Forgive this lawyer like answer….It depends.
The Office of Quality Review (OQR) conducts Quality Reviews by pulling random disability determinations to ensure the record supports the determination and the evidence and the determination conform to SSA operating policies and procedures. OQR is tasked with helping ensure that disability decisionmakers out in the field are doing their job properly. OQR’s goal is to make sure that disabled people are approved and non-disabled people are denied. This is accomplished by reviewing samples of all case types both favorable and unfavorable at all levels; initial, recon and hearing.
The Quality Review Process
After reviewing the file, OQR must determine whether or not the prior decision was properly made. If a case was properly decided, the OQR affirms the initial decision. If the case was improperly decided, OQR will return the case in order for the deficiency to be corrected.
Frequency of Reviews
It is unclear how often reviews are conducted. The Government Accounting Office did an audit in 2016 and reported that 20,851 quality reviews were completed by the OQR. In 2016, there were 2,422,539 determinations made by the Social Security Administration (SSA). You can find the report here. From these figures, we could make an assumption that about 1% of all disability determinations undergo a Quality Review.
Percentage of Cases that Are Overturned
I was not able to find statistics regarding the percentage of Quality Reviews that result in a different decision. I was; however, able to find statistics regarding Targeted Denial Reviews. Targeted denial reviews are reviews of individuals that were denied benefits. This review is separate and different from Quality Reviews, which review all decision types. I do think there is value in looking at this data though. If the ‘Reversal Rate’ of Target Denial Reviews is anywhere from 6.2% to 10% we could assume that the results of Quality Reviews would be about the same.
Fiscal Year Cases Reviewed Cases Returned Return Rate Decisions Reversed Reversal Rate 2013 45,462 4,701 10.30% 3,259 7.20% 2014 26,688 2,768 10.40% 1,833 6.90% 2015 52,165 4,935 9.50% 3,214 6.20% 2016 43,649 5,088 11.70% 3,376 7.70% 2017 52,446 6,111 11.65% 3,851 7.34% 2018 54,823 6,952 12.70% 4,226 7.70% 2019 56,696 8,231 14.52% 4,774 8.42% 2020 36,786 6,390 17.37% 3,671 9.98%
Well, is a Quality Review Good or Bad?
Again, it depends. For the vast majority of claimants Quality Reviews will have no impact whatsoever on your claim. If 1% of decisions receive Quality Reviews and 10% of those Quality reviews are reversed, then only about .1% of all claimant’s will have their outcome altered by a Quality Review. This does not answer the question for those 1% that actually get a Quality Review letter though.
Is this review good or bad? Unfortunately, it still depends. If your case was denied and it is up for review, I would say it’s a good thing. It likely gives you about a 10% chance that it will be approved after the review. This review is an extra look at your case above and beyond what is typically afforded claimants.
If your case was approved, getting a letter about a Quality Review is not a letter you want to get. That being said, in the grand scheme of things, the odds of your favorable decision turning into an unfavorable decision are likely less than 10%.