Predesignation of Personal Physician Information and Form

By Mark Leeds, Attorney at Law

Have you ever been injured at work and find yourself sitting inside of your employer’s industrial medical clinic wondering if you are going to be seen by a competent medical doctor? Or whether your supervisor is going to call the clinic and tell the doctor what to do? Or whether the doctor at the clinic cares more about his contract with the employer than your health and well being?

In most cases workers’ compensation laws permit you to “predesignate’’ your own doctor. If you have predesignated your own personal physician before an industrial injury you can go directly to your personal doctor and continue treating with that doctor instead of being forced to go to the industrial clinic. Below you will find a Predesignation of Personal Physician form link. Complete it and give it to your employer as soon as possible. Without the predesignation form, your employer will refer you to their industrial clinic.

Most employers have a Medical Provider Network (MPN). This is a list of approved doctors much like your own private insurance. These doctors are not “company doctors”. They cover all specialties and geographic locations. Although each MPN is different, all of them have doctors with whom I am very comfortable and use regularly in my cases. If you have not predesignated a doctor, you may choose a doctor from this MPN list instead of continuing to treat with the industrial clinic at any time. You do not have to wait 30 days.

If your employer has an MPN you may, BEFORE YOU ARE INJURED, complete the Predesignation of Physician form. The requirements are that: 1) you must have previously been examined by the doctor; 2) the doctor is a M.D. (medical doctor) or D.O. (osteopath) and; 3) the doctor is willing to act as your treating doctor for your workers’ compensation case by signing the form. 

If you belong to Kaiser, list one of the Kaiser doctors who has seen you before or just list Kaiser and have your doctor or the administrator of the medical facility you regularly go to sign the form. 

If your medical history has been with a chiropractor only, and not with a doctor, fill out the predesignation form listing your chiropractor anyway. It may be accepted and you have nothing to lose.

Your right to predesignate does not apply when your employer does not have a MPN. Your employer can send you to their clinic and control your care for the first 30 days after your injury. After that, you can go to any doctor, a chiropractor too. If you refuse to go to the employer’s clinic and go to your own doctor, you will not be entitled to receive workers’ compensation benefits during the first 30 days. However, you can apply for State Disability benefits.  

Good luck and feel free to contact me or my staff regarding any questions.

LEGAL DISCLAIMER: This website is for informational purposes only. 

If you are seeking legal advice or representation, please contact us at (562) 427-7700.
Pursuant to Labor Code Section 5432(a), making a false or fraudulent workers’ compensation claim is a felony subject to up to 5 years in prison or a fine of up to $50,000.00 or double the value of the fraud, whichever is greater, or by both imprisonment and fine. 
Law Offices of Mark R. Leeds
3888 Cherry Avenue, Suite 100
Long Beach, CA 90807
Telephone: (562) 427-7700 Fax: (562) 427-7707