Pre-Designation Form
Download FormThis is a form created by the Division of Workers' Compensation, consistent with Labor Code Section 4600(d), that allows an injured worker to predesignate a physician before an industrial injury occurs.
What Pre-Designation Lets You Do
If a physician was properly predesignated before an industrial injury, the injured worker can treat with that physician instead of a company-selected physician. This applies whether or not a Medical Provider Network (MPN) is in place.
Requirements
The form itself lists the requirements you must meet to predesignate a physician. Among other things, your doctor must agree to be predesignated and must sign the form. It is worth reading the requirements closely before you submit it, so that your predesignation is valid when you need it.
How to Submit the Form
It is imperative that your doctor sign the form. When you give it to your employer, you should (1) obtain written confirmation that the employer acknowledged receipt of the form, and (2) request that a copy be kept in your personnel file.
How GEKLAW Can Help
Predesignating your own physician can make a real difference in the care you receive after a work injury. If you have questions about predesignation or your right to choose your treating doctor, our attorneys are here to help.
