Find the Right California Workers' Comp Form

Throughout the course of any Workers’ Compensation case, an injured worker will receive a wide variety of forms, regarding everything from medical treatment to financial benefits. It is extremely important to read the forms carefully, and contact an attorney to confirm what action, if any, needs to be taken. Keep in mind that many of these forms include strict timelines that must be met.

Pre-Designation Form

Download Form

This is a form that was created by the Division of Workers’ Compensation, consistent with Labor Code Section 4600(d), to allow an injured worker to predesignate a physician prior to an industrial injury.

The form itself lists the requirements to be able to predesignate a physician. If a physician was properly predesignated before an industrial injury, then an injured worker can go to that physician instead of a company selected physician. This applies whether there is a Medical Provider Network (MPN) in place or not.

It is imperative that your doctor sign the form, and that when you give it to your employer you (1) obtain a written confirmation that the employer acknowledged receipt of this form and (2) request that a copy of the form be kept in your personnel file.


Do I have a case? Free Case Evaluation.

Click Here

© 2017 GEKLAW, Inc. All Rights Reserved.

Personal Injury · Disclaimer · Privacy · Sitemap

Back to top