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Quality Review Board and SSA Disability Decisions

Do I want my disability case reviewed by the Quality Review Board?

Recently on our disability forum we had a user ask, “It seems that my case has been approved but I received notification that my case was sent to the Quality Review Board for review. Will this hurt my case? Are they just trying to make sure that the Disability Determination Services office (DDS) did their job?”

The Social Security Administration has created quality assurance programs that are directed by the Office of Quality Performance. According to the SSA, “OQP has ten regional field sites around the country that measure and monitor our services in all 50 states. Each regional field site contains two program branches:  The Assistance and Insurance Program Quality Branch (AIPQB) and the Disability Quality Branch (DQB).”

Why did the SSA establish a qualify review board? Their goal is to ensure “the laws, regulations, and policies of the SSA administration are applied equally and fairly to each individual that contacts the agency.”

Purpose of the Quality Review Board

According to the SSA, the quality review board ensures that everyone from the medical examiner to the disability adjudicator is doing their job. It is a checks and balance of the disability process to ensure that the regulations established by the SSA are followed by each state DDS office. This is done by allowing a reviewer, who is trained in each aspect of the process, to find any discrepancies.

While reviewing the claim the reviewer may choose to overturn the examiner’s decision or they may request more information about the Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) case.

Complaints about the Quality Review Board

Like most SSA processes there have been complaints about the Quality Review Board: they are just reviewing cases which have been approved, it adds time to the disability process and winning benefits at a higher level can be tough if the quality reviewer has agreed you are NOT disabled.

1. Reviewing cases which have been approved

There have been some complaints that the cases which are intercepted by DQB, reviewed, and then sent back to DDS, or disability determination services, to be worked on again were often the cases which were marked for approval and not the cases that had been marked for denial.  Some argue this is because the SSA is trying to limit the number of cases which are approved.

2. Time added to the processing of the claim

If your claim has been chosen for a Quality Review it will be delayed. How long is anyone’s guess. It could be a few days, a few weeks or a few months, depending on who has to review the case and whether they have to request additional medical information.

3. Winning on appeal after a Quality Review

If you are denied after a Quality Review it is more unlikely that if you decide to file a reconsideration and appeal your denial you will continue to be denied again. Why? Because your case has been reviewed in detail and not only did the disability examiner decide you were not disabled but a quality review specialist also agreed with the denial decision.

So to answer the disability applicant’s question- if your case was going to be approved it is better if it is not reviewed by the Quality Review Board. If you had been denied, it will depend- if the Quality Review Board reverses the denial it’s good, if they agree with the denial it could hurt your case if you decide to appeal the denial decision.
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