Iron Workers Negotiated Workers’ Compensation Program

Pre-Designating Medical Providers

You have the right to have your personal physician treat you should you become injured. However you must pre-designate in writing the name, address and telephone number of your physician prior to your becoming injured. If you wish to have your personal physician teat you in case of injury you must fill out the form below, sign and date it, and return it to your employer.

Employee Personal Physician Pre-Designation Form