| Party Type | Name | Address Line 1 | Address Line 2 | City | State | Zip Code | Phone | Fax |
| Claimant | Dakota Cooper | | | | | | | |
| . . . Claimant's Rep | . . . Levy, Leff & DeFrank, Attorneys at Law | 195 Church Street | 14th Floor | New Haven | CT | 06510- | (203) 777-6887 | (203) 776-9448 |
| Employer | Reilly Green Mountain Platform Tennis Courts | 300 Boston Post Road | | Orange | CT | 06477- | | |
| . . . Insurer Contact | . . . Selective Insurance Company of America | PO Box 7252 | | London | KY | 40742- | (800) 777-9656 | (877) 352-6860 |
| . . . . . . Insurer's Rep | . . . . . . Montstream Law Group, LLP | 175 Capital Boulevard, Suite 204 | | Rocky Hill | CT | 06067- | (860) 659-1341 | (860) 657-8519 |