The Short Answer: Social Security Disability Insurance (SSDI) quality reviews aren’t necessarily good or bad for your disability claim. They’re just Social Security’s way of ensuring its disability decisions are accurate and comply with federal rules. A quality review may not change the decision on your claim for better or worse, but it’s possible, so our disability attorneys understand if you’re nervous after receiving notice your approved claim is being reviewed. Read below for more.
The Social Security Administration (SSA) sometimes double-checks decisions on awarding disability claims by conducting a “quality review.”
It randomly grabs a group of recent decisions on Social Security Disability Insurance (SSDI) benefits and looks for reasons why denied benefits should be approved, or approved benefits should be denied.
So it’s possible for a quality review to change the result of your disability claim.
A division in Social Security called the Office of Quality Review will also look for other problems in the way claims examiners decided your case—even if their findings don’t change the outcome.
People sometimes call these reviews “quality branch reviews.” Anyone trying to get Social Security Disability benefits who hears about this process might wonder, “Is an SSDI quality review good or bad for my disability claim?”
For the claims examiners who made decisions on cases, the reviews absolutely can have consequences because the results reflect on their own job performance.
For people applying for Social Security Disability benefits, it’s more difficult to tell whether reviews tend to hurt their chances at getting benefits overall, or if they don’t make much difference.
About 1 percent of claims get picked for quality reviews. One thing that’s certain is that if your case is picked, it will cause a delay in how long it takes for you to receive benefits. It could be weeks or months.
The Social Security Disability lawyers at the Levine Benjamin Law firm have helped thousands of people in Michigan and Ohio win disability benefits. And we’ve seen it all.
In this blog post, we’ll explain what happens in an SSDI quality review and how you can protect yourself in the process.
What Happens in a Social Security Disability Quality Review
When Social Security does a quality review on a disability claim, it focuses on the initial decision on your disability application as it was handled by your state’s office of Disability Determination Services (DDS).
The people in DDS offices aren’t directly employed by Social Security; instead, they’re with your state government. So this is a way for Social Security to check their work.
This is a summary of Social Security’s own instructions on what its quality reviewers will do when they examine a case:
- Review all the documents in the case
- Check to see if the evidence in the case supports the decision that was made to award or deny benefits
- If everything lines up, declare it a “clean case”
- If there’s a problem, determine if a medical or psychological consultant should review the case
- Decide if the problem means the decision on awarding or denying the claim should be reversed
- Decide if an error would change the period of time that a person is officially be considered to have a disability for the purposes of granting benefits
- Decide if there’s an error in the process that needs to be corrected, but it doesn’t change whether someone’s benefits are approved or for what period of time
- Write down a clear explanation of the problem found
- Possibly send the case back to the original decision-maker at Social Security with instructions on what to change
SPECIAL NOTE: This is different from a Continuing Disability Review (CDR), in which you’re already receiving Social Security Disability benefits but after a period of years, the government checks to see if you’re still eligible.
When an SSDI quality review impacts a disability claim, the disability attorneys at Levine Benjamin make it their mission to protect their clients’ rights throughout the process.
If you’ve heard your case is under quality review, and you’re not sure what to do next, you can learn more about your options by talking to our disability law firm for a free case consultation.
How an SSDI Quality Review Could Affect Your Disability Case
These are the major impacts you may see from an SSDI quality review of your application for disability benefits:
No. 1: It could delay the final decision on your case—and when you start receiving benefits. The length of delay will depend on the complexity of your case.
No. 2: It could lead to a reversal of the decision, which could work in your favor, or against you.
No. 3: It could change how much you’ll receive in back benefits when you’re awarded benefits. If the review finds that your qualifying disability started longer ago than what was previously decided, you could receive more in back pay. But if they move the date later, you would get less.
One of the most important things you can do to protect your rights if your disability application gets flagged for a quality review is to work with an experienced disability lawyer.
A quality review hitting your case isn’t your fault, and you shouldn’t suffer for it.
This is what your lawyer can do:
- Keep you informed about what’s going on with your claim
- Make sure your needs aren’t forgotten in Social Security’s process
- Help you appeal the decision if you end up getting denied
If a review leads to a denial, you can still appeal that decision just like any other denial.
A disability attorney who thoroughly understands how the Social Security Disability system works may be able to use information from the quality review to correct or improve your argument for disability benefits going forward.
At Levine Benjamin, we mean it when we say, “From applying to appealing, we help you every step of the way.”
If you have questions about quality reviews or any other part of your disability claim, get in touch with us.
Frequently Asked Questions About SSDI Quality Reviews
If you’re applying for disability benefits and you’ve had your application selected for a quality review, you probably have questions.
You can schedule a consultation with our Detroit disability lawyers to talk about your specific situation. Below, check out some answers to the most common questions about getting your claim picked for a Social Security Disability quality review.
What is a federal quality review?
A federal quality review (FQR) is an internal SSA process in which the government checks if it is making a disability decision correctly and following federal rules.
Agencies in every state conduct initial evaluations of disability benefits applications. FQRs help the Social Security Administration determine if states are properly handling disability claims.
Can a federal quality review change my disability decision?
It is possible that a federal quality review could change the decision on your disability claim. It could work out against you, or it could work to your benefit.
If the SSA thinks claims evaluators didn’t follow proper procedures, a denial could change into an approval, or an approval could change to a denial.
If you get denied disability benefits after an FQR, you can still go through the appeals process to argue why you should receive benefits.
How much time does a federal quality review add to my case?
Some disability applicants report getting a notification that a federal quality review will take seven to 10 days, but wait times can get longer—weeks or months—depending on the complexity of your disability claim, whether reviewers found a problem and the workload facing state and SSA employees.
What percentage of claims are affected by a quality review?
Social Security doesn’t publish precise statistics about how many claims go through this process. The process for selecting which cases to review is random. People who work with the disability system estimate around 1% of claims get picked for FQRs.
What is a Federal Pre-Effectuation Review (PER)?
It’s easy to mix up a federal quality review with a federal pre-effectuation review (PER) of your disability claim. Half of all disability approvals go through the extra check of a PER as part of the process of confirming decisions to award benefits. So by all available accounts, it is much more common than an FQR.
The PER isn’t meant to spot-check the claims evaluators like an FQR. Instead, it’s a built-in process to maintain accuracy in the entire Social Security Disability process.
Can an SSDI quality review affect my back pay?
In some cases, a quality review of your SSDI claim could affect your back pay if the review determines the established onset date of your disability is different from what you were approved for. Social Security calculates your back pay starting from your onset date.
If the review finds that your medical condition began earlier, you would receive more back pay. If the review finds that it began later, that could reduce how much you receive in back benefits.
Is a federal quality review the same as a continuing disability review?
No, a federal quality review happens after the state agency makes its decision but before Social Security finalizes your award or denial.
A continuing disability review is a check into the claims of people who are currently receiving disability benefits.
