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C. California Department of Insurance — Appeals to the Insurance Commissioner. After you follow the <br />appropriate dispute resolution process described above, if (1) we or the WCIRB decline to review your <br />request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject <br />your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to <br />CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 at seq. <br />You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your <br />Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written <br />decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days <br />after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals <br />to the Insurance Commissioner is: <br />Administrative Hearing Bureau <br />California Department of Insurance <br />45 Fremont Street, 22nd Floor <br />San Francisco, CA 94105 <br />415.538.4102 <br />You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the <br />WCIRB, may be affirmed, modified or reversed. <br />III. Resources Available to You in Obtaining Information and Pursuing Disputes <br />A. Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder <br />ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims <br />information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the <br />WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. <br />The address of the policyholder ombudsman is WCIRB, 1221 Broadway, Suite 900, Oakland, CA 94612, Attn: <br />Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778.7159 (phone), <br />415.371.5288 (fax) and ombudsman(LDwcirb.com (email). <br />B. California Department of Insurance - Information and Assistance. Information and assistance on policy <br />questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP (4357) or <br />insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing <br />Bureau, see the contact information in paragraph II.C. <br />This notice does not change the policy to which it is attached. <br />Form PN 04 99 01 G (03/19) Printed in U.S.A. <br />Rime Mattagement DMsion <br />REVIEWED&APPRDVEDBY: <br />'� Risk Management Analyst <br />