Quality Assurance Review for my SSDI case?Recently on our legal forum a user asked, I have been waiting almost a year to receive Social Security Disability Insurance (SSDI) benefits for a severe back injury I suffered in a car accident. I recently received notification that the SSA Office of Quality Assurance and Performance Assessment is going to review my case. Should I be concerned and will this increase the time I will have to wait for my SSDI benefits?
What is a Quality Assurance Review?Social Security Administration field offices review SSDI applications to ensure the applicant meets the nonmedical requirements to qualify for Social Security Disability Insurance benefits. If they do, the SSDI application is sent to a state office for further review. State names for this office can differ by state, but it is most commonly referred to as Disability Determinations Services (DDS). Although the staff at DDS offices are not employees of the federal government or the Social Security Administration (SSA), the SSA has created standards and policies and procedures that they intend for the DDS to use to make their medical determination for each disability case. To ensure that these policies and procedures are followed, however, the SSA Quality Assurance Review Board will routinely request a sample of cases from different state DDS offices. They will perform what is termed a Quality Assurance Review. Reviews may be performed on cases which have been decided and approved or denied or those which are currently still under review.
Will a Quality Assurance Review increase the processing time for my SSDI application?Unfortunately, if your SSDI case has been pulled for review it will most definitely increase the time you will have to wait to receive benefits. In fact, the review time could increase the wait time by weeks or by months. The case may even have to be sent back to the original SSDI case examiner for further review. If your case has been pulled for a Quality Assurance Review you should be contacted by the SSA. Although this is not always the case, the SSA is supposed to keep you abreast of changes in your SSDI application status. If you have questions about the status of your case you should contact the SSA at 1-800-772-1213. Why was my SSDI case chosen for a Quality Assurance Review? One in every one hundred cases is randomly chosen from each DDS office for review. Cases chosen include those which were denied benefits, those approved for benefits, and those still under review. If your case was chosen it not only lengthens the processing time, several other outcomes are also possible:
- If your case is already approved and the DBQ agrees with the approval, you will start receiving benefits.
- If your case has been denied and the DBQ agrees, you will not get benefits and your case will be closed.
- If your case has been approved and the DBQ disagrees, you may have your benefits denied.
- In some cases, the DBQ may decide there are documentation deficiencies and send the case back to the SSA for correction.