Physician Pre-Designation

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.

Note: A 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 (e.g. Kaiser Permanente). A specialist or specialty group, such as an orthopedist, cannot be pre-designated.

Resources


If physician is either a M.D. or D.O.

If physician is either a Chiropractor or an Acupuncturist

Submit your form via one of the following methods:

  • Secure Workers’ Compensation Submission Form (an OnBase/PolyDoc form)

    • Please log in using your Cal Poly Pomona credentials (BroncoName and password)

    • Once you have logged in please upload your completed Personal Physician Pre-Designation Form (documentation) as prompted

  • Sealed inter-office mail (marked as Confidential)

  • In-person to the HR Customer Service Center in the Student Services Building 121, Second Floor