 Klamath Falls, OR 97601 NAIC Number: 250112538 NAIC Number: 312320000

West American Insurance Company X L Insurance America, Inc. 350 E 96th Street 505 Eagleview Blvd. Indianapolis, IN 46240 Exton, PA 19341-0636 NAIC Number: 443930148 NAIC Number: 245541285

West Bend Mutual Insurance Company X L Specialty Insurance Company 1900 S. 18th Avenue 505 Eagleview Blvd. West Bend, WI 53095 Exton, PA 19341-0636 NAIC Number: 153501243 NAIC Number: 378851285

Westchester Fire Insurance Company Zenith Insurance Company 1 Beaver Valley Road - 4E 2105 W. White Oaks Drive Wilmington, DE 19803 Springfield, IL 62074 NAIC Number: 211210626 NAIC Number: 132690336

Western Casualty & Surety Company Zurich American Insurance Company of Illinois c/o American States Ins. Co. P.O. Box 968041 P.O. Box 461 Schaumburg, IL 60196-8041 St. Louis, MO 63166-0461 NAIC Number: 278550212 NAIC Number: 260930020 Zurich Insurance Company Western Continental Insurance Company P.O. Box 968041 20 Exchange Place, 11th Floor Schaumburg, IL 60196-8041 New York, NY 10005 NAIC Number: 165350212 NAIC Number: 257710686

Western Employers Insurance Company 1400 N. Harbor Boulevard P.O. Box 5347 Fullerton, CA 92635 NAIC Number: 328830369