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Form032014Victor Valley Community College District Workers Compensation: Redesignation of Personal Physician you have health insurance, and you are injured on the job you have the right to be treated

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How to fill out workers compensation pre-designation of

01

Obtain the pre-designation form from your employer or the workers' compensation board.

02

Fill in your personal information, including your name, address, and contact information.

03

Include the name of your designated physician or medical provider.

04

Sign and date the form to confirm your pre-designation choice.

05

Submit the completed form to your employer or the workers' compensation board for processing.

Who needs workers compensation pre-designation of?

01

Employees who want to designate a specific physician or medical provider to treat any work-related injuries or illnesses.

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What is workers compensation pre-designation of?

Workers compensation pre-designation is a process that allows employees to choose their own healthcare provider for work-related injuries or illnesses before an incident occurs.

Who is required to file workers compensation pre-designation of?

Employees who wish to pre-designate a physician for their workers' compensation claims are required to file a pre-designation form with their employer.

How to fill out workers compensation pre-designation of?

To fill out the workers compensation pre-designation form, employees should provide their personal information, the name and address of the chosen healthcare provider, and sign the form to acknowledge their choice.

What is the purpose of workers compensation pre-designation of?

The purpose of workers compensation pre-designation is to empower employees to select their preferred medical provider for treatment of work-related injuries, ensuring they receive care from someone they trust.

What information must be reported on workers compensation pre-designation of?

The information that must be reported includes the employee's name, contact information, the chosen physician's name, address, and any required signatures.

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