OFFICE OF WORKERS' COMPENSATION, EH&S
August 25, 1994
ALL AT UCSD
SUBJECT: Medical Treatment Policy for Workers' Compensation Injuries
Effective September 1, 1994, UCSD employees sustaining a work-related injury or illness should obtain initial medical treatment at either the Thornton Hospital ER/Urgent Care or the UCSD Medical Center ER.
Employees wishing to be treated by their personal physician or by another health care provider for the entire injury period, MUST FILE A WRITTEN NOTICE WITH THEIR DEPARTMENT PRIOR TO THE INJURY. Attached is a DESIGNATION OF PHYSICIAN FORM that may be completed by employees wishing to designate a treating doctor in the event of a work-related injury or illness. Since only one form is attached, please keep it as an original and make photocopies to service all employees in your department. If an employee already has a form on file, a new form is not required unless the employee wants to update the information. The completed form should be kept in the employee's departmental personnel file for future reference.
If you have any questions about this new policy, please call the Workers' Compensation Office at any of the following numbers: 534-0136, 534-4785 or 534-2092.
Van Jahnes-Smith
Manager
Attachment
======================================================================== DESIGNATION OF PHYSICIAN FORM
EMPLOYEE NAME:_____________________________________________________
DEPARTMENT:________________________________________________________
In the event I have a job-related injury or illness, I request treatment by the following licensed physician/HMO or chiropractor:
DOCTOR'S NAME:_____________________________________________________
DOCTOR'S ADDRESS OR HMO FACILITY:__________________________________
___________________________________________________________________
DOCTOR'S TELEPHONE NUMBER:_________________________________________
SIGNATURE OF EMPLOYEE:_____________________________________________
DATE FORM WAS COMPLETED:___________________________________________
IMPORTANT: This form must be returned to your supervisor and placed in your departmental personnel file to complete your physician designation.
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MEDICAL TREATMENT FOR UCSD WORKERS' COMPENSATION INJURIES
Prompt medical care is a key element for a fast recovery from an injury or illness. Quality emergency medical care and follow-up treatment can often mean the difference between complete recovery from an injury or illness, or lasting physical disability. If you are injured at work, report the injury immediately to your supervisor, who will direct you to the UCSD Medical Center Emergency Room or the Thornton Hospital Emergency Room/Urgent Care.
Employees wishing to be treated by their personal physician for the entire period of a work-related injury or illness may file a DESIGNATION OF PHYSICIAN FORM with their department. The form must be completed prior to the injury and be in the employee's departmental personnel file. If you do not file a DESIGNATION OF PHYSICIAN FORM, your initial medical care for a work-related injury or illness will be directed by UCSD.
If you have any questions regarding this form, please call the Workers' Compensation Office at the following numbers: 534-0136, 534-4785, 534-2092.
REV. 8/94