Workers’ Compensation Claims Administrators University/SLAC
DATE OF INJURY: On or before 10/31/98 or 9/1/00 to present
Administrator:
Zurich North America, P.O. Box 7774, San Francisco CA 94120-7774 Telephone: (415) 538-7100; (800) 701-4926 Fax number for Supporting Documents only: (415) 538-7150 (must include claim number) Medical Only Claims – A work-injury claim in which no indemnity benefits are payable: Name Title Phone Number E-Mail Daniel Koos Supervisor 916-636-5257 daniel.koos@zurich.com Myra Elliott Claims Examiner (916) 859-2466 myra.elliott@zurichna.com Tier 2 Claims (Minor Lost Time) Emma Fleder Claims Examiner Other than Medical Only Claims Rina Yan Supervisor Jennifer Khomin Claims Examiner Juanita Chavez-Gordon Claims Examiner Martha Deacon Claims Examiner
(415) 538-7223
emma.fleder@zurichna.com
(415) 538-7224 (415) 538-7485 (415) 538-7434 (415) 538-7402
rina.yan@zurichna.com jennifer.khomin@zurichna.com juanita.chavez-gordon@zurichna.com martha.deacon@zurichna.com
DATE OF INJURY: between 11/1/98 and 8/31/00
Administrator:
Intercare Insurance Services, P.O. Box 40009, Fresno, CA 93755-0009 Telephone: (559) 447-1029 Fax: (559) 446-0670 Other than Medical Only Claims Tom Walther Claim Manager George Romo Claims Examiner
(559) 437-2920 (559) 437-2927
twalther@intercareins.com gromo@intercareins.com
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Workers’ Compensation Claims Administrators SHS, USHC and Stanford Hospital & Clinics
DATE OF INJURY: 4/1/00 to present
Administrator:
Octagon Risk Services, P.O. Box 2065, Oakland CA 94606-0065 Physical Address: 2101 Webster Street, Suite 900, Oakland CA 94612 Telephone: (510) 452-9300 Medical Only Claims – A work-injury claim in which no indemnity benefits are payable: Name Title Phone Number E-Mail Grinnah Bautista Claims Examiner (510) 874 5216 Grinnah.Bautista@OctagonRS.com Other than Medical Only Claims Peter King Claims Managers Scot Corrigan Claims Supervisor Monica Harper Claims Examiner Patrice Grant Claims Examiner Zelyn Lumanlan Claims Examiner
(510) 267-1282 (510) 874 5209 (510) 874 5250 (510) 847 5286 (510) 874 5220
Peter.King@OctagonRS.com Scot.Corrigan@stpaul.com Monica.Harper@OctagonRS.com Patrice.Grant@OctagonRS.com Zelyn.Lumanlan@OctagonRS.com
DATE OF INJURY: between 11/1/97 and 3/31/00
Administrator:
Intercare, P.O. Box 19544, Irvine CA 92623 Fax 949 752 7189 Name Brenda Pelligra Title Claims Examiner Phone Number (800) 394-9308 E-Mail Not available
DATE OF INJURY: on or before 10/31/97
Administrator:
Zurich North America, P.O. Box 7774, San Francisco CA 94120-7774 Telephone: (415) 538-7100; (800) 701-4926 Fax number for Supporting Documents only: (415) 538-7150 (must have claim number) Name Rina Yan Jennifer Khomin Zen Leonardo Martha Deacon Title Supervisor Claims Examiner Claims Examiner Claims Examiner Phone Number (415) 538-7224 (415) 538-7485 (415) 538-7491 (415) 538-7402 E-Mail rina.yan@zurichna.com jennifer.khomin@zurichna.com zen.leonardo@zurichna.com martha.deacon@zurichna.com
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