Predesignate a Physician

You May Predesignate Your Physician under Certain Circumstances

Your ability to choose your own doctor depends upon the following variables:

• Health Care Organization (HCO) or Medical Provider Network. Your employer or workers' compensation insurance carrier selects the doctor if your employer has established a medical provider network or offers an HCO.
• Group Health Insurance. You may predesignate your personal physician if your employer offers a group health insurance plan. The physician must participate in that plan prior to your injury.
• You may not predesignate if your employer does not offer any of the preceding options.

Additional Factors

You must predesignate your personal physician in writing. You may predesignate a medical group under certain conditions. The doctor must be your regular primary care physician and must agree to the predesignation. In addition, the doctor must have treated you in the past and have your medical treatment records.

If you have predesignated a physician in accordance with the above requirements, you may go to this doctor for treatment immediately after your injury.

Effective January 1, 2003, your employer must provide all new employees with a form on which they may predesignate their personal physician. However, this predesignation is available only to those employees whose employers offer an HCO or Group Health Insurance.

Contact your claims representative for more information.

The information provided is not intended to supersede or be used in lieu of the “notice of benefits” handout that employers are required to provide to workers. For State Fund policyholders, this notice is in the New Employee's Guide to Workers' Compensation (English/Spanish) - e13286 [448 k].