Pre-Designation of Personal Physician in Case of Injury

Workers in California, if injured on the job, have always been able to see their own doctor instead of the employer-designated doctor if they had pre-designated the name of the doctor and submitted the information to the Agency. However, there has been a change to the form requirement: your doctor must agree to treat you for your Worker’s Compensation injury, and they must sign off on the form in advance of injury. The completed form must be on file in the Human Resources office.

The Pre-designation form you can use if you would like to pre-designate your personal physician for Worker’s Compensation.  Please submit the completed form to Zenobia Henderson, Personnel Clerk, in Human Resources.

Thank you,

Bonnie