What to Do When Your Personal Doctor Disagrees with the Company Doctor

Estimated reading time: 18 minutes

Key Takeaways

• When your personal doctor disagrees company doctor, act quickly: document every visit, notify the employer/adjuster in writing, and preserve evidence.

• Workers comp conflicting medical opinions are common; disagreements can stem from timing, specialty differences, diagnostic uncertainty, or context/incentives.

• In California, QME vs treating physician California rules mean a Qualified Medical Evaluator often decides disputes over causation, MMI, and permanent disability, while IMR addresses treatment denials.

• Build a strong medical record: detailed treating-physician reports, objective tests, consistent symptom logs, and contemporaneous documentation carry weight.

• If benefits or care are at risk in a doctor dispute work injury case, consider consulting a workers’ compensation attorney for case-specific guidance.

• This article is informational only; procedures and timelines can change—verify with your state agency and consult an attorney for advice specific to your situation.

Table of Contents

• Introduction

• Quick Summary / TL;DR

• Why Doctors Disagree in Workers’ Comp Cases

• Who’s Who: Treating Physician, Company Doctor, QME/AME, and IMR

• Treating Physician / Personal Doctor

• Company Doctor / Insurance Doctor

• QME (Qualified Medical Evaluator) — California-specific

• AME (Agreed Medical Evaluator)

• IMR (Independent Medical Review)

• QME vs Treating Physician California — How Disputes Are Resolved (California-specific)

• Common Scenarios of Differing Evaluations

• Immediate Steps to Take When Doctors Disagree

• Formal Dispute-Resolution Options in Workers’ Comp

• QME Process (California-specific)

• AME (Agreed Medical Evaluator)

• IMR Process and Timing

• Medical-Legal Evaluations and Hearings

• Other State Pathways

• How Conflicting Opinions Are Weighed

• How to Prepare for a QME or Medical-Legal Exam

• What to Bring to the Exam

• Requesting a Medicolegal Report from Your Treating Physician

• What to Expect at the Exam

• How the QME Report Affects Benefits and Treatment

• When to Hire an Attorney and What They Can Do

• Signs You Should Consult a Lawyer

• How an Attorney Helps in a Doctor Dispute Work Injury Case

• If You Cannot Afford an Attorney

• Practical Tips and Timelines

• Practical Documentation Tips

• Typical Timelines to Expect

• Sample Checklists You Can Build Yourself

• Immediate Actions Checklist

• Documents to Gather

• Symptom and Function Log Fields

• Short Anonymized Case Examples

• Case A: Surgery Approved After QME

• Case B: Causation Confirmed by QME

• Case C: IMR Approves Disputed Treatment

• Resources

• Conclusion

• FAQ

Introduction

When your personal doctor disagrees company doctor about your work injury, it can be scary and confusing. If your personal doctor disagrees company doctor in the first days of a claim, take control by documenting everything, notifying your employer and the claims adjuster in writing, and exploring dispute options like the QME/IME or IMR process. This guide explains why workers comp conflicting medical opinions occur, the roles of each doctor, the dispute paths available, and practical steps you can take right now to protect your medical care and benefits.

This is informational content only. Procedures and timelines vary by state and can change—consider contacting your state workers’ compensation agency or consult an attorney for advice specific to your case.

Quick Summary / TL;DR

When your personal doctor disagrees company doctor, move fast: document every visit and symptom, notify your employer and claims adjuster in writing, and ask your treating physician for a detailed written opinion (diagnosis, causation, restrictions, treatment plan). If treatment or benefits are affected, you may request a QME in California or use the applicable dispute process in your state, and consider seeking legal guidance if denials persist. Keep organized records and preserve all evidence; those details determine outcomes.

Why Doctors Disagree in Workers’ Comp Cases

Disagreements are common, not unusual. Workers comp conflicting medical opinions happen for predictable reasons, and understanding them helps you respond effectively. See a practical overview of common causes of conflicting opinions to better frame your next steps.

• Timing of evaluation. Your treating physician may have seen you from day one, while the company doctor evaluated you weeks later. Symptoms evolve; a strain may progress to radiculopathy, changing the diagnosis and return-to-work recommendation. This can affect authorization (e.g., initial rest vs. later PT or imaging).

• Different specialties. An orthopedist and a neurologist can interpret the same MRI differently; one may recommend surgery, while the other suggests conservative care. That difference might mean a surgical request is denied pending more therapy.

• Diagnostic uncertainty. Chronic pain and soft-tissue injuries often lack clear objective tests. One doctor may find limited range of motion and functional impairment; another focuses on normal imaging and says you can return to full duty, impacting wage-loss benefits.

• Incentives and context. An insurer-selected doctor works within the claims process and may emphasize guidelines and administrative rules. Instead of assuming bias, use the dispute procedures designed to resolve these normal conflicts.

These reasons do not automatically invalidate either doctor’s opinion. They explain why differing injury evaluations workers comp occur and why formal dispute processes exist.

Who’s Who: Treating Physician, Company Doctor, QME/AME, and IMR

Knowing the role of each medical evaluator helps you decide what to do next, especially when opinions clash.

Treating Physician / Personal Doctor

The treating physician manages your care and may be chosen by you (state rules vary). Their reports usually include diagnosis, a causation opinion (whether work caused or aggravated your condition), objective findings, recommended treatment, work restrictions, and whether you have reached MMI (Maximum Medical Improvement). If you are unsure about choosing a doctor or switching, this guide to choosing your own doctor in workers’ comp explains common rules and options.

Company Doctor / Insurance Doctor

The employer or insurer may send you to a doctor for an evaluation—often an IME or utilization review context. These opinions may limit treatment or say you can return to work sooner. If you disagree, preserve your treating doctor’s detailed records and follow your state’s dispute process.

QME (Qualified Medical Evaluator) — California-specific

In California, a QME is an independent evaluator certified through the DWC QME program. When a medical dispute arises (for example, causation, MMI, permanent disability), an injured worker or attorney can request a QME panel, select a QME from the list, attend the exam, and receive a medical-legal report. The QME report often carries significant weight at hearings before a judge. For background and forms, visit the California Division of Workers’ Compensation. (California-specific; rules vary in other states.)

AME (Agreed Medical Evaluator

An AME is a doctor both sides agree to use instead of a panel QME. Parties sometimes choose an AME in complex disputes, especially when represented by attorneys. An AME’s report typically has considerable influence in resolving a dispute.

IMR (Independent Medical Review)

IMR is used to resolve disputes about the medical necessity of treatment, usually after utilization review denies or modifies a request. IMR does not decide causation or permanent disability; it focuses on whether a treatment meets evidence-based standards.

QME vs Treating Physician California — How Disputes Are Resolved (California-specific)

When a medical dispute arises in California about causation, MMI, or permanent disability, the QME pathway is commonly used, and the QME’s reasoned medical-legal report carries substantial weight with judges. By contrast, IMR is used when treatment is denied, modified, or delayed after utilization review and does not resolve causation disputes. (Rules vary by state—check your agency or consult an attorney.) Learn more at the DWC’s QME page and the California DWC home.

Common Scenarios of Differing Evaluations

Here are frequent situations where differing injury evaluations workers comp appear, and what that can mean for your benefits and care.

• Different diagnoses. Example: herniated disc vs. muscle strain. Implication: surgery vs. conservative care. Action: ask your treating physician for a detailed write-up tying symptoms to objective findings; if coverage hinges on this, consider the QME process where applicable.

• Disputes about causation. Example: work-related vs. pre-existing condition. Implication: compensability and wage benefits. Action: collect prior medical history, job duties, and injury timeline that support work-related aggravation; see this overview on pre-existing conditions and workers’ comp.

• MMI and permanent disability disagreements. Example: one doctor says you’ve reached MMI, another says you need continued care. Implication: benefit transitions and future medical rights. Action: gather objective tests, specialist consults, and clarify functional limits; read about temporary vs. permanent disability and how impairment ratings affect outcomes.

• Work restrictions / fitness-for-duty conflicts. Example: light-duty limits vs. full-duty clearance. Implication: return-to-work obligations and accommodations. Action: request specific, task-based restrictions (lifting, pushing, pulling, standing, sitting); learn more in this guide on a safe return to work after injury.

• Recommended treatment intensity. Example: surgery vs. conservative care (PT, injections). Implication: authorization and timing. Action: ensure the treating doctor cites exam findings, imaging, and guidelines; if denied, IMR may be available for treatment disputes.

Tip: Keep copies of imaging and reports; bring them to any medical-legal exam so each evaluator is working from the same objective data.

Immediate Steps to Take When Doctors Disagree

When your personal doctor disagrees company doctor, follow this focused action plan. It doubles as a checklist you can build yourself.

1. Confirm your claim is filed and document every medical visit. Record the date, provider name, symptoms, diagnosis codes (if you have them), prescriptions, and treatment recommendations. Keep originals and a digital backup. If your claim isn’t filed, see how to file a workers’ comp claim step-by-step and consider California’s DWC-1 form download guide for CA examples.

2. Ask your treating physician for a detailed written opinion. Request diagnosis; a causation statement tied to clinical findings and imaging; recommended treatments and timelines; work restrictions; and whether you’ve reached MMI (and why). Specifics and objective references strengthen your position.

3. Notify your employer and claims adjuster in writing that you disagree with the company doctor’s opinion. Reference the date of the company exam, state you disagree, and attach or list supporting records from your treating physician (visit notes, imaging). Ask for confirmation of receipt and which dispute process applies (e.g., panel QME in California or your state’s equivalent). If communications stall, this guide on an unresponsive workers’ comp adjuster includes practical escalation steps.

4. Preserve and organize evidence. Keep medical records, imaging discs and reports, prescriptions, job description, accident report, witness contacts, and pay stubs showing missed work. A strong record supports you in any doctor dispute work injury case. For structure, see tips on documenting a work injury.

5. Request a second opinion or QME/IME/IMR when appropriate. A second clinical opinion can clarify diagnosis. In California, a QME is used for causation, MMI, or permanent disability disputes; IMR is used after treatment denials. Start at the DWC’s QME page for California-specific steps.

6. Keep a daily medical/functional log. Track date/time, pain (1–10), activities limited, medications and side effects, work limitations, and missed work. Consistent logs help resolve workers comp conflicting medical opinions.

7. If urgent symptoms arise, get immediate care and notify the adjuster. If a provider recommends urgent imaging or surgery, prioritize your health, then inform the adjuster in writing and add the records to your file.

Maintain a neutral, factual tone in communications. Clear documentation and timely requests often do more than arguments to resolve differences.

Formal Dispute-Resolution Options in Workers’ Comp

Different processes resolve different issues. Understanding which pathway applies helps you move efficiently from disagreement to decision.

QME Process (California-specific)

In California, a worker or their attorney requests a QME panel from the DWC’s QME program when there is a medical dispute (e.g., causation, MMI, permanent disability). A panel (list) is issued, you select one QME, attend the exam, and the QME issues a medical-legal report. Panels may be available within a few weeks, but timelines vary—verify current timeframes with the California Division of Workers’ Compensation (procedures and timeframes may change). QME reports are frequently used by judges to decide contested issues at hearings.

AME (Agreed Medical Evaluator)

When both parties agree on a single evaluator, they can select an AME instead of a panel QME. AMEs are common in represented cases and can streamline resolution. The AME’s report is typically given substantial weight.

IMR Process and Timing

IMR resolves disputes about medical necessity after a utilization review denial or modification. The IMR reviewer evaluates whether the requested treatment meets guidelines. Decisions often arrive in about 30–60 days (timelines can vary; confirm current rules through agencies or reputable advocacy sources such as the IMR process explained by Legal Aid at Work).

Medical-Legal Evaluations and Hearings

QME/AME reports, deposition testimony, treating records, and objective testing form the backbone of medical-legal evidence. Judges weigh reasoned opinions that cite exam findings, diagnostic imaging, and consistent history. If you need a deeper refresher on the role of medical-legal reports, see this overview of workers’ comp medical-legal reports.

Other State Pathways

States outside California may use panel IMEs, utilization review appeals, or state medical examiners. Check your state workers’ compensation agency for specific procedures (processes and timelines change).

How Conflicting Opinions Are Weighed

To resolve workers comp conflicting medical opinions, adjusters and judges look for consistent history, objective findings (imaging, tests), contemporaneous documentation, and reasoned medical explanations that tie symptoms and function to exam and diagnostic results. Detailed treating-physician notes and well-supported medical-legal reports often carry the day.

How to Prepare for a QME or Medical-Legal Exam

Preparation helps the evaluator see the full picture and reduces the risk of misunderstandings.

What to Bring to the Exam

• Complete medical records: recent visit notes, hospital records, clinic notes.

• Imaging: MRI/CT/X-ray films or CDs plus printed radiology reports.

• Medication list and proof of conservative care: PT notes, injections, home exercise summaries.

• Job description and employer incident report (duties, weights, tools/equipment handled).

• Your daily medical/functional log (dates, pain levels, limits, work impact).

• A concise one-page statement describing onset, course of symptoms, and specific functional limits at work and home.

Travel to a QME in California can be reimbursable—see this CA-focused guide to workers’ comp mileage reimbursement for covered costs and documentation tips.

Requesting a Medicolegal Report from Your Treating Physician

Ask your treating physician to include: diagnosis; causation analysis referencing exam findings and objective tests; functional limitations tied to specific tasks (lifting, pushing, pulling, standing, sitting, reaching); recommended treatment and timelines; and whether you have reached MMI (and on what basis). Precise, task-based restrictions also aid return-to-work planning; this return-to-work guide explains how restrictions translate into safe assignments.

What to Expect at the Exam

The QME/IME will review your records, ask about your history, and perform a focused examination. They may conduct provocative tests and document range of motion, strength, neurological signs, and pain behavior. The evaluator synthesizes findings in a medical-legal report that the adjuster and, if needed, a judge will review. If you want a primer on the process, see what a QME is in workers’ comp and preparation tips.

How the QME Report Affects Benefits and Treatment

The QME’s opinion often resolves disputes over causation, MMI, and permanent disability (California-specific), while IMR addresses whether denied treatment is medically necessary. The report can influence wage replacement duration, the transition from temporary to permanent benefits, and the scope of future medical care. If you are moving from temporary to permanent benefits, review this explainer on temporary vs. permanent disability and how that shift affects payments.

When to Hire an Attorney and What They Can Do

Legal support can be critical when medical disputes threaten necessary treatment or lost-wage benefits. This section is informational only; for case-specific guidance, consult a lawyer.

Signs You Should Consult a Lawyer

• Benefits or treatment remain denied after you followed the dispute process.

• Serious or complex causation questions (e.g., cumulative trauma, latent conditions).

• Large permanent disability exposure or potential major surgery.

• Repeated denials or delays causing financial hardship or job instability.

How an Attorney Helps in a Doctor Dispute Work Injury Case

• Review records and identify strengths/gaps in your treating physician’s medicolegal report.

• File the right requests: panel QME or AME, and ensure the correct issue (causation vs. medical necessity) follows the proper path (QME vs. IMR).

• Collect missing records, coordinate depositions, and represent you at conferences and hearings before a workers’ compensation judge.

• Negotiate settlement options, explaining trade-offs in light of impairment ratings and long-term medical needs.

To learn how firms typically guide injured workers, see this general overview of a workers’ compensation attorney’s role (educational article).

If You Cannot Afford an Attorney

Consider reputable nonprofit resources such as Legal Aid at Work for information and potential assistance. Availability and eligibility vary by location and program.

Practical Tips and Timelines

Practical Documentation Tips

• Keep a dated medical log summarizing pain levels, activities you can/cannot do, meds, side effects, and missed work.

• Scan and back up documents; a clear file naming convention (YYYY-MM-DD_provider_document-type) helps track the claim.

• Send important letters by email and certified mail; keep proof of delivery and a communications log.

• Ask your treating doctor to put diagnosis, causation, treatment plan, and restrictions in writing after each key visit.

• Respond promptly to requests for exams or records; missed deadlines can harm your position.

For structure and examples, explore this guide to documenting a work injury.

Typical Timelines to Expect

• QME panel availability (California): commonly a few weeks, but the queue varies—verify with the California DWC.

• IMR decisions: often 30–60 days depending on program timelines; confirm current guidance through resources like Legal Aid at Work.

• Hearings/appeals: several months is common depending on docket backlogs.

Timelines vary — check DWC or your state agency. California-specific information is on the California Division of Workers’ Compensation. If a denial persists during these waits, consult this explainer on appealing a workers’ comp denial.

Sample Checklists You Can Build Yourself

Rather than using templates, build simple checklists you can maintain and update as your case progresses.

Immediate Actions Checklist

• Confirm the claim is filed and you have claim/adjuster info.

• Collect a detailed treating-physician opinion (diagnosis, causation, restrictions, treatment plan, MMI status).

• Notify the employer/adjuster in writing that you disagree with the company doctor’s opinion and attach supporting records.

• Request the appropriate dispute path (QME/IME; IMR for treatment denials) when benefits or care are affected.

• Keep a daily symptom and function log.

Documents to Gather

• Medical records (clinic/hospital notes, specialist consults) and imaging (reports and discs).

• Prescriptions and proof of conservative care (PT notes, injections).

• Job description, injury/incident report, and witness names if applicable.

• Pay stubs, schedule records, and any proof of missed work.

• All letters/emails to and from your employer/insurer; delivery receipts.

Symptom and Function Log Fields

• Date/time, pain level (1–10), and location of pain or numbness.

• Activities you could not do or could do only with difficulty (lifting/pushing/pulling, standing/sitting duration).

• Medications taken and side effects.

• Work restrictions experienced during shifts; missed work days/hours.

Short Anonymized Case Examples

Case A: Surgery Approved After QME

Background: Jane’s treating orthopedist recommended surgery; the company doctor recommended only PT. Action: Jane organized imaging and detailed treating notes and pursued a QME. Outcome: The QME agreed surgery was reasonable based on objective findings; surgery was authorized. Lesson: Detailed medicolegal support and consistent documentation resolved workers comp conflicting medical opinions.

Case B: Causation Confirmed by QME

Background: Mike’s personal physician linked his shoulder tear to repetitive overhead work; the company doctor blamed a pre-existing condition. Action: Mike gathered task descriptions, prior medical records, and early treatment notes and requested a panel QME. Outcome: The QME found work-related aggravation; wage and medical benefits continued. Lesson: Clear timeline and job-duty evidence help in a causation dispute.

Case C: IMR Approves Disputed Treatment

Background: A treating physician requested injections; utilization review denied them. Action: The worker submitted an IMR with recent treatment notes and evidence-based citations from the physician. Outcome: IMR overturned the denial and approved injections. Lesson: For treatment disputes, IMR focused on medical necessity and supporting guidelines.

Resources

• California Division of Workers’ Compensation — agency page with forms, procedures, and updates (California-specific).

• How to request a QME — DWC QME page — official information on panel requests, exams, and reports (California-specific).

• Legal Aid at Work — worker advocacy and educational resources, including IMR-related information.

• WorkInjurySource — practical articles and explainers about work injuries, benefits, and disputes.

For foundational context, you can review these educational articles: how to file a workers’ comp claim, choosing or changing a workers’ comp doctor, and understanding the QME process.

Conclusion

When your personal doctor disagrees company doctor, remember that disagreement is common and solvable. The fastest path to clarity is strong documentation: comprehensive treating-physician reports, consistent symptom logs, and the correct dispute pathway (QME vs. IMR). If workers comp conflicting medical opinions are stalling care or pay, consider getting legal guidance; it can make the difference in how evidence is presented and weighed. This article is informational only; consult an attorney for advice specific to your situation, and verify current procedures through your state agency.

Need help now? Get a free and instant case evaluation by US Work Accident Lawyers. See if your case qualifies within 30-seconds at https://usworkaccidentlawyer.com.

FAQ

Can the company doctor stop my treatment?

A company or insurance doctor can recommend stopping or changing treatment, but you can dispute that through your state’s process. In California, you may request a QME for disputes about causation, MMI, or disability, and use IMR for treatment denials. Document your care and keep your treating provider’s records current to support your doctor dispute work injury case.

Who decides when opinions conflict?

It depends on the issue and the state. In California, a QME/AME often decides disputes over causation, MMI, or permanent disability, while IMR addresses treatment denials. Elsewhere, similar mechanisms exist through the state’s workers’ comp agency; they are designed to resolve workers comp conflicting medical opinions.

Does a QME override my treating physician?

In California, the QME’s well-reasoned report often carries significant weight in legal disputes, but the treating physician’s contemporaneous records and objective findings remain important. If you disagree with a QME, options may include seeking an AME (if both sides agree) or asking a judge to weigh the evidence.

What if I disagree with the QME?

You may pursue an AME if the parties agree, or ask a judge to resolve the dispute based on the record and testimony. Consider consulting an attorney for case-specific guidance in a doctor dispute work injury case.

How long will it take to resolve a dispute?

Timelines vary. QME panels may be issued within weeks; IMR decisions often take 30–60 days; hearings can take several months depending on backlog. Verify current timing with your state agency, as differing injury evaluations workers comp processes can change.