Form 9783 Predesignation of Personal Physician - California

Form 9783 Predesignation of Personal Physician - California

What Is Form 9783?

This is a legal form that was released by the California Department of Industrial Relations - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 9783?
A: Form 9783 is the Predesignation of Personal Physician form.

Q: What is the purpose of Form 9783?
A: The purpose of Form 9783 is to allow workers in California to select their personal physician for workers' compensation medical treatment.

Q: Who can use Form 9783?
A: Form 9783 can be used by workers in California who want to predesignate their personal physician for workers' compensation cases.

Q: What information is required on Form 9783?
A: Form 9783 requires the worker's personal information, their chosen personal physician's information, and the worker's signature.

Q: Who should I submit Form 9783 to?
A: Form 9783 should be submitted to your employer or the insurance company handling your workers' compensation claim.

Q: Is there a deadline for submitting Form 9783?
A: Yes, Form 9783 must be submitted to your employer or insurance company within 30 days of starting your employment.

Q: Can I change my predesignated personal physician?
A: Yes, you can change your predesignated personal physician by submitting a new Form 9783 to your employer or insurance company.

Q: What if I don't predesignate a personal physician?
A: If you don't predesignate a personal physician, your employer or their workers' compensation insurance will provide you with a medical provider.

Q: Can my employer refuse my predesignated personal physician?
A: In most cases, your employer cannot refuse your predesignated personal physician if certain conditions are met, such as the physician being your primary treating physician for at least three years.

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Form Details:

  • Released on July 1, 2014;
  • The latest edition provided by the California Department of Industrial Relations;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 9783 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations.

Download Form 9783 Predesignation of Personal Physician - California

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