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Administrative Hearing Bureau <br /> California Department of Insurance <br /> 1901 Harrison Street, 3rd Floor Mailroom <br /> Oakland, CA 94612 <br /> 415.538.4243 <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, One Montgomery Street, Suite 400, San Francisco, <br /> CA 94104, Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778,7159 <br /> (phone), 415.371.5288 (fax) and ombudsman wcirb.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, seethe 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 J (06/25) Printed in U.S.A. Page 3 of 3 <br />