CA DWC Form 9783 2013 free printable template

Clear All Fields v010113 Personal Physician Designation Form DWC FORM 9783 In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness by

How to fill out dwc form 9783

How to fill out dwc form 9783:

1. Begin by obtaining the most recent version of the dwc form 9783. This can typically be found on the official website of the relevant organization or agency.
2. Carefully read the instructions provided with the form. Familiarize yourself with the purpose of the form and the information that needs to be provided.
3. Start by filling out your personal information accurately. This may include your name, address, contact details, and any other requested information.
4. Move on to the specific sections of the form that require additional information. This may vary depending on the purpose of the form, but make sure to provide all required details as accurately and thoroughly as possible.
5. Pay attention to any additional supporting documentation that may be required. Ensure that you attach all necessary documents, such as receipts, invoices, or proof of identification, as specified in the instructions.
6. Review the completed form to ensure all information is accurate and complete. Make any necessary corrections or additions before submitting the form.
7. Submit the dwc form 9783 according to the provided instructions. This may involve mailing the form to a specific address, submitting it online, or delivering it in person.

Who needs dwc form 9783:

1. The dwc form 9783 may be required by individuals who have been involved in a workplace injury or illness and are seeking workers' compensation benefits.
2. Employers may also need to complete this form for reporting purposes or to provide information related to a workers' compensation claim.
3. Additionally, insurance companies, healthcare providers, and legal representatives may need to fill out this form as part of the workers' compensation process.

People Also Ask about

What is the 9780.1 regulation?

(1) Notice of the predesignation of a personal physician is in writing, and is provided to the employer prior to the industrial injury for which treatment by the personal physician is sought.

What does personal physician mean?

Personal physician means a doctor of medicine, a doctor of osteopathy, or a doctor of chiropractic, who prior to the injury has directed the medical treatment of the employee and who retains the employee's medical records and medical history.

What is the designation of PTP?

The Professional Transportation Planner® (PTP) certification program is designed for candidates who have a wide-range of education and experience in transportation planning. Currently, no other certification program is offered that specifically addresses the work performed by transportation planners.

What is Labor Code 4061?

Labor Code §4061 is utilized to obtain a comprehensive medical legal evaluator in order to determine permanent indemnity issues or the need for future medical treatment (not used for an employee to object to a UR decision pursuant to LC section 4610).

What is the Labor Code 132a damages?

California Labor Code 132a establishes a policy that employers should not discriminate against workers who are injured in the workplace. The labor code provides for damages for any employee who is discriminated against for filing (or intending to file) a workers' compensation claim.

What is a 4600 letter workers compensation?

Download Form. This is a form that was created by the Division of Workers' Compensation, consistent with Labor Code Section 4600(d), to allow an injured worker to predesignate a physician prior to an industrial injury. The form itself lists the requirements to be able to predesignate a physician.

What does predesignation of personal physician mean?

If you pre-designate a physician, you will have to seek treatment through a designated medical facility until we receive documentation of the physician's agreement to be pre-designated. You are able to pre-designate a provider if the following conditions are met: Your employer offers group health coverage.

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What is CA DWC Form 9783?

CA DWC Form 9783, also known as the 'Claims Administrator's Report of Initial Notification of an Employee's Injury or Illness,' is a form used in California's workers' compensation system to report the initial notification of a workplace injury or illness.

Who is required to file CA DWC Form 9783?

The form must be filed by claims administrators of workers' compensation claims in California when they receive notice of an injury or illness from an employee.

How to fill out CA DWC Form 9783?

To fill out CA DWC Form 9783, claim administrators must provide information regarding the injured employee, including their contact details, a description of the injury or illness, the date of occurrence, and any other pertinent information required by the form.

What is the purpose of CA DWC Form 9783?

The purpose of CA DWC Form 9783 is to ensure timely reporting and processing of workplace injury claims, facilitating appropriate benefits and medical treatment for injured employees.

What information must be reported on CA DWC Form 9783?

CA DWC Form 9783 must report information such as the employee's name, address, social security number, the date and description of the injury or illness, employer’s details, and the claims administrator's information.