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Cal Poly Pomona
Human Resource Services
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Administrative Affairs Division
 
 
 
 

Workers' Compensation

 

Physician Pre-Designation

Employees have the option of pre-designating their personal physician as their treating physician in the event of a work-related injury/illness. This designation must occur prior to a work-related injury/illness and your physician must agree to be pre-designated. Employees bear the responsibility of keeping their physician pre-designation current. A copy of the "Notice of Pre-Designation of Personal Physician" form is attached for your convenience. If you choose to pre-designate, please follow the directions to complete the form and return it to Risk Management, CLA Bldg. 98, Room B1-35.

Note: "Personal Physician" includes a medical group, if the medical group is composed of licensed doctors of medicine or osteopathy operating as a multi-specialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries (for example, Kaiser).

An orthopedic specialist or specialty group cannot be pre-designated.

Forms