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STATE OF GEORGIASUBSEQUENT INJURY TRUST FUND2004ANNUAL REPORTIf you wish to acquire this report in an alternative format,please contact our office at the address and telephone numbers listed inside.
Subsequent Injury Trust Fund – 2004 Annual ReportPage iiSTATE OF GEORGIASUBSEQUENT INJURY TRUST FUNDSuite 500 North Tower1720 Peachtree Street, NWAtlanta, Georgia 30309-2462Website: www.sitf.georgia.govTelephone: (404) 206-6360Facsimile: (404) 206-6363This publication can be downloaded from the SITF Website.For additional copies, please call the telephone number listedabove or write to our address.
Subsequent Injury Trust Fund – 2004 Annual ReportPage iiiOFFICIALSBOARD OF TRUSTEESJohn T. Fervier, II ChairmanDon Avery, MemberJim C. Beck, Sr. MemberJames F. Braswell, MemberJames C. Thompson, MemberEX-OFFICIO MEMBERSStan Carter, State Board of Workers' CompensationJohn W. Oxendine, Insurance, Safety Fire CommissionerADMINISTRATORRichard W. McGeeDEPUTY ADMINISTRATORDavid L. Taylor
Subsequent Injury Trust Fund – 2004 Annual ReportPage ivMission StatementThe Subsequent Injury Trust Fund provides reimbursements andinformation to employers, insurers, and their agents, in thoseWorkers’ Compensation claims involving individuals with apre-existing permanent impairment.Vision StatementThe Board of Trustees and staff of the Subsequent Injury TrustFund commit to bringing awareness of the financial benefitsavailable to employers, insurers, and their agentsby continuing our efforts to build positive relationsin the risk management arena.
Subsequent Injury Trust Fund – 2004 Annual ReportPage vTable of ContentsFund Administration .1Introduction 1How the Fund Works 1Reimbursement from the Fund 1Claims Administration 2Claims Activity – 2004 2Financial Activity - 2004 3CLAIMS FILED IN 2004 .4Insurance Companies 4Group Self-Insured Employers 9Self-Insured Employers 10Reimbursements Paid .17Insurance Companies 17Group Self-Insured Employers 22Self-Insured Employers 23Individual Employers 29Assessment 2004.60Legal Requirements 60Assessment Calculation 61Assessment Adjustment for 2003 61Assessment Rate for 2004 61Assessments Due for 2003 - 2004 62Insurance Companies 62Group Self-Insured Employers 70Self-Insured Employers 71
Subsequent Injury Trust Fund – 2004 Annual ReportPage 1FUND ADMINISTRATIONIntroductionOn July 1, 1977, the Georgia General Assembly enacted legislation establishing theSubsequent Injury Trust Fund. It is designed to reduce the impact of singularly large workers'compensation claims in the event a worker with a disability, injured on the job, aggravates a preexisting permanent impairment.The Subsequent Injury Trust Fund is a separate state agency, governed by a five-memberBoard of Trustees appointed by the Governor for six-year terms. The administrator with a staffof 30 employees conducts the actual administration of the fund.How the Fund WorksThe fund helps workers with disabilities by providing employers, who are not subject to theAmericans with Disabilities Act, with incentives to hire or retain qualified workers withdisabilities. The fund supports insured employers by keeping workers' compensation premiumsunder control, and if an employer is self-insured, keeps the workers' compensation exposure atthe deductible levels.In order for an employer/insurer to be eligible for reimbursement from the fund, the on-the-jobinjury of the employee must be directly caused by or combined with a prior impairment to createa greater liability for lost-time benefits and medical expenses. In addition, the employee musthave a pre-existing impairment that the employer considered to be permanent and likely to be ahindrance to employment, and the employer must have knowledge of the prior impairmentbefore the subsequent injury occurs.O.C.G.A.§34-9-361 contains a list of conditions that are presumed to be permanent and likely tobe a hindrance to employment provided the employer could demonstrate prior knowledge.Reimbursement from the FundAll licensed workers' compensation insurance carriers and self-insured employers authorized bythe State Board of Workers’ Compensation in the state of Georgia may access the fund.Employers/insurers must notify the fund of a possible claim by filing a Notice of Claim no laterthan 78 weeks following the date of injury.In addition to the mandatory Notice of Claim, the employer must submit a notarized Employer’sKnowledge Affidavit, certifying prior knowledge of the worker’s pre-existing permanentimpairment.Employers/insurers may be reimbursed for all weekly income benefits payable after 104 weeks;for 50% of all medical and rehabilitation expenses between 5,000 and 10,000; and for 100%of all medical and rehabilitation expenses in excess of 10,000.If the subsequent injury was not caused by or related to a prior impairment, the reimbursementfor medical expenses may be reduced or denied completely.
Subsequent Injury Trust Fund – 2004 Annual ReportPage 2Claims AdministrationThe employer/insurer maintains management of the employee’s claim for the life of that claim.Once the fund has been notified of the claim, the employer/insurer must keep the fund apprisedof all developments, including settlement negotiations.The fund investigates the claim to determine eligibility for reimbursement.When areimbursement agreement is reached between the fund and the employer/insurer, it must beapproved by the State Board of Workers' Compensation. If an agreement cannot be reached,either party may request a mediation conference or a hearing with the State Board of Workers'Compensation.Claims Activity – 2004The following is a breakdown of claims activity for calendar year 2004. For information on prioryears, please call (404) 206-6357 or visit our website at www.sitf.georgia.gov.Open ClaimsClaims ReceivedJanuary 1, 200419,450Calendar Year 200418,071Closed Claims ReopenedCalendar Year 2004981Claims ClosedCalendar Year 200416,313Open ClaimsDecember 31, 200422,279Claims AcceptedCalendar Year 20041531Claims DeniedCalendar Year 2004128Notices in PendingCalendar Year 20042,043
Subsequent Injury Trust Fund – 2004 Annual ReportPage 3Financial Activity - 2004The following table depicts the fund’s revenues, expenditures, and fund balance for the calendaryear ending December 31, 2004. The fund’s year-end balance is part of the formula forestablishing the annual assessment. For information on prior years, please call (404) 206-6357or visit our website at www.sitf.georgia.gov.Beginning Balance January 1, 200463,454,578.81 63,454,578.81RevenuesAssessments – 2003,adjusted assessments – 2002,and payments and refunds forprior yearsInterest EarnedMiscellaneous IncomeTotal RevenuesExpendituresOperating CostReimbursements(negotiated checks)Total ExpendituresNet LossEnding Balance December 31, 3,763.78101,362,256.55103,386,020.33(8,439,006.61) 55,015,572.20
Subsequent Injury Trust Fund – 2004 Annual ReportPage 4CLAIMS FILED IN 2004Insurance CompaniesThe following is a list of insurance companies that filed a Notice of Claim with the SubsequentInjury Trust Fund in 2004. A total of 229 insurance companies filed approximately 11,064claims.Claims Reported by Insurance CompaniesACE AMERICAN INSURANCE COACE FIRE UNDERWRITERS INS. COACE PROPERTY & CASUALTY INSAIG NATIONAL INS. CO.AIU INSURANCE COALEA NORTH AMERICAAMCOMP ASSURANCEAMCOMP PREFERREDAMERICAN & FOREIGN INS CO.AMERICAN ALTERNATIVE INSAMERICAN CAS CO OF READING PAAMERICAN ECONOMY INS COAMERICAN GUAR & LIAB INS COAMERICAN HOME ASSURANCE COAMERICAN INSURANCE COAMERICAN INTER INS CO OF GAAMERICAN INTERN. SOUTH INS COAMERICAN MFG. MUTUAL INSAMERICAN MOTORISTS INS COAMERICAN PROTECTION INS COAMERICAN RESOURCES INS COAMERICAN STATES INS COAMERICAN ZURICH INS COAMERISURE INSURANCE COAMGUARD INSURANCE CO.ARCH INSURANCE COARGONAUT GREAT CENTRL INS COARGONAUT INSURANCE COASSOCIATED INDEMNITY CORPASSOCIATED INDUSTRIES INS COASSOCIATION INSURANCE COASSURANCE CO. OF AMERICAATLANTIC MUTUAL INS. COATLANTIC SPECIALTY INS COAUTO OWNERS INS. COClaims 1162110628111327
Subsequent Injury Trust Fund – 2004 Annual ReportBANCINSURE, INC.BANKERS STANDARD INS COBENCHMARK INS COBITUMINOUS CASUALTY CORPBRIDGEFIELD CASUALTYBUILDERS INSURANCECANAL INSURANCE COCAPITAL CITY INS COCASUALTY RECIPROCAL EXCHGCENTENNIAL INSURANCE COCENTRAL MUTUAL INS COCHARTER OAK FIRE INS COCHUBB INDEMNITY INS COCHURCH MUTUAL INS COCINCINNATI INSURANCE COCLARENDON NATIONAL INS COCOLUMBIA NATIONAL INS COCOMBINED SPECIALTY INS COCOMMERCE & INDUSTRY INS COCOMMERCIAL INS OF NEWARK NJCOMMERCIAL MUTUAL INS COCOMPANION PROP & CASCONNECTICUT INDEMNITY COCONTINENTAL CASUALTY COCONTINENTAL INSURANCE COCOREGIS INSURANCE COCORNERSTONE MUTUAL INS COCORNERSTONE MUTUAL INS COCRUM & FOSTER INDEMNITY COCUMIS INS SOCIETY INCCYPRESS INSURANCE CODISCOVER PROPERTY & CASEASTGUARD INSURANCE COELECTRIC INSURANCE COEMC PROPERTY & CASUALTYEMPLOYERS INS OF WAUSAUEVEREST NATIONAL INSEVEREST SECURITY INS COEXCELSIOR INSURANCE COFAIRFIELD INSURANCE COFARMLAND MUTUALFCCI INSURANCE COMPANYFEDERAL INSURANCE COFEDERATED MUTUAL INS COFEDERATED RURAL ELECTRIC INSFEDERATED SERVICE INS COFFVA MUTUAL INS COPage 5461141290145161321108874314
Subsequent Injury Trust Fund – 2004 Annual ReportFIDELITY & DEPOSIT CO OF MDFIDELITY & GUAR UNDERWRITERSFIDELITY & GUARANTY INS COFIRE & CASUALTY INS CO OF CTFIREMAN'S FUND INS COFIREMAN'S FUND INS CO OF GAFIRST LIBERTY INS CORPFIRST NATL INS CO OF AMERFLORISTS' MUTUAL INS COGA INSURERS INSOLVENCY POOLGA RESTAURANT MUTUAL CAP INS CGA TIMBER HARVERSTERS'GENERAL INS CO OF AMERICGEORGIA CASUALTY & SURETY COGEORGIA INSURANCE COGERBER LIFE INS COGLOBE INDEMNITY COGRANGE MUTUAL CASUALTY COMPANYGRANITE STATE INS COGRAPHIC ARTS MUTUAL INS COGREAT AMER INS CO OF NYGREAT AMERICAN INS COGREAT NORTHERN INS COGREAT WEST CASUALTY COGROCERS INSURANCE COGUARANTEE INSURANCE COGUIDEONE MUTUAL INS COGULF INSURANCE COMPANYHANOVER INSURANCE COHARCO NATIONAL INS COHARLEYSVILLE MUTUAL INS COHARLEYSVILLE-ATLANTIC INS COHARTFORD ACCIDENT & INDEMNITYHARTFORD CASUALTY INS COHARTFORD FIRE INSURANCE COHARTFORD INS CO OF S.E.HARTFORD INS OF THE MIDWESTHARTFORD UNDERWRITERS INSHEALTH CARE MUTUAL CAPTIVEHOSPITALITY MUT CAPTIVE INSHOUSTON GENERAL INS COINDEMNITY INS CO OF NAINSURANCE CO OF N.A.INSURANCE CO OF STATE OF PAINSURANCE CORP. OF NEW YORKKEY RISK INSURANCE COLEGION INS CO-IN LIQUIDATIONPage 01816211118741281114
Subsequent Injury Trust Fund – 2004 Annual ReportLIBERTY INSURANCE CORP.LIBERTY MUTUAL FIRE INSLIBERTY MUTUAL INSURANCE COLM INSURANCE CORPLUMBERMENS MUTUAL CAS COLUMBERMEN'S UNDERWRITINGMADISON INSURANCE COMAG MUTUAL INS COMARYLAND CASUALTY COMPANYMEDMARC CASUALTY INSMIDWEST EMPLOYERS CASUALTY COMITSUI SUMITOMO INS CO OF AMERMUTUAL ASSURANCE INC.NATIONAL AMERICAN INSURANCE CONATIONAL FIRE INS CO HARTFORDNATIONAL SURETY CORPNATIONAL TRUST INSURANCE CONATIONAL UNION FIRE OF PITT PANATIONWIDE MUTUAL INS CONETHERLANDS INSURANCE CONEW HAMPSHIRE INSURANCE CONORGUARD INSURANCE CO.NORTHERN INS CO OF NYOHIO CASUALTY INSURANCE COOLD DOMINION INSURANCE COOLD REPUBLIC INSURANCE COONEBEACON AMERICA INS COONEBEACON INSURANCE COPACIFIC EMPLOYERS INSURANCEPACIFIC INDEMNITY COPEERLESS INSURANCE COMPANYPENN LUMBERMENS MUTUALPENN MFG ASSOC INSPETROLEUM CASUALTY COPHOENIX INSURANCE COPRINCETON INSURANCE COPROTECTIVE INSURANCE COPROVIDENCE PROPERTY & CASUALTYPROVIDENCE WASHINGTON INS COREALM NATIONAL INSURANCEREDLAND INSURANCE CORELIANCE INS CO IN LIQUIDATIONREPUBLIC-FRANKLIN INSURANCE COROCHDALE INSURANCE COMPANYROYAL & SUNALLIANCE INS. COROYAL INDEMNITY COROYAL INS CO OF AMERICAPage 42861222111044161351954344
Subsequent Injury Trust Fund – 2004 Annual ReportS.E. EMPLOYER MUT. CAP. INS COSAFECO INS CO OF ILLINOISSAFECO INSURANCE CO AMERICASAFEGUARD INSURANCE COSAFETY NATIONAL CASUALTYSECURITY INS CO OF HARTFORDSELECTIVE INS CO OF AMERICASELECTIVE INS CO OF SESELECTIVE INSURANCE CO OF SCSELECTIVE WAY INSURANCE COSENTRY INSURANCE A MUTUAL COSOMPO JAPAN INS, OF AMERICASOUTHEASTERN US CAP. INS, INCSOUTHERN GUARANTY INSURANCE COST PAUL FIRE & CASUALTY INS COST PAUL FIRE & MARINE INS COST PAUL GUARDIAN INS COST PAUL MERCURY INS COSTAR INSURANCE COSTATE FARM FIRE & CASUALTY COTECHNOLOGY INSURANCE COTIG INSURANCE COTOKIO MARINE & NICHIDO FIRETRANS PACIFIC INS COTRANSCONTINENTAL INS COTRANSPORTATION INSURANCE COTRAVELERS CAS & SUR COTRAVELERS CAS & SUR CO OF AMERTRAVELERS INDEMNITY CO OF CTTRAVELERS INDEMNITY COMPANYTRAVELERS INDEMNITY OF AMERTRAVELERS INSURANCE COTRAVELERS PROP CAS CO OF AMERTWIN CITY FIRE INSURANCE COU.S. FIDELITY & GUARANTY INSU.S. SPECIALTY INS. CO.UNITED BUSINESS INS CO (A MUTUUNITED STATES FIRE INSURANCEUNIVERSAL UNDERWRITERS INSUTICA MUTUAL INSURANCE COUTICA NATIONAL ASSURANCE COVALLEY FORGE INSURANCE COVANLINER INSURANCE COVIGILANT INSURANCE COVILLANOVA INS CO-IN LIQUIDATIOWAUSAU BUSINESS INSURANCEWAUSAU UNDERWRITERS INS COPage 6845319193164161275341217
Subsequent Injury Trust Fund – 2004 Annual ReportWESTFIELD INSURANCE COWESTPORT INSURANCE CORPXL SPECIALTY INSURANCE COZENITH INSURANCE COZURICH AMERICAN INS COZURICH AMERICAN INS CO OF ILTotal of Companies 229Page 9Total16293518273711,064Group Self-Insured EmployersFollowing is a list of group self-insured employers that filed a Notice of Claim with theSubsequent Injury Trust Fund in 2004. A total of 17 group self-insured employers filedapproximately 1,004 claims.Claims Reported by Group Self-Insured EmployersAGRITRUST OF GEORGIAAMBULANCE PROVIDERS ASSOC.ASSOCIATION CTY COM GA SICOMPTRUST AGC OF GEORGIACONSTRUCTION SUPPLIERS' ASSOCGA ASSOC OF CONVENIENCE STORESGA AUTO DEALERS ASSOCIATION SIGA EDUCATION WC TRUST FUNDGA HOSPITAL ASSOC WCSI FUNDGA MUNICIPAL ASSN WCSIFGA OILMEN'S ASSOCIATIONGA OPERATORS SELF-INSURERSGA SCHOOL BD ASSOC W C FUNDGEMC WORKERS' COMP FUNDGTMA/AYSA SELF INSURANCEROOFING & SHEET METAL ASSOCSOUTHEASTERN LUMBER MFR ASSOCTotal of Companies 17Claims 004
Subsequent Injury Trust Fund – 2004 Annual ReportPage 10Self-Insured EmployersFollowing is a list of self-insured employers that filed a Notice of Claim with the SubsequentInjury Trust Fund in 2004. A total of 305 self-insured employers filed approximately 6,277claims.Claims Reported by Self-Insured EmployersAAA COOPER TRANSPORTATIONABF FREIGHT SYSTEM, INCACUITY BRANDSAGL RESOURCES, INC.ALEXIS PLAYSAFE, INC.ALLIED SYSTEMS LTDANHEUSER-BUSCH COMPANIES, INC.ARCHBOLD MEDICAL CENTERARCHDIOCESES OF ATLANTAARCHER-DANIELS-MIDLAND COASPLUNDH TREE EXPERT COATHENS REG. HLTH SYS INCATHENS-CLARKE COUNTYATLANTA BOARD OF EDUCATIONATLANTA CITY OFATLANTA HOUSING AUTHORITYAUGUSTA-RICHMOND CO BD COMMAUTOZONE, INCAVERITT EXPRESS, INCAVONDALE MILLS INCBARTOW COUNTY BD OF EDUCATIONBEAULIEU OF AMERICABELLSOUTH CORPORATIONBERRY COLLEGEBHA GROUP INCBIBB COUNTY BD-COMMISSIONBIBB COUNTY BOARD OF EDUCATIONBIG LOTS STORES, INC.BJ'S WHOLESALE CLUB INCBLOSSMAN COMPANIES, INCBLUE BIRD BODY COMPANYBLUE CIRCLE AMERICABOBS CANDIES, INC.BREMEN-BOWDEN INVESTMENT CO.BROWN INDUSTRIESBRUNSWICK, CITY OFBURLEN CORPORATIONC T HARRIS INCClaims 816621421026
Subsequent Injury Trust Fund – 2004 Annual ReportC. W. MATTHEWS CONTRACTING INCCAGLE'S INC, & SUBSIDIARIESCANDLER HEALTH SYSTEMCATOOSA CO. BD. OF EDUCATIONCEMEX (SOUTHDOWN INC.)CENTRAL GEORGIA HEALTH SYSTEMSCERTAINTEED CORPORATIONCERULEAN COMPANIES INC.CHATHAM COUNTY BD OF EDUCATIONCHATHAM COUNTY GEORGIACHEROKEE CO BD OF COMMISSIONERCHEROKEE CO BD OF EDUCATIONCHILDREN'S HEALTHCARE OF ATLCLAYTON COUNTY BD OF EDUCATIONCLAYTON COUNTY COMMISSIONERSCLAYTON COUNTY WATER AUTHORITYCMI INDUSTRIES INC.COACHMAN REC. VEHICLE CO OF GACOBB COUNTY BD/COMMISSIONERSCOBB COUNTY SCHOOL SYSTEMCOCA-COLA COMPANYCOCA-COLA ENTERPRISES INCCOLONIAL GROUPCOLONIAL PIPELINE COMPANYCOLQUITT CO BD OF EDUCATIONCOLUMBIA COUNTY BOECOLUMBUS FOUNDRIES INCCOLUMBUS REGIONAL HEALTHCARECONAGRA FOODS, INCCONTI GROUP COMPANIES, INCCONTINENTAL TIRE N. AMER., INCCOOPER INDUSTRIES, INCCOOPER TIRE AND RUBBERCOSTCO WHOLESALE CORP.COTTRELL INCCOVINGTON, CITY OFCOWETA CO BOARD OF EDUCATIONCOWETA COUNTY BOCCRACKER BARREL OLD CNTRY STORECRAWFORD & COMPANYCRIDER'S POULTRY INCCRISP COUNTY BD OF EDUCATIONDALTON CITY OFDAN RIVER, INC.DART CONTAINER CORPORATIONDECATUR, CITY OFDEKALB COUNTY BOARD-EDPage 32231331517332241113
Subsequent Injury Trust Fund – 2004 Annual ReportDEKALB COUNTY GOVERNMENTDEKALB REGIONAL HLTHCARE SYSDELHAIZE AMERICA INC.DELPHI AUTOMOTIVE SYS INC.DELTA AIRLINES, INC.DIXIE GROUP & SUBSIDIARIESDOLLAR GENERAL CORPDOUGHERTY COUNTY BOCDOUGLAS ASPHALT COMPANYDOUGLAS CO BD OF COMMISSIONERSDOUGLAS COUNTY SCHOOLSDOUGLAS, CITY OFDULUTH, CITY OFDURAND-WAYLAND, INCEAST POINT, CITY OFELBERTA CRATE & BOX COMPANYELBERTON GRANITE ASSOCIATIONELBERTON, CITY OFEMORY UNIVERSITYENGELHARD CORPORATIONEQUITY GROUP GA DIVISIONESTES EXPRESS LINESFAYETTE COUNTY BD OF COMMFAYETTE COUNTY BD OF EDUCATIONFEDERAL EXPRESS CORPFEDERATED DEPARTMENT STORESFEDEX GROUND PKG SYSFIELDALE FARMS CORPORATIONFLEETWOOD HOMES OF GA INCFLEXSTEEL INDUSTRIES INCFLORIDA ROCK INDUSTRIES INCFLOWERS FOODS INC.FLOYD CO. BD. OF COMMISSIONERSFLOYD COUNTY BD OF EDUCATIONFLOYD HLTHCARE MGMT INCFLYING J, INC.FORD MOTOR COMPANYFORSYTH CO BD OF COMMISSIONERSFORSYTH CO. BD. OF EDUCATIONFREUDENBERG-NOKFULTON COUNTY BD OF EDUCATIONFULTON COUNTY, GEORGIAFULTON-DEKALB HOSPITAL AUTHYGA INTAL HEALTH/SOUTH FULTONGA S.I. GUARANTY TRUST FUNDGANNETT CO. INC & SUBSIDIARIESGENERAL MOTORS CORPORATIONPage 810428221345178114218
Subsequent Injury Trust Fund – 2004 Annual ReportGEORGIA DUCK & CORDAGE MILLGEORGIA STATE OFGEORGIA-PACIFIC CORPORATIONGFF HOLDING CO/GENERAL FIBERSGLYNN COUNTY BOARD OF COMMSNRSGLYNN COUNTY SCHOOLSGOLDEN PANTRY FOOD STORES INCGOODY PRODUCTS, INC.GREAT DANE LTD PARTNERSHIPGRESS FOODS INCGRIFFIN-SPALDING SCHOOLSGUARDIAN AUTOMOTIVE CORPGULFSTREAM AEROSPACE CORPGWINNETT CO BD OF EDUCATIONGWINNETT COUNTY BD OF COMMISSGWINNETT HOSPITAL SYSTEMHALL COUNTY BOARD OF EDUCATIONHAMILTON HEALTH CARE SYSTEMHAPEVILLE CITY OFHARRISON POULTRY, INCHAVERTYS FURNITUREHENRY CO BOARD OF EDUCATIONHERCULES INCORPORATEDHERSCHEND FAMILY ENTERTAINMENTHILLCREST FOODS, INCHILTON HOTELS CORPORATIONHON INDUSTRIES, INC.HORMEL FOODS CORPHORTON HOMES, INCHOUSTON COUNTY BD OF EDUCATIONHOUSTON COUNTY COMMISSIONERSHOWARD SHEPPARD INCHUTCHESON MEDICAL CENTERHYATT CORPORATIONIKON OFFICE SOLUTIONSINGLES MARKETS INCINTERNATIONAL PAPER COMPANYJ H HARVEY COMPANYJ. C. PENNEY COMPANY, INC.JOHN WIELAND HOMES, INCJOHNS MANVILLE INT'L., INC.JONES COMPANY (THE)KAHN CONSTRUCTION COMPANY INCKEEBLER COMPANYKELLEY MANUFACTURING COMPANYKIMBERLY-CLARK CORPKING & PRINCE SEAFOOD CORP.Page 1343831314319311
Subsequent Injury Trust Fund – 2004 Annual ReportKLEEN-TEX INDUSTRIESKLLM TRANSPORTK-MART CORP-IN BANKRUPTCYKROGER COMPANY, THELABOR READY SE III LPLAGRANGE, CITY OFLANGDALE INDUSTRIESLAWRENCEVILLE, CITY OFLEVI STRAUSS & COLIBERTY NATIONAL LIFE INS COLIMITED BRANDS, INCLOUISIANA-PACIFIC CORPLOWE'S HOME CENTERS, INCMACON CITY OFMACON/BIBB CO WATER & SEWERAGEMARIETTA CITY SERVICESMAR-JAC POULTRY, INC.MARRIOTT INTERNATIONAL, INC.MARTAMCLANE COMPANY, INC.MEADWESTVACOMEMORIAL MEDICAL CENTER, INC.MERCK & CO INCMICROMERITICS INSTRUMENTS CORPMILAN EXPRESS COMPANY, INCMOHAWK INDUSTRIES, INCMONROE, CITY OFMOUNT VERNON MILLSMULLITE CO OF AMERICAMUSCOGEE COUNTY SCHOOL DISTNATIONAL SERVICES INDUSTRIESNEWTON COUNTYNORDSON CORPORATIONNORDSTROM, INC.NORMAN W FRIES/CLAXTON POULTRYNORTHEAST GEORGIA HEALTH SYSNORTHSIDE HOSPITALOLD DOMINION FREIGHT LINES INCOVERNITE TRANSPORTATION COOWENS-CORNINGOWENS-ILLINOIS INCOXFORD CONSTRUCTION COPARKER HANNIFIN CORPATIONPATTERSON PUMP COMPANYPCC AIRFOILS LLCPHOEBE PUTNEY MEMORIAL HOSPPIGGLY WIGGLY CAROLINA CO INCPage 572421411556
Subsequent Injury Trust Fund – 2004 Annual ReportPRESBYTERIAN HOMES OF GARACETRAC PETROLEUM, INCRANDOLPH COUNTY HOSP AUTHORITYRIVERDALE, CITY OFRMC USA, INC.ROCKDALE CO. BD OF EDUCATIONROCKWELL AUTOMATION, INCROME, CITY OFROOKER ADMINISTRATIVE SERVICESROPER CORPORATIONROSWELL CITY OFRTM, INC.RUBY TUESDAY INCRYAN'S FAMILY STEAK HOUSESRYDER SYSTEMS INCSAINT JOSEPH'S OF SAVANNAHSATILLA HEALTH SERVICES INCSAVANNAH CITY OFSHAW INDUSTRIES INCSHEPHERD MEDICAL CENTERSHERWIN-WILLIAMS COMPANYSHONEY'S LLCSI CORPORATIONSIZEMORE ,INC.SKF USA INCSNELL CONTRACTORSSOUTH GEORGIA MEDICAL CENTERSOUTHEAST GA HLTH SYSTEMSOUTHEASTERN FREIGHT LINESSOUTHERN COMPANYSOUTHERN MILLS INCSOUTHERN REGIONAL HEALTH SYS.SPALDING CO BOARD OF COMMSPRINGS INDUSTRIES INCST FRANCIS HOSPITALST JOSEPH HOSPITAL/AUGUSTASTANLEY WORKS & SUBSIDIARIESSTONE CONTAINER CORPORATIONSUPERIOR RIGGING & ERECTING COT. M. POLYFILM, INCTALON EQUITIES, INCTANNER HEALTH SERVICESTARGET CORPORATIONTERMINIX SERVICE, INCTEXTILE RUBBER & CHEMICALTEXTRON, INCTHERMAL CERAMICSPage 1111241234
Subsequent Injury Trust Fund – 2004 Annual ReportTHREE SPRINGS INC.TIP TOP POULTRY INCTRC STAFFING SERVICES, INCTROUP CO. BOARD OF EDUCATIONTYSON FOODS INCUNILEVER UNITED STATESUNITED AIRLINESUNITED CATALYSTS, INCUNITED HEALTH SERVICES INCUNIVERSITY HOSPITALUSF HOLLAND, INC.USG CORPORATIONVALDOSTA CITY OFVARIETY WHOLESALERSVISITING NURSE HEALTH SYSTEMWAFFLE HOUSEWALKER COUNTY BD OF EDUCATIONWALTON CO BOARD OF EDWAREHOUSE HOME FURNISHINGSWARNER ROBINS CITY OFWATKINS ASSOCIATED INDUSTRIESWCI OUTDOOR PRODUCTS INCWELLSTAR HEALTH SYSTEMWENDY'S INTERNATIONAL INCWEST GEORGIA HEALTH SYSTEMWEST POINT STEVENS, INCWESTVACO CORPORATION & SUBSWEYERHAEUSER COMPANYWHITFIELD COUNTY BOEWINN-DIXIE STORES INCYELLOW FREIGHT SYSTEM INCYKK CORPORATION OF AMERICATotal of Companies 305Page 6,277
Subsequent Injury Trust Fund – 2004 Annual ReportPage 17REIMBURSEMENTS PAIDInsurance CompaniesFollowing is a list of insurance companies that were reimbursed by the Subsequent Injury TrustFund in calendar year 2004. A total of 200 insurance companies were reimbursed a combinedtotal of 54,774,503.79.Reimbursements Paid to Insurance CompaniesACE AMERICAN INSURANCE COACE PROPERTY & CASUALTY INSAIG NATIONAL INS. CO.AIU INSURANCE COALFA INSURANCE CORPALLIED INSURANCE COMPANYALLSTATE INSURANCE COAMERICAN ALTERNATIVE INSAMERICAN AUTOMOBILE INS COAMERICAN CAS CO OF READING PAAMERICAN ECONOMY INS COAMERICAN HOME ASSURANCE COAMERICAN INSURANCE COAMERICAN INTER INS CO OF GAAMERICAN INTERN. SOUTH INS COAMERICAN INTERNATIONAL INS COAMERICAN MFG. MUTUAL INSAMERICAN MOTORISTS INS COAMERICAN PROTECTION INS COAMERICAN RESOURCES INS COAMERICAN SAFETY CASUALTY INSAMERICAN STATES INS COAMERICAN STATES INS CO OF TXAMERICAN ZURICH INS COAMERISURE INSURANCE COARGONAUT GREAT CENTRL INS COARGONAUT INSURANCE COASSOCIATED INDEMNITY CORPATLANTIC MUTUAL INS. COAUTO OWNERS INS. COBANKERS STANDARD FIRE & MARINEBANKERS STANDARD INS COBENCHMARK INS COBITUMINOUS CASUALTY CORPBRIDGEFIELD CASUALTY 946.691,806.21106,664.241,809.52
Subsequent Injury Trust Fund – 2004 Annual ReportBUILDERS INSURANCECANAL INSURANCE COCAPITAL CITY INS COCENTENNIAL INSURANCE COCENTRE INSURANCE COCHARTER OAK FIRE INS COCHUBB INDEMNITY INS COCHURCH MUTUAL INS COCINCINNATI INSURANCE COCITIZENS INS CO OF AMERICACLARENDON NATIONAL INS COCOLUMBIA NATIONAL INS COCOMBINED SPECIALTY INS COCOMMERCE & INDUSTRY INS COCOMMERCIAL MUTUAL INS COCOMPANION PROP & CASCONNECTICUT INDEMNITY COCONTINENTAL CASUALTY COCONTINENTAL INSURANCE COCORNERSTONE MUTUAL INS COCORNERSTONE MUTUAL INS COCYPRESS INSURANCE CODEERFIELD INSURANCE CODISCOVER PROPERTY & CASELECTRIC INSURANCE COELECTRIC MUTUAL LIAB INS LTDEMPLOYERS INS OF WAUSAUEVEREST NATIONAL INSFAIRFIELD INSURANCE COFAIRMONT INSURANCE COFARMINGTON CASUALTY COFCCI INSURANCE COMPANYFEDERAL INSURANCE COFEDERATED MUTUAL INS COFEDERATED RURAL ELECTRIC INSFFVA MUTUAL INS COFIDELITY & CAS CO OF NYFIDELITY & GUARANTY INS COFIREMAN'S FUND INS COFIREMAN'S FUND INS CO OF GAFIREMAN'S FUND INS OF GAFIREMAN'S FUND OF WISCONSINFIRST NATL INS CO OF AMERFLORISTS' MUTUAL INS COGA INSURERS INSOLVENCY POOLGA RESTAURANT MUTUAL CAP INS CGA TIMBER HARVERSTERS'Page ,363.1143,761.623,229,618.87148,852.86229,477.35
Subsequent Injury Trust Fund – 2004 Annual ReportGCAP MUTUAL CAPTIVE INSGENERAL ACCIDENT INS OF AMERGENERAL INS CO OF AMERICGEORGIA CASUALTY & SURETY COGEORGIA INSURANCE COGERBER LIFE INS COGLENS FALLS INS COGRAPHIC ARTS MUTUAL INS COGREAT AMER INS CO OF NYGREAT AMERICAN INS COGROCERS INSURANCE COGUIDEONE MUTUAL INS COGULF INSURANCE COMPANYHANOVER INSURANCE COHARBOUR SPECIALITY INSHARLEYSVILLE MUTUAL INS COHARLEYSVILLE-ATLANTIC INS COHARTFORD ACCIDENT & INDEMNITYHARTFORD CASUALTY INS COHARTFORD FIRE INSURANCE COHARTFORD INS CO OF S.E.HARTFORD INS OF THE MIDWESTHARTFORD UNDERWRITERS INSHEALTH CARE MUTUAL CAPTIVEHIGHLANDS INS COHOME INS. CO-IN LIQUIDATIONHOSPITALITY MUT CAPTIVE INSHOUSTON GENERAL INS COINDEMNITY INS CO OF NAINSURANCE CO OF N.A.INSURANCE CO OF STATE OF PAJEFFERSON PILOT FIN INS COKEY RISK INSURANCE COLEGION INS CO-IN LIQUIDATIONLIBERTY INSURANCE CORPLIBERTY MUTUAL FIRE INSLIBERTY MUTUAL INSURANCE COLM INSURANCE CORPLUMBER MUTUAL INSURANCE COLUMBERMENS MUTUAL CAS COLUMBERMEN'S UNDERWRITINGMANAGEDCARE MUT CAPTIVE INSMARYLAND CASUALTY COMPANYMONUMENTAL GENERAL CASNATIONAL AMERICAN INSURANCE CONATIONAL FIRE INS CO HARTFORDNATIONAL SURETY CORPPage 3
Subsequent Injury Trust Fund – 2004 Annual ReportNATIONAL TRUST INSURANCE CONATIONAL UNION FIRE OF PITT PANATIONWIDE MUTUAL INS CONETHERLANDS INSURANCE CONEW HAMPSHIRE INSURANCE CONORTH AMERICAN SPECIALTY INSNORTHBROOK PROP & CAS INS COOCCIDENTAL FIRE & CAS CO OF NCOHIO CASUALTY INSURANCE COOLD REPUBLIC INSURANCE COONEBEACON AMERICA INS COONEBEACON INSURANCE COPACIFIC EMPLOYERS INSURANCEPACIFIC INDEMNITY COPENN LUMBERMENS MUTUALPENN MFG ASSOC INSPHOENIX INSURANCE COPRINCETON INSURANCE COPROVIDENCE WA INS CO OF N YREALM NATIONAL INSURANCERELIANCE INS CO IN LIQUIDATIONRELIANCE NAT INS CO IN LIQ.ROYAL & SUNALLIANCE INS. COROYAL INS CO OF AMERICAS.E. EMPLOYER MUT. CAP. INS COSAFECO INSURANCE CO AMERICASECURITY INS CO OF HARTFORDSELECT INSURANCE COSELECTIVE INS CO OF AMERICASELECTIVE INS CO OF SESELECTIVE INSURANCE CO OF SCSENTRY INSURANCE A MUTUAL COSOUTHEASTERN US CAP. INS, INCSOUTHERN FIRE & CASUALTY COSOUTHERN GUARANTY INSURANCE COST PAUL FIRE & MARINE INS COSTANDARD FIRE INSURANCE COSTAR INSURANCE COSTATE AUTOMOBILE MUTUAL INSSTATE FARM FIRE & CASUALTY COSTATE FARM GENERAL INS COTIG INSURANCE COTIG PREMIER INSURANCE COTOKIO MARINE & NICHIDO FIRETRANS PACIFIC INS COTRANSCONTINENTAL INS COTRANSPORT INSURANCE COPage 604.22219
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