Employees from occupational hearing conservation programs often do not get the expected and needed type of evaluation, diagnosis, or treatment from the clinical audiologist or physician. Often, there is a misunderstanding about how an occupational hearing conservation program works, what an occupational audiologist does, as well as what the management, employee, and occupational audiologist expect from the clinical audiologist and physician. The following cases demonstrate the problem. In the first case, a medical referral was made for a middle-aged female employee who showed a change in hearing with a mild, flat, hearing loss, bilaterally. She was exposed to significant levels of noise, 92-dBA time weighted average (TWA). The employee and supervisor reported the employee wore hearing protection devices (HPDs) consistently. The employee demonstrated correct insertion of the HPDs. A tuning fork test suggested a possible conductive component. The employee was referred to an otologic clinic for diagnosis at the company’s expense. A company notes audiograms were sent to the clinic. The report from the clinic showed noise-induced hearing loss as a diagnosis in view of positive otoacoustic emissions (OAEs) and indications of Eustachian tube dysfunction. When challenged, the audiologist offered to change the diagnosis.