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.

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). A specialist or specialty group, such as an orthopedist, cannot be pre-designated.

Submit your form via our Secure Workers’ Compensation Submission Form (an OnBase/PolyDoc form), sealed inter-office mail (marked as Confidential), or in person to the HR Customer Service Center.

How to Submit using our Secure Workers’ Compensation Submission 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.