The Social Security Disability Quality Review Process

When you apply for Social Security disability benefits, a claims examiner with the Disability Determination Services (DDS) agency in your state will review your application to determine if you're disabled. The decisions made by DDS claims examiners are made according to a set of standards that are set out by the federal Social Security Administration (SSA).

Why Does the SSA Review DDS Decisions?

Even though each state Disability Determination Services agency is funded by the federal government, DDS claims examiners aren't employees of the SSA or under the agency's direct supervision. To make sure that each DDS agency is making disability determinations that are in line with federal policies and standards, the SSA conducts a Quality Review Process to ensure consistency across states.

How Does the Quality Review Process Work for Social Security?

The SSA randomly samples disability applications from each DDS at regional Social Security offices called Disability Quality Branches (DQB), sometimes referred to as "Quality Control."

Quality Control reviews both decisions awarding benefits and decisions denying benefits.

Overall, roughly one in every 100 cases is pulled from a DDS to be part of the sample reviewed by Quality Control. If your case is selected for "QC review," the SSA will notify you that your case is going to be reviewed (but the notification won't tell you whether your claim has been approved or denied).

What Are the Steps of the DQB Quality Control Process?

When your case is selected for quality control, the DQB reviews your case to ensure that the DDS claims examiner who made a decision on your application did their job properly.

Reviewing a Claim for Quality Control

For the DQB, reviewing a claim includes:

• making sure that the medical evidence in your file supports the examiner's decision
• checking that all medical documentation that is required is in your file
• determining that the vocational rules were applied properly, and
• reviewing whether you were given the correct residual functional capacity (RFC).

What the DQB Can Do After a Quality Review

Depending on whether quality control agrees with your previous award or denial, the DQB will then do the following:

• agree with DDS that you qualify for benefits and send your application to the payment processing center
• agree with DDS that you don't qualify for benefits and close your case
• overturn DDS's decision that you are disabled and "return" your claim to DDS, or
• overturn DDS's decision that you aren't disabled and award you benefits.

Quality control can send back ("return") cases to the DDS to be fixed if the DQB thinks your application was decided improperly or has technical issues, such as missing paperwork. (Managers at DDS view returns from DQB as black marks on their agency's processing statistics and frown upon examiners who have too many returned cases each year.)

If your case is chosen for review by the DQB, it will take longer for you to get an answer about whether or not you'll receive disability benefits. You'll likely receive a decision on your initial application much later than the average of four to six months that it usually takes for DDS to make decisions on initial applications.

Does DQB Review Administrative Law Judge Decisions?

Even if you've received a favorable decision from an administrative law judge (ALJ), your decision can still be reviewed. But it will be reviewed by the Social Security's Office of Appellate Operations (OAO). OAO has its own quality control branch that randomly selects favorable ALJ decisions and reviews them to make sure that the judge followed SSA policies and procedures.

OAO can pull favorable decisions for review within 60 days of the date of the ALJ decision. You'll receive a notice in writing if your case was chosen for review. Unlike DQB, OAO doesn't randomly review unfavorable ALJ decisions. If you were denied benefits after a disability hearing, you'll have to appeal the decision yourself.