[ Claim Number:
400117008 ]
Claim Detail
Case:
Wiggins, Rochene vs Dave & Buster's
| Injury Date: |
04/02/2021 |
|
Filing District: |
Bridgeport |
| Injured Body Part (Primary): |
Ankle |
|
Claim Status: |
Non-Litigated |
| Date of Birth: |
|
|
Nature of Injury: |
(Unknown) |
Forms Filed
(Click to display)
Hearings
(Click to display)
Interested Parties to Claim
| Party Type | Name | Address Line 1 | Address Line 2 | City | State | Zip Code | Phone | Fax |
| Claimant | Rochene Wiggins | | | | | | | |
| Employer | Dave & Buster's | 1201 Boston Post Road | | Milford | CT | 06460- | (203) 701-4830 | |
| . . . Insurer Contact | . . . ESIS Northeast WC Claims | P.O. Box 716 | | Portland | ME | 04104- | (860) 408-8602 | ( ) - |
| Bureau of CSE | Office of Child Support Services | 55 Farmington Avenue | | Hartford | CT | 06105-3725 | (860) 424-4989 | (860) 951-2996 |