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Administrati::0 Dearing B rea❑ <br />California Department of Ins:1rance <br />1901 ❑arrison Street, 3rd Floor Mailroom <br />Oaidand, CA 94612 <br />41 ❑.::38.4243 <br />Yo❑ :18[:6 t0a rigid to a earing iDafore tip Insurance Commissioner, and o-r action, or tip action of t e <br />WCIRB, may :]a affirmed, modified or reEorsed. <br />III. Resources Available to You in Obtaining Information and Pursuing Disputes <br />A. Policyholder Ombudsman. Pi�s:lant to California Insurance Code Section 11 ❑i-2.6, a policyEolder <br />om❑❑dsman is a[LiilaF]e at t❑e WCIRB to assist yo❑ in oEtaining and e[LiI❑ating t0a rating, policy, and claims <br />information referenced in I.A. and I.B., a❑o[Fe. T❑e om❑❑dsman may ad[Else yo❑on any disp❑te wit❑ ❑s, to <br />WCIRB, or on an appeal to t❑e Instance Commissioner p❑rsEiant to Section 11 ❑30 of tE-e InsFirance Code. <br />T❑e address of tEle policy❑older om❑❑dsman is WCIRB, One Montgomery Street, SE]te 400, San Francisco, <br />CA 94104, Attn❑Policy❑older Om❑Edsman. T❑e policyEolder om❑Edsman can ❑a reac❑ad at 41 ❑.❑❑8.01119 <br />[p❑one441 [E1301.E288 [famand om❑F-dsman❑ wciracom [email[] <br />B. California Department of Insurance - Information and Assistance. Information and assistance on policy <br />❑❑astions can ❑e oElained from to Department of Ins[rance ConsEner ❑OTLI❑E, 800.9211.11ELP 143❑❑❑or <br />ins Orance.ca.go❑ For ❑❑astions and correspondence regarding appeals to t❑e AdministratiE0 Dearing <br />Berea❑, see t-e contact information in paragrap❑ II.C. <br />Tus notice does not ciange t:1a policy to wuc❑ it is attac:10d. <br />Form PN 04 99 01 J (06/25) Printed in ❑.S.A. Page 3 of 3 <br />