Predesignated Physicians Forms
Caltech provides medical treatment to employees who have accepted workers' compensation claims. However, employees have the right to name either a personal physician, personal chiropractor, or personal acupuncturist, who will provide medical treatment in the event of a work-related injury.
If you wish to predesignate a personal physician, chiropractor, or acupuncturist, please contact the Disability & leave Administration Unit in Human Resources.
- If the forms are incomplete, if you fail to return the forms, or if your selected provider (physician, chiropractor, acupuncturist) does not meet the predesignation requirements, your request may be disapproved.
- The predesignation forms must be on file in the Disability & Leave Administration Unit prior to an injury occurring.
If there are any questions, contact the Disability & Leave Administration Unit at (626) 395-4577 or (626) 395-8382.