Tuesday, June 03, 2008

Quality Reviews of SSD Cases

On a prior post (Social Security Disability Residual Functional Capacity Form - how to get one), someone commented about their case being diverted to quality control. Here's what they said:

1. The disability examiner told that them the reconsideration appeal had been decided.

2. The case had been sent for a qualify review.

3. The examiner wouldn't or couldn't tell her what the decision was.

Ok, I'm no expert on quality control. I didn't work in internal quality control at my office and I didn't work at DQB (not some variation of dairy queen but "disability quality branch"). However, this is a situation with which I am very familiar.

This is what happens. A disability examiner finishes a case. And by that I mean that the examiner has read all the medical evidence, has done an RFC writeup (these are mentioned in the post linked at the top of this page), has consulted with either his unit medical consultant or unit mental consultant, or both, and has "slapped" a decision on the case. He's done with the case, right? Well, not necessarily. In a relatively small percentage of decisions, a case will be selected for outside quality review. Allegedly, this is to make sure that disability examiners make correct decisions AND to catch mistakes they may have made.

Here are the questions that usually come up regarding quality reviews of SSD cases:

1. What kind of cases get selected by quality control for review? All kinds. Meaning all impairments, all ages (of claimants), and all types of decisions (cases that were marked for approval by a disability examiner and cases that were marked for denial).

2. Is it a bad sign if your case is sent out for a quality review? No, it just means that yours was randomly selected.

3. How long will a disability case stay at quality review? There's no way to know. Examiners whose cases are selected for review are not told how long a case will be review and, therefore, cannot tell a claimant how long it will be. They are as much in the dark as the claimant. I have personally seen cases get delayed by a quality review for as long as three months (which is very unfair to the claimant, obviously).

4. If my case was supposed to be an approval, will this get changed to a disability denial? It could happen. However, if your case was supposed to be a denial, it could be changed to an approval. Or, the quality reviewer could simply agree with whatever decision the examiner had originally arrived at.

5. Why won't the disability examiner tell me what his or her decision was before the case went to quality review? Because he could get fired for doing so. Which, in my opinion and looking at it from the standpoint of a low paid government employee, is a very good reason not to say anything. However, there's another reason too. If he tells you what his decision was and this decision gets changed by quality review, he will, in effect, have told you the wrong thing...Which is probably why he's not supposed to say anything in the first place and why he could get fired for doing so.

6. Should I be nervous about having my case reviewed? No, it is simply part of the long, irritating process of filing a disability claim with the social security administration. Although, this does make the process a longer one.

Return to the Social Security Disability SSI Benefits Blog


Blogger Claribel said...

Just to let you know... Today I learned my SSDI case has been approved on reconsideration with an onset date of Feb. 2008 (applied on Apr. 2006) after being unnable to work since Oct. 2005. I guess I won't have any backpay. Can you explain what will happen if I decided to appeal? I will be talking to my attorney next week.

4:55 PM  
Blogger Disability Blogger said...

Hi Claribel,

I spoke with a CR (claims rep) about this (CRs work in field offices while disability examiners--I used to be one--make medical decisions). The CR believed that if you appealed the onset date, social security would continue to process your current decision to get you into pay status. The CR really didn't have any input on the risk factor. My advice would be to speak with your attorney, as you indicated you plan to do.

7:42 AM  
Blogger freddyeasman said...

My case has been approved by dds, but has been sent to the Quality review board. Is this social securitys way of making sure that DDS did there job correct?

5:01 PM  

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