When you apply to Social Security for disability benefits, the Disability Determination Services (DDS) agency in your state reviews your application to determine if you are medically disabled. The decisions made by DDS claims examiners are made according to a set of standards that are set out by the federal government.
Why the SSA Reviews DDS Decisions
Because DDS claims examiners are not employees of the Social Security Administration (SSA) or under the SSA's direct supervision, the SSA conducts "Quality Assurance" reviews to make sure each DDS is making disability determinations that are in line with federal policies and standards. This ensures that there is consistency in applying those standards to all Social Security disability applications, regardless of where the applicant lives.
Selection of Cases to Be Reviewed
The SSA's Quality Assurance Review Board looks at a sample of disability claims from each DDS at regional offices called the Disability Quality Branches (DQB), sometimes referred to as quality control. Each DQB reviews selected Social Security disability cases from each DDS. The cases that are reviewed are selected randomly from all of the cases that were decided by the DDS, including decisions awarding benefits and decisions denying benefits. Overall, roughly one in every 100 cases are pulled from a DDS to be a part of the sample to be reviewed by DQB. If your case is selected, you be notified that your case is going to be reviewed.
How the DQB Reviews a Case
If your case is selected, the DQB reviews your case to ensure that the employee (the claims examiner) who made a decision on your application did their job properly. This includes making sure that there is medical evidence in your file to support the examiner's decision and that all documentation that is required is in the file. The DQB will also consider whether the examiner considered your medical evidence appropriately and in its entirety, whether the vocational rules applied properly, and whether you were given the correct RFC (residual functional capacity rating).
Results of DQB Reviews
After the review, there are a few things that can happen. If the DDS approved you for disability benefits, the DBQ can agree with the decision and send your application through to the SSA so that you begin to receive benefits. If the DDS denied you for disability benefits, the DBQ can agree with the decision and close your case.The DBQ also has the power to overturn the application ruling made by DDS; the DBQ can overturn rulings to award benefits or to deny benefits.
If there are technical problems with your application that the DQB finds, such as missing paperwork, the DQB may send your entire application back to DDS to be fixed. Cases that are found to have technical errors, or are reversed entirely, are sent back to the DDS as "returns." (Managers at DDS view returns from DQB as black marks on their agency's processing statistics---and frown upon any examiner who has more than a minimal number of returned cases each year.)
One thing that is certain is that if your case is chosen for review by the DQB, it will increase the time it takes for you to get an answer about whether or not you will receive disability benefits.
Learn more about the Social Security process here: Filing for Social Security Disability