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EMPLOYEES REDESIGNATION OF PERSONAL PHYSICIAN TO: UC IMC Human Resources Workers Compensation Unit 200 S. Manchester Orange, CA 92868 P: (714) 4566597 F: (855) 2516438 Email: CCDM UCI.edu Physician

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What is employees pre-designation of personal?

Employees pre-designation of personal is a form that allows employees to designate a personal representative for workers' compensation purposes.

Who is required to file employees pre-designation of personal?

All employees are required to file employees pre-designation of personal form.

How to fill out employees pre-designation of personal?

Employees can fill out the form by providing their personal information and the contact information of their designated representative.

What is the purpose of employees pre-designation of personal?

The purpose of employees pre-designation of personal is to ensure that there is a designated representative who can act on behalf of the employee in case of a workers' compensation claim.

What information must be reported on employees pre-designation of personal?

Employees must report their full name, contact information, and the full name and contact information of their designated representative.

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