This guide breaks down what a second opinion is (and isn’t), how it differs from a QME, where deadlines trip people up, and the common mistakes that quietly cost injured workers time, money, and health.
Quick take: What is a “second opinion” in workers’ comp?
A second opinion means another treating doctor reviews your diagnosis or treatment plan, often because you disagree with your Primary Treating Physician (PTP). Typical triggers:
“You’re released to full duty” when you can barely lift a grocery bag.
“No surgery needed” even though your symptoms are worsening.
A diagnosis that doesn’t match what your body is telling you.
In California, second opinions generally happen within the insurer’s Medical Provider Network (MPN). There are exceptions, but assume MPN first.
Real talk: People don’t ask for second opinions when everything’s going great. If you’re considering one, your gut is already flagging a problem. Listen to it.
Second opinion vs. QME: They’re not the same thing
This confusion causes a ton of delays, so let’s separate the roles:
Second opinion (treating doctor):
Focused on diagnosis or treatment. This doctor can recommend care (e.g., imaging, PT, injections, surgery) and submit requests that go through Utilization Review (UR) and, if denied, Independent Medical Review (IMR).QME (Qualified Medical Evaluator):
A non-treating evaluator who writes a med-legal report about disputed issues (causation, permanent impairment, work restrictions, MMI, etc.). A QME does not treat you or push treatment through UR. Their report can heavily influence your benefits, good or bad.
Which one do you need?
Fighting about treatment (“Do I need surgery? More PT? Imaging?”) → start with a second opinion.
Fighting about causation, disability level, MMI status, or work restrictions → that’s a QME issue.
Why timing matters (and where people lose rights)
In workers’ comp, the calendar is as important as the chart.
If you’re unrepresented and request a second opinion, you typically need to notify the adjuster/employer that you dispute the PTP’s opinion and schedule the second-op within about 60 days (usually inside the MPN). Miss windows, and you can waive options.
QME timelines are strict too, from requesting the panel to the doctor’s deadline to issue a first report. If a QME report is late and someone properly objects, a replacement panel can be issued. (Strategy matters here.)
Getting labeled MMI (Maximum Medical Improvement) early can cut off Temporary Disability (TD) checks and push you toward a settlement before you’re ready. If you disagree with an early MMI call, you need to act quickly and through the right channel (often QME).
Remember: Delays are part of the system. Deadlines are how you fight back.
You may also like: Your Medical Treatment Can Impact Your Workers’ Comp Benefits
The MPN roadblock (and what to do about it)
Most claims require you to treat within the Medical Provider Network. That can feel limiting—especially if you trust a personal doctor through a spouse’s plan. In most cases, outside opinions won’t carry weight unless you’ve lawfully gotten out of the MPN (there are exceptions, but they’re technical).
What to do instead:
Use your MPN rights to switch PTPs or get a second opinion within the network.
If a requested treatment is denied by UR and then IMR, look for what blocked approval (e.g., missing psych clearance before a back surgery request, smoking cessation requirements, inadequate documentation) and fix that. Then resubmit when circumstances change.
Common pain points (you’re not alone)
“My doctor barely examined me and sent me back to work.”
“I can’t lift 10 pounds, but my note says I can lift 50.”
“The QME never treated me, why do they get the final say?”
“I missed one appointment and now everything’s delayed.”
“I was told I’m at MMI, but I still need treatment.”
The system is designed to get you back to work. That’s why weekly wage benefits have hard caps and time limits (e.g., TD generally maxes at 104 weeks, with rare exceptions). Plan your moves with that reality in mind.
Readers are also interested in: When Do I Need a Third Opinion?
A simple playbook to use your second opinion wisely
Write down the dispute.
“The PTP says light duty; I can’t lift 5 lbs without pain.” Specifics help the next doctor help you.Ask for your records now.
Notes, imaging or UR denials. Bring the paper trail to your second-op so they can address the right criteria.Stay inside the MPN (unless you’ve lawfully exited).
Pick a doctor known for thorough exams and detailed charting.Document functional limits in real life terms.
“Can stand 10 minutes. Pain 8/10 after sitting 30 minutes. Drops objects with right hand.” These details anchor better work-status notes.If treatment is denied, fix the reason.
UR/IMR denials often cite missing prerequisites. Knock those out, then re-request.Know when it’s a QME issue.
Disputes over MMI, causation, or permanent impairment usually need a QME (not a second-op).If a QME is already set and you just hired counsel—ask before you go.
In limited scenarios, not attending the first exam (under attorney direction) can allow a different specialty/panel. Once you’re examined, you’re often stuck with that QME.
Red flags that mean “move now”
You’re released to full duty, but basic tasks spike your pain.
You’re stamped MMI while treatment disputes are still unresolved.
Your TD checks stop because of an MMI finding you disagree with.
A QME appointment is on the calendar and you don’t have representation.
The doctor says your condition isn’t work-related and you disagree.
Mistakes to avoid
Waiting. Most damage happens early: conservative clinics, rushed exams, low disability ratings, “no future medical.”
Assuming the QME will order treatment. They won’t. Only your treating doctor can submit requests into UR.
Using an outside, non-MPN doctor for the second opinion (and expecting it to carry weight).
Missing deadlines for scheduling second-ops or objecting to late/defective QME reports.
Going to a QME alone without understanding specialty or reputation. Panels involve chance; strategy matters.
FAQ: Fast answers to the questions everyone asks
1. Is a second opinion the same as changing my PTP?
No. You can seek a second opinion and still switch PTPs within the MPN if allowed.
2. Can I bring a second opinion from my own private doctor?
Usually no, not if you’re bound to the MPN. Talk to an attorney about exceptions.
3. What if the QME report is terrible?
Options include deposing the QME, submitting stronger treating-doctor evidence (e.g., a detailed P&S/PR-4 report when appropriate), or through litigation. Asking the judge to order an IME in place of the QME in limited circumstances.
4. UR denied my surgery. Am I stuck for a year?
Often, yes, unless you can show a change in circumstances (e.g., new imaging, completed prerequisites). Then you can re-request.
5. Do I really need a lawyer?
You don’t have to. But the insurer has a defense attorney. Having an applicant attorney early helps you avoid landmines and focus on healing.
Bottom line
If you’re searching for a workers’ comp second opinion, something already feels off and that’s your cue to act. Use your MPN rights, document your real-world limits, watch the deadlines, and route the right disputes to the right process (second-op for treatment, QME for med-legal issues). Above all, protect your dignity, your health, and your timeline.
Questioning a doctor’s decision or feel unheard in your recovery? Don’t navigate it alone, visit www.pacificworkers.com or call (800) 606-6999 for a free consultation.
About the Author
Bilal Kassem President and Co-founder
Bilal Kassem is the co-founder of Pacific Workers and a nominee for Applicant Attorney of the Year. With a deep-rooted passion for helping injured workers, Bilal leads with empathy and empowers his team to deliver world-class service from the very first interaction.
In addition to representing thousands of injured workers across California, Bilal has built a proven track record handling complex medical disputes, including second opinions and QME issues. His deep knowledge of the workers’ comp system and ability to identify strategic medical pathways has helped countless clients secure essential treatment and fair compensation when it mattered most.