49 CFR § 391.47
Resolution of conflicts of medical evaluation
See your compliance status for this section
3-minute free audit. CFR-cited gap report. No signup.
What does 49 CFR § 391.47 require?
49 CFR 391.47 provides a dispute-resolution path when a medical examiner has determined a driver is unqualified under 49 CFR 391.41 but the driver (or a treating specialist) disagrees. The driver submits relevant medical records and specialist opinions to FMCSA, which reviews and issues a binding determination. This pathway is used most often for cardiovascular conditions, neurological conditions, and complex multi-condition cases where the standard medical examiner may lack specialty expertise. Resolution takes 30-90 days typically.
Regulation text (summary)
Applications for determination of a driver's medical qualifications under physical standards in 49 CFR 391.41 may be submitted to FMCSA when there is a disagreement between the medical examiner and another medical specialist or where the driver believes the medical examiner's determination is incorrect. FMCSA's Office of Carrier, Driver, and Vehicle Safety Standards reviews submitted medical records and issues a final determination on the driver's physical qualification.
Read full regulation at eCFR.govWho must comply with 49 CFR § 391.47?
Drivers seeking to challenge a medical examiner's disqualification determination, and motor carriers supporting such challenges. FMCSA's review process is voluntary — the driver can also choose to accept the disqualification and pursue retesting after the underlying condition is treated.
What happens if you violate 49 CFR § 391.47?
49 CFR 391.47 itself does not create a violation pathway — it is a dispute resolution mechanism. However, a driver who operates a CMV during a pending FMCSA review (i.e., before FMCSA issues a final determination overturning the examiner's disqualification) is operating while unqualified, subject to standard 49 CFR 391.11 enforcement.
Penalty range
Annual citations
YoY penalty trend
How to comply (implementation checklist)
- 1When a driver receives an unfavorable medical determination, advise them of the 391.47 review option.
- 2Compile relevant medical records (specialist evaluations, treatment history, imaging) for FMCSA submission.
- 3Submit the application to FMCSA's Office of Carrier, Driver, and Vehicle Safety Standards with required documentation.
- 4During the pending review, ensure the driver does NOT operate a CMV — they remain unqualified.
- 5Document the application date and FMCSA case number in the DQF.
- 6Upon FMCSA determination, update the DQF and resume or maintain dispatch decisions accordingly.
Common misinterpretations
- Misinterpretation: 'I can keep driving during the FMCSA review.' Reality: The driver remains unqualified until FMCSA issues a final determination overturning the disqualification. Operating during the review period is a 391.11 violation.
- Misinterpretation: '391.47 is the same as the 391.49 exemption program.' Reality: 391.47 resolves CONFLICTS in existing medical evaluations. 391.49 is for drivers seeking ALTERNATIVE qualification standards (monocular vision, hearing, ITDM, etc.) where standard 391.41 cannot be met.
- Misinterpretation: 'FMCSA always sides with the driver.' Reality: FMCSA reviews the medical evidence on the merits. Outcomes are split — some drivers are restored to qualified status, others have the examiner's disqualification affirmed.
Real enforcement examples
Anonymized from public FMCSA enforcement summaries. Penalty amounts reflect assessed and final settled values where disclosed.
Driver disqualified for cardiovascular condition successfully obtained FMCSA review in 2024 — specialist evaluation supporting fitness was accepted; driver restored to qualified status with 6-month certificate validity.
Source: FMCSA medical review summaries, anonymized
Carrier received $13,200 penalty in 2025 after allowing a driver to operate during a pending 391.47 review. The carrier had assumed the application stayed the disqualification, which it did not.
Source: FMCSA SafetyNet 2025 enforcement summary, anonymized
How FileFlo handles 49 CFR § 391.47
FileFlo's compliance rule-pack MED-49CFR391.47 automatically checks every document you upload against this regulation. Auto-detects document type, parses key fields, sets renewal alerts, and surfaces this section in your audit binder if a gap is found.
Already evaluating? Start a 5-day free trial →
Frequently asked questions
What is 49 CFR 391.47 used for?▾
Resolving disputes about a driver's medical qualification when the medical examiner and a treating specialist disagree, or when the driver believes the examiner's determination was incorrect. FMCSA reviews medical evidence and issues a binding determination.
Can my driver keep driving while FMCSA reviews?▾
No. The driver remains unqualified until FMCSA issues a final determination overturning the disqualification. Operating during the review is a violation.
How long does FMCSA review take?▾
Typically 30-90 days depending on case complexity and the volume of medical evidence submitted.
How is 49 CFR 391.47 different from 49 CFR 391.49?▾
49 CFR 391.47 resolves conflicts in MEDICAL EVALUATIONS — used when the examiner and a specialist disagree. 49 CFR 391.49 provides an ALTERNATIVE qualification pathway for drivers who cannot meet 49 CFR 391.41 (monocular vision, ITDM, hearing). Different problems, different solutions.
What conditions commonly use the 391.47 review?▾
Cardiovascular conditions (especially post-MI, post-stent, post-CABG), neurological conditions (seizure history, post-stroke), psychiatric conditions, complex multi-system disease where standard medical examiners may lack specialty expertise.
Who pays for the 391.47 review?▾
There is no FMCSA fee. The driver (or carrier supporting the application) covers any cost of obtaining additional specialist evaluations and medical records to submit with the application.
Related regulations
Related guides
Sources + reviewer
Primary source: eCFR.gov: 49 CFR § 391.47
Reviewed by Chad Griffith (Founder + CEO, FileFlo) on