California DWC-AD Form 9783 (often searched as “WCAB DWC-AD 9785” because of its tie to Title 8 CCR §9785) is the optional state predesignation form that lets a California employee name a personal physician to treat them for a future on-the-job injury. The form is governed by Labor Code §4600(d) and 8 CCR §9780.1, and it must be in your employer’s hands before the injury happens or it has no legal effect.
The stakes are real. Most California employers steer hurt workers into a Medical Provider Network (MPN) or to a company-chosen clinic for the first 30 days, but a valid predesignation in your file lets you go straight to your own doctor on day one. According to the California Workers’ Compensation Institute, fewer than 7% of California workers predesignate before injury, which means most lose the right to their own physician simply because the paperwork was never filed.
Here is what you will learn in this guide:
- 📝 How to fill out every field on DWC Form 9783 (and the related DWC Form 9783.1 for chiropractors and acupuncturists) line by line
- 🩺 Who qualifies as a “personal physician” under Labor Code §4600 and which specialties are disqualified
- 📂 Exactly which documents and signatures you must gather before handing the form in
- 🏥 How predesignation interacts with your employer’s MPN and group health coverage
- ⚠️ The 10 most common mistakes that void a predesignation and how to avoid each one
What the Form Is and Who Must File It
The DWC-AD 9783 Predesignation of Personal Physician form is a one-page written notice you give your employer to lock in your own M.D. or D.O. as the doctor who will treat you if you suffer a work-related injury. The companion form, DWC-AD 9783.1 Notice of Personal Chiropractor or Personal Acupuncturist, performs the same function for a personal D.C. or L.Ac., but it works differently because of statutory limits in Labor Code §4601. Both forms tie back to Title 8 of the California Code of Regulations §9780–9785, which is where the “9785” in many search queries comes from.
The form is filed by the employee, not the employer. The employer’s role is to distribute the optional form (or its own version) at the time of hire as part of the new-hire packet required by 8 CCR §9880, and then to keep the completed form in the personnel file. There is no government agency that receives DWC 9783. It is a private notice between worker and employer, and the only proof of filing is the employer’s date-stamped receipt.
Eligibility is narrow. To use DWC 9783, the worker must (1) have non-occupational group health coverage at the time of injury, (2) name a physician who has previously directed their medical treatment and retains their records, and (3) get the doctor’s written agreement in advance to be predesignated, per 8 CCR §9780.1. Skip any one of these three prongs and the predesignation is invalid, even if the form itself is filled out perfectly.
The current revision date printed on the official form is July 1, 2014, and that revision is still the operative version as confirmed by the Cornell-hosted text of 8 CCR §9783. Always confirm the revision date in the lower-left corner of the PDF you download before you sign, because employers sometimes circulate outdated photocopies that omit the chiropractor exclusion language.
Before You Start: Documents and Information You Need
Predesignation fails most often not because the form is hard, but because workers sign and submit it without the supporting pieces in place. Gather every item below before you write a single character on the form, and confirm each with your doctor’s office during a quick phone call.
- Your full legal name as it appears on your Social Security card. The employer cross-checks personnel records, and a nickname or middle-initial mismatch can delay matching the form to your file.
- Your current home address. If you have a P.O. Box, use the USPS-recognized street address as well, because some claims administrators reject P.O. Boxes alone.
- Your employer’s exact legal name. This is the name on your W-4 or pay stub, not the storefront brand name. The wrong legal entity can void the notice.
- The name of your group health insurance plan. Labor Code §4600(d)(1) conditions predesignation on having non-occupational health coverage, so you must be enrolled when you sign.
- Your personal physician’s name, license type (M.D. or D.O.), and specialty. Only a family practitioner, general practitioner, board-certified internist, OB-GYN, or pediatrician qualifies under the DIR predesignation rules.
- The physician’s office street address and phone number. A hospital name alone is not enough; the claims administrator routes records to the street address.
- Your physician’s written agreement to be predesignated. The doctor must agree in advance and sign the form or a separate letter, per the CSUSM predesignation instructions.
- Confirmation that your physician retains your medical history and records. A doctor you saw once five years ago does not qualify; the regulation requires an ongoing treatment relationship.
- A photocopy or scan of the completed form for your own records. If the employer later loses it, your dated copy with the employer’s signature is your only proof.
If even one item is missing, pause and gather it. A predesignation handed in without the physician’s signature is the single most common reason claims administrators reject the notice after an injury.
Where to Get the Form and How to Access It
The official DWC-AD 9783 PDF lives on the California Department of Industrial Relations site at the DWC Forms page. Click the entry labeled “Predesignation of Personal Physician (DWC 9783)” to download the fillable PDF. The companion form for chiropractors and acupuncturists, DWC 9783.1, is listed directly beneath it.
Many employers embed the form inside their new-hire packet, so check there first. The Hartford insurance carrier hosts a clean copy that is identical to the DIR version, and California State University campuses such as CSU Chico publish their own branded versions. Any of these is acceptable as long as the substance matches the regulation.
You may also create your own written notice, because 8 CCR §9780.1 calls DWC 9783 “optional.” A homemade letter that includes the physician’s name, business address, your group health plan, and the doctor’s signed agreement satisfies the statute. Most workers still use the official form because claims administrators recognize it instantly and rejection risk drops.
Print two copies. Sign both in blue ink (so the original is obvious), give one to your HR contact, and keep the other. If your employer uses an electronic onboarding platform such as Workday or BambooHR, upload a scanned PDF that includes the physician’s wet signature; a typed name in a signature box is not a substitute.
Step-by-Step: How to Fill Out DWC Form 9783 Line by Line
The official form has six fillable areas, each tied to a specific regulatory requirement under 8 CCR §9783. Work through them in the order printed on the form, and do not skip the physician signature block, because that single field is the most common cause of rejected predesignations.
Field 1: Employee Notice Section (Top Block)
What it asks in plain English. This top block is the legal “I am telling you” statement that names the doctor you want to treat you if you get hurt at work.
How to answer it. Read the printed paragraph carefully; you do not write anything inside it. Your job is to make sure the printed language is intact and unaltered, because crossing out or rewording this block voids the form.
Example entry. Marisol Chen downloads the July 1, 2014 revision and confirms the top paragraph begins “If your employer or your employer’s insurer does not have a Medical Provider Network…” exactly as printed.
Nuance or edge case. If your employer has an MPN, the top block still works for M.D./D.O. predesignation because Labor Code §4616.3(d) carves out a valid predesignated personal physician from the MPN. The chiropractor form (9783.1) does not get that carve-out.
Common mistake and consequence. Some workers white-out the MPN language thinking it does not apply to them; doing so invalidates the form and lets the claims administrator route the worker to the MPN clinic after an injury.
Misconception. Many filers believe this block is “just boilerplate” and can be replaced with their own wording. It is not boilerplate; it is the statutory notice language required by 8 CCR §9783, and altering it defeats the predesignation.
Field 2: Name of Doctor (M.D. or D.O.)
What it asks in plain English. Write the full name and credential of the medical doctor or doctor of osteopathy you want to treat you.
How to answer it. Print the doctor’s first and last name exactly as it appears on their California medical license, followed by the credential (M.D. or D.O.). Verify the spelling on the Medical Board of California license lookup.
Example entry. Dr. Anita Rao, M.D. — not “Dr. Rao” or “Anita Rao.”
Nuance or edge case. If your personal physician practices inside a medical group such as Kaiser or Sutter, you may name the group entity instead of the individual doctor, provided the group is a single corporation or partnership of licensed M.D.s or D.O.s offering integrated multispecialty care, as explained in the Visalia USD predesignation notice.
Common mistake and consequence. Listing a specialist (cardiologist, dermatologist, orthopedist) instead of a qualifying primary-care doctor; the predesignation will be rejected because §9780.1 limits eligible specialties to family practice, general practice, internal medicine, OB-GYN, and pediatrics.
Misconception. Many workers think any doctor they like can be predesignated. The regulation is specific about specialty, and a beloved orthopedist who fixed your knee last year does not qualify as a personal physician.
Field 3: Office Address and Phone of Doctor
What it asks in plain English. Provide the street, city, ZIP, and phone number of the doctor’s office.
How to answer it. Write the full street address (no P.O. Box), city, two-letter state abbreviation, five-digit ZIP, and a 10-digit phone number with area code. Use the address on the doctor’s letterhead, not a hospital billing address.
Example entry. Bayview Family Medicine, 1422 Lombard Street, Suite 210, San Francisco, CA 94123, (415) 555-0190.
Nuance or edge case. If the doctor practices at multiple offices, list the one where your records are physically maintained. Claims administrators send fax authorizations to this exact address under §9785(g).
Common mistake and consequence. Using a hospital’s main switchboard address; treatment authorizations get lost in central mailrooms and your urgent care can be delayed by weeks.
Misconception. Filers often think a P.O. Box is fine because mail still reaches the doctor. It is not fine; the regulation contemplates a physical “business address” where records can be obtained.
Field 4: Employee Name (Print)
What it asks in plain English. Print your own full legal name.
How to answer it. Use the name on your Social Security card and your I-9, in all caps or standard case, exactly matching your employer’s payroll records.
Example entry. MARISOL ELENA CHEN.
Nuance or edge case. If you recently married and your payroll record still shows your maiden name, use the payroll name and add a note in the margin that the legal name change is pending; this preserves the cross-reference to your personnel file.
Common mistake and consequence. Writing a nickname like “Mari Chen”; HR may file the form in the wrong personnel folder and it will not surface when the injury occurs.
Misconception. Workers assume the employer will figure out a nickname. Large employers with thousands of files cannot, and the form may sit in a “to be matched” drawer for months.
Field 5: Employee Address
What it asks in plain English. Print your current residential address.
How to answer it. Street, apartment number, city, CA, ZIP. Update HR immediately if you move, because the address on this form must match the address on file when the injury is reported.
Example entry. 2317 Geary Boulevard, Apt 4B, San Francisco, CA 94115.
Nuance or edge case. Active-duty military spouses and traveling workers may list a permanent California address even if temporarily living elsewhere; the DIR FAQ on predesignation treats domicile as controlling.
Common mistake and consequence. Using a former address; mailed authorization forms after an injury go to the wrong place and treatment delays trigger a 50% increase in utilization review denials.
Misconception. Filers believe the address is only for mailing. It is also used by claims administrators to confirm identity and venue under WCAB rules.
Field 6: Employee Signature and Date
What it asks in plain English. Sign your name and write the date you are signing.
How to answer it. Sign in blue or black ink. Use MM/DD/YYYY format for the date. The signature must be original on at least one copy; electronic signatures are accepted only when the employer’s onboarding platform is the system of record.
Example entry. Marisol Chen, 03/14/2026.
Nuance or edge case. If you sign electronically inside an employer portal such as ADP Workforce Now, make sure the portal’s audit trail captures the timestamp; print the audit-log page and keep it with your copy.
Common mistake and consequence. Forgetting the date; an undated form has no provable “before injury” status and the predesignation can be defeated at deposition.
Misconception. Workers think the signature alone is enough. The date is equally important because the entire defense to a post-injury predesignation challenge is the timestamp.
Field 7: Physician Signature Block
What it asks in plain English. Your doctor signs the form to confirm that they agree to be your predesignated physician.
How to answer it. Take the form to the doctor’s office, ask the medical assistant to route it to the physician, and pick it up signed. The doctor prints their name, signs, and dates. Some practices require a one-page cover letter; the Geklaw practice guide recommends faxing the form with a return envelope.
Example entry. Anita Rao, M.D., signature, 03/12/2026.
Nuance or edge case. If the doctor refuses to sign because their malpractice carrier prohibits workers’ comp work, you must find a different qualifying primary-care doctor; you cannot self-certify the agreement.
Common mistake and consequence. Submitting the form without the physician’s signature; claims administrators automatically reject unsigned predesignations and you lose the right to your own doctor on day one of treatment.
Misconception. Filers assume verbal agreement from the doctor is enough. It is not; §9780.1(a)(3) requires written agreement in advance.
Field 8 (DWC 9783.1 only): Chiropractor or Acupuncturist Name and Address
What it asks in plain English. On the separate DWC 9783.1 form, name your personal D.C. or L.Ac. and their business address.
How to answer it. Print the provider’s full name with credential (D.C. or L.Ac.), the office street address, city, state, ZIP, and phone. Verify the chiropractic license through the California Board of Chiropractic Examiners.
Example entry. Dr. James Okafor, D.C., Pacific Spine Clinic, 880 El Camino Real, Suite 5, Burlingame, CA 94010, (650) 555-0144.
Nuance or edge case. If your employer has an MPN, you may only switch to a D.C. or L.Ac. inside the MPN; the predesignation does not override the MPN for chiropractic care, as the DIR §9783.1 text confirms.
Common mistake and consequence. Workers list a chiropractor on the DWC 9783 (M.D./D.O.) form by accident; the form will be void because a D.C. is not a “physician” under Labor Code §3209.3.
Misconception. Many workers think a chiropractor can serve as their full treating physician throughout the claim. By statute, a chiropractor cannot be the treating physician after 24 visits, except for postsurgical physical-medicine visits, as detailed in the City of Chico predesignation notice.
Three Filled-Out Examples Using Real Scenarios
The following three scenarios show how three different California workers complete DWC 9783 (or 9783.1) end to end. Each table has the form section in the left column and the worker’s exact entry in the right column.
Scenario 1: Marisol Chen — Tech Employee Predesignating Her Family Doctor
Marisol just accepted a software engineer offer at a San Francisco startup. She wants to keep her family doctor, who delivered her son and has treated her for a decade, in case she develops a repetitive-strain injury.
| Form Section | What Marisol Enters |
|---|---|
| Form used | DWC-AD 9783 (Rev. 07/01/2014) |
| Employer name | Lattice Robotics, Inc. |
| Group health plan | Anthem Blue Cross PPO |
| Doctor name and credential | Anita Rao, M.D. |
| Doctor specialty | Family Practice |
| Doctor office address | 1422 Lombard Street, Suite 210, San Francisco, CA 94123 |
| Doctor phone | (415) 555-0190 |
| Employee name | MARISOL ELENA CHEN |
| Employee address | 2317 Geary Boulevard, Apt 4B, San Francisco, CA 94115 |
| Employee signature and date | Marisol Chen, 03/14/2026 |
| Physician signature and date | Anita Rao, M.D., 03/12/2026 |
| Delivery method | Hand-delivered to HR on 03/16/2026; HR initialed and date-stamped copy |
Scenario 2: Tomás Ortega — Construction Worker Predesignating a Chiropractor
Tomás works for a Sacramento drywall contractor. He has chronic lower-back issues and has seen the same chiropractor for seven years. His employer does not have an MPN, so DWC 9783.1 is the right form.
| Form Section | What Tomás Enters |
|---|---|
| Form used | DWC-AD 9783.1 (Rev. 07/01/2014) |
| Employer name | Vega Drywall & Acoustic, LLC |
| MPN status confirmed | No MPN — verified with HR on 02/02/2026 |
| Chiropractor name | James Okafor, D.C. |
| Chiropractor office address | 880 El Camino Real, Suite 5, Sacramento, CA 95814 |
| Chiropractor phone | (916) 555-0144 |
| Employee name | TOMÁS RAFAEL ORTEGA |
| Employee address | 4112 Stockton Boulevard, Sacramento, CA 95820 |
| Employee signature and date | Tomás Ortega, 02/05/2026 |
| 24-visit cap acknowledged | Yes — initialed on the form margin |
| Delivery method | Certified mail to HR, return receipt 02/07/2026 |
Scenario 3: Aisha Bennett — Hospital Nurse Whose Employer Has an MPN
Aisha is a registered nurse at a Los Angeles hospital that uses an MPN. She wants her internal-medicine doctor as her predesignated physician and confirms with HR that the MPN does not block M.D. predesignation.
| Form Section | What Aisha Enters |
|---|---|
| Form used | DWC-AD 9783 (Rev. 07/01/2014) |
| Employer name | St. Vincent Regional Hospital, Inc. |
| MPN name | Anthem MPN of California (verified) |
| Group health plan | Kaiser Permanente HMO |
| Doctor name and credential | Priya Natarajan, M.D. |
| Doctor specialty | Internal Medicine (board certified) |
| Doctor office address | 3500 Wilshire Boulevard, Suite 1200, Los Angeles, CA 90010 |
| Doctor phone | (213) 555-0177 |
| Employee name | AISHA NICOLE BENNETT |
| Employee address | 1830 South Bundy Drive, Apt 6, Los Angeles, CA 90025 |
| Physician signature and date | Priya Natarajan, M.D., 04/02/2026 |
| Delivery method | Uploaded to Workday on 04/05/2026; downloaded HR confirmation PDF |
How to File the Completed Form
DWC 9783 is not filed with any state agency. You hand it to your employer, and the employer keeps it in your personnel file. That said, how you deliver it matters because your only proof later is the delivery record.
In person. Walk the signed form to HR. Ask the HR representative to date-stamp two copies, keep one, and give you the other. This is the gold-standard delivery method because the date stamp is impossible to dispute. There is no fee. Processing time is immediate. Your proof is the date-stamped employee copy.
Certified mail with return receipt. Mail the signed form to the registered HR address using USPS Certified Mail with return receipt requested. The fee is approximately $4.85 for certified service plus $3.65 for the return receipt as of the most recent USPS rate change. Processing time runs three to five business days. Your proof is the green return-receipt card with the recipient’s signature.
Employer onboarding portal. Upload a scanned PDF into Workday, BambooHR, ADP, or Paycom. There is no fee. Processing time is immediate. Download the platform’s audit-log page that shows your upload timestamp; that log is your proof.
Email to HR. Some smaller employers accept email. Send the scanned PDF as an attachment, request a read receipt, and ask HR to reply with “received and filed.” There is no fee. Your proof is the reply email.
Fax. Older employers may still use fax. Send to the HR fax line and keep the confirmation page that shows the recipient number and “OK” status. No fee beyond your fax cost. Proof is the confirmation page.
Whatever channel you use, never surrender your only signed original. Always retain a copy with the physician’s wet signature visible.
What Happens After You File
Once HR has your form, they place it in your personnel file and, in well-run shops, also forward a copy to the workers’ compensation claims administrator named in the employer’s posted DWC-7 notice. Nothing visible happens after that until an injury occurs.
If you are later injured on the job, you report the injury on the DWC-1 claim form within 30 days, as required by Labor Code §5400. The claims administrator then checks your personnel file for a valid predesignation. If your DWC 9783 is on file and complete, the administrator must authorize your predesignated physician to begin treatment immediately and arrange records transfer under §9781(d).
If the predesignation is missing, incomplete, or undated, the administrator may direct you to the employer-chosen physician or the MPN clinic for the first 30 days. After 30 days, you have the right to free physician choice under Labor Code §4600(c), but that is a month of lost continuity with your own doctor.
You may also request a one-time change of physician at any time under §9781(b), independent of predesignation. That right does not require any form and need not be in writing.
Mistakes to Avoid When Filling Out the Form
Predesignation is unforgiving because the entire defense to a denied form is whether the paperwork was perfect before the injury. Avoid these specific errors.
- Submitting after the injury. A predesignation signed the day after a fall has no legal effect; the claims administrator will reject it.
- Missing physician signature. The most common error; without the doctor’s written agreement, the form is void under §9780.1.
- Naming a disqualified specialty. Cardiologists, orthopedists, and dermatologists are not eligible; only family practice, general practice, internal medicine, OB-GYN, and pediatrics qualify.
- Listing a chiropractor on the M.D. form. Use DWC 9783.1 for D.C. and L.Ac.; the M.D./D.O. form will be rejected.
- No group health coverage. Predesignation only works if you have non-occupational health insurance; an uninsured worker cannot predesignate.
- Using a P.O. Box for the doctor. Claims administrators need a physical address for records transfer.
- Crossing out the MPN language. Altering the printed statutory paragraph voids the form.
- Failing to date the signature. Without a date, you cannot prove the form predated the injury.
- Using a nickname instead of legal name. HR may misfile the form and it will not surface when needed.
- Not keeping a copy. If the employer loses the original, you have no proof of timely filing.
- Naming a doctor who has not treated you before. The doctor must have directed your prior care and retain your records.
- Assuming the form covers spouses and dependents. It does not; only the employee who signs it is protected.
Do’s and Don’ts
Do sign the form on or before your first day of work, because the protection only attaches before injury.
Do ask your physician to sign first, then bring the signed form to HR so you can submit a complete package in one trip.
Do keep a scanned and a paper copy in two separate locations, because employers occasionally lose personnel files during mergers.
Do update your form within 30 days if you change personal physicians, because the old form names a doctor who no longer has your records.
Do confirm your group health coverage is active on the signature date, since lapsed coverage voids the predesignation under §9780.1(a)(1).
Do verify your doctor’s specialty qualifies by checking the Medical Board license lookup.
Don’t use white-out or correction tape on the form, because any alteration to statutory language can be challenged.
Don’t sign a blank form and ask HR to fill in the doctor’s name later; the doctor’s written agreement must come first.
Don’t rely on a verbal “yes” from your doctor; only a signed form or letter satisfies the regulation.
Don’t assume an MPN blocks all predesignation; it only blocks the chiropractor/acupuncturist predesignation, not the M.D./D.O. predesignation.
Don’t wait until after a minor injury to file, because once injured you lose the right to predesignate for that claim.
Don’t name a hospital or clinic as your “personal physician” unless it qualifies as an integrated multispecialty medical group under Labor Code §4600(d)(3).
Pros and Cons of Filing on Your Own vs. With Help
Most workers complete DWC 9783 without legal help, but the calculation changes when an MPN is involved or the worker has a complex medical history.
Pros of self-filing.
- Cost-free, because the form is a single page and requires no filing fee.
- Fast, since most workers can complete it in 20 minutes after the doctor signs.
- Empowering, because you control the choice of doctor without an intermediary.
- Private, since no attorney or third party needs to see your medical history.
- Universally accepted, because the form is the DIR’s own template.
Cons of self-filing.
- Easy to invalidate if any of the three statutory prongs is missed.
- No second set of eyes on whether your doctor’s specialty actually qualifies.
- Risk of submitting to the wrong HR person at a large employer.
- No follow-up reminder system if you change doctors and forget to update.
- No advocacy if the claims administrator later disputes the predesignation.
Pros of using an applicants’ attorney or HR consultant.
- The attorney confirms specialty eligibility before you submit.
- The attorney drafts a backup letter that supplements the form.
- A professional witnessed signature is harder to challenge at deposition.
- The attorney tracks the form for you across job changes.
- If a dispute arises, the attorney already has the file ready for the WCAB.
Cons of using help.
- Cost, because most applicants’ attorneys do not handle pre-injury work pro bono.
- Slower turnaround due to attorney scheduling.
- Privacy trade-off, since the attorney sees your medical history.
- Possible over-lawyering of a one-page form.
- Risk of attorney conflicts if you later hire a different firm post-injury.
FAQs
Do I write my maiden name or married name in the Employee Name field?
Yes — use whichever name appears on your employer’s payroll system. The form must match your personnel file exactly, so use the name HR has on record for you today.
Can I predesignate a doctor who works for Kaiser?
Yes — Kaiser qualifies as an integrated multispecialty medical group under Labor Code §4600(d)(3), so you may name either your individual Kaiser doctor or “Kaiser Permanente Medical Group.”
Is predesignation still valid if my employer has a Medical Provider Network?
Yes — an MPN does not block a valid M.D. or D.O. predesignation under Labor Code §4616.3(d). The MPN does block chiropractor and acupuncturist predesignation, however.
Do I need to list my doctor’s specialty in Field 2?
No — the form does not have a specialty box, but the doctor must in fact be a family practitioner, general practitioner, internist, OB-GYN, or pediatrician under §9780.1.
Can I use a P.O. Box in the Employee Address field?
No — use your residential street address. Claims administrators need a physical address to verify identity and venue under WCAB rules.
Does my doctor have to sign the form, or is a separate letter enough?
Yes — either works. A signed DWC 9783 or a separate signed letter from the doctor satisfies the written-agreement requirement of §9780.1(a)(3).
Can I predesignate a chiropractor on DWC 9783?
No — chiropractors must be named on the separate DWC 9783.1 form. A D.C. listed on the M.D./D.O. form will be rejected.
Is there a filing fee for DWC 9783?
No — there is no fee. The form is delivered to the employer, not to a state agency.
Do I have to file a new form when I change jobs?
Yes — predesignation is employer-specific. A new employer means a new form, ideally on day one of the new job.
Can I predesignate without health insurance?
No — non-occupational group health coverage is a statutory prerequisite under Labor Code §4600(d)(1).
Does the date in Field 6 need to match the doctor’s signature date?
No — the doctor may sign first, and you may sign later, as long as both signatures predate the injury.
Can my spouse or child use my predesignated physician for a work injury?
No — predesignation only protects the employee who signed the form. Spouses and dependents have no claim under DWC 9783.
How long does my predesignation stay valid?
Yes — it remains valid indefinitely with the same employer, as long as your group health coverage continues and your doctor continues to retain your records.
What happens if HR loses my form?
Yes — your dated copy with the physician’s signature is your backup proof. Resubmit immediately and ask HR to date-stamp the resubmission.
Can I name two doctors as backups?
No — the form allows one personal physician. If your primary doctor retires, file a new DWC 9783 naming the replacement.
Related reading
- How to Fill Out California WCAB Application for Adjudication of Claim + FAQs
- How to Fill Out California WCAB Compromise and Release + FAQs
- How to Fill Out California WCAB DWC-1 (w/Examples) + FAQs
- How to Fill Out California WCAB Permanent and Stationary Report + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs
- How to Fill Out California WCAB DWC-AD 10133.32 (w/Examples) + FAQs