How to Predesignate your Personal Physician

To predesignate your personal physician (if you are eligible to do so), you must notify your employer in writing. You may prepare your own written statement, use optional DWC Form 9783 provided by the state Division of Workers’ Compensation, or use a form provided by your employer

Facts about Predesignating

1. You can predesignate a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who treated you in the past and has your medical records.

2. The doctor must be a general practitioner, internist, pediatrician, obstetrician-gynecologist, or family practitioner who is your primary care physician.

3. You cannot predesignate your personal chiropractor or acupuncturist, but if you give your employer the name of your personal chiropractor or acupuncturist in writing before you are injured, you may switch to this chiropractor or acupuncturist upon request, after you first see a doctor chosen by a claims administrator.

4. The doctor you predesignate must agree in advance to treat you for any job injuries and illnesses. The agreement must be documented, either by the doctor signing the predesignation form or by some other form of documentation. Include the documentation when you give your employer the predesignation form or statement.

5. There different rules for predesignating if your employer or the insurer has a contract with a health care organization (HCO):

• If your employer or the insurer has a contract with an HCO, the employer or insurer must give you DWC Form 1194 within 30 days after your date of hire and at least once a year. You can use this form to predesignate your personal physician, personal chiropractor, or personal acupuncturist.

• You are not required to show that your doctor agreed to be predesignated.

• If you do not predesignate each time you are given this form, your employer will enroll you in the HCO and you will be treated in the HCO for job-related injuries.

 

Related Topics:

• California Employees Rights

• California Laws

• Benefits (Compensation)

• Predesignating a Physician

• Filing a Claim

• Resolving Disputes

• Workers’ Compensation Facts

• California Workers Comp FAQs