What happens to your denied claim during a quality review
When Social Security denies your SSDI claim, the case does not automatically go into a quality review. Instead, a small percentage of denials are randomly selected for review by a different examiner at Social Security's central office. This is a separate process from your right to request reconsideration—it happens behind the scenes and you are not told it is occurring.
The examiner who reviews your case during quality control is looking at whether the original decision followed the rules correctly. They check whether the right medical evidence was considered, whether the law was applied properly, and whether the reasoning in the denial letter makes sense. If they find an error, they can overturn the denial and approve your claim. If they find no error, the denial stands.
This process is not the same as reconsideration, which is your right to request. Quality review happens whether you ask for it or not, but it is rare—only a fraction of denials are selected. You cannot request a quality review yourself or find out whether your case was chosen.
Key Takeaways
- Social Security randomly selects a small percentage of denials for quality review by a different examiner, separate from reconsideration.
- A quality review examiner checks whether the original decision followed the rules and considered the right evidence, and can overturn the denial if they find an error.
- You will not be notified that your case is undergoing quality review, and you cannot request one yourself.
- Quality review is not a substitute for reconsideration—you should still request reconsideration within 60 days of your denial letter if you want to challenge the decision.
- The outcome of a quality review (approval or continued denial) is sent to you by mail, just like any other decision.
How Social Security selects cases for quality review
Social Security uses a sampling method to choose which denials get reviewed. The agency does not disclose the exact formula, but cases are selected at random rather than based on the type of disability, the reason for denial, or any characteristic of your claim. This means your case has the same chance of being selected as any other denial in the system.
The review happens at the Office of Quality Review, which is part of Social Security's central office in Baltimore. Examiners there have access to your entire file—the medical records, the vocational informed report if one was used, the notes from the original examiner, and the denial letter. They re-read everything from scratch.
The timeline for quality review is not fixed. A case may be selected weeks or months after the denial is issued. You will not receive notice that the review is happening; you will only learn the outcome when you receive a new decision letter in the mail.
What the quality review examiner is actually checking
The quality review examiner is not re-deciding your case based on their own judgment. Instead, they are auditing whether the original examiner followed Social Security's rules. They look for specific types of errors: whether the examiner considered all the medical evidence you submitted, whether they properly applied the medical-vocational guidelines, whether they correctly assessed your residual functional capacity, and whether the reasoning in the denial letter is supported by the evidence in the file.
If the original examiner made a factual error—for example, they said you had no treatment records when you actually submitted them—the quality review examiner can catch that and reverse the denial. If the examiner misapplied the law—for instance, they denied you based on a rule that does not actually exist—that error can also be corrected. However, if the original examiner made a judgment call that is within the bounds of the rules, the quality review examiner will usually let it stand, even if they might have decided differently.
Quality review does not consider new medical evidence. The examiner only looks at what was in your file when the original decision was made. If you have new medical records, you cannot submit them as part of a quality review—you would need to request reconsideration and include the new evidence with that request.
The difference between quality review and reconsideration
Quality review and reconsideration are two separate processes that can both happen to your claim, but they work differently. Reconsideration is your right—you can request it within 60 days of your denial letter, and a new examiner will look at your case and consider any new evidence you submit. You control whether reconsideration happens and when you request it.
Quality review is random and automatic. You do not request it, you do not control the timing, and you cannot submit new evidence. It is an internal audit of whether the original decision was made correctly.
Both can result in approval. If your case is selected for quality review and the examiner finds an error, you will be approved. If you request reconsideration and the new examiner agrees your claim should be approved, you will be approved. However, you should not wait to see if your case is randomly selected for quality review. The odds are against you—most denials are not reviewed. Instead, you should request reconsideration within 60 days if you believe the denial was wrong.
What happens if quality review overturns your denial
If the quality review examiner finds that the original decision was wrong and overturns the denial, you will receive an approval letter in the mail. The letter will explain that the case was reviewed and the denial has been reversed. You will then begin receiving SSDI benefits, and your case will move into the ongoing review process that applies to all beneficiaries.
The approval date will be set based on when your claim was originally filed, not when the quality review was completed. This means your back pay will include the period from your original filing date through the month you are approved, minus any months you were working and earning over the substantial gainful activity limit.
If you have already requested reconsideration, and your case is also selected for quality review, Social Security will typically process whichever review is completed first. If quality review approves you before reconsideration is finished, the reconsideration will be closed because you are already approved.
What happens if quality review upholds the denial
If the quality review examiner finds no error in the original decision, the denial is upheld and you will receive a letter saying so. This does not prevent you from requesting reconsideration—you still have the right to do so within 60 days of your original denial letter, even if a quality review has already been completed.
In practice, if a quality review has upheld the denial, reconsideration may be less likely to result in approval, because the case has now been reviewed twice and both times the examiner found the denial was correct. However, reconsideration is still worth requesting if you have new medical evidence or if you believe the examiners misunderstood something about your condition or work history.
If you exhaust reconsideration and are still denied, your next step is to request a hearing before an Administrative Law Judge, which is a different process with different rules and a higher approval rate than reconsideration.
Timeline and what to expect in the mail
There is no set timeline for quality review. A case may be selected and reviewed within a few weeks of the denial, or it may take several months. Social Security does not send you notice that your case is under review, so you will not know it is happening.
When the quality review is complete, you will receive a decision letter in the mail. The letter will state whether the denial has been upheld or reversed. If it is reversed, the letter will include information about when your benefits will begin and how to expect your first payment. If it is upheld, the letter will explain that the case was reviewed and the original decision was found to be correct.
Do not assume that because you have not heard anything, your case is not being reviewed. Social Security does not provide updates on quality review status. The only way you will know the outcome is when the decision letter arrives.
Frequently Asked Questions
Can I learn about my case is being reviewed for quality control?
No. Social Security does not notify you that your case has been selected for quality review, and you cannot call to ask whether it is happening. You will only learn the outcome when you receive a decision letter in the mail.
If my case is in quality review, should I still request reconsideration?
Yes. You do not know whether your case will be selected for quality review, and most denials are not. You should request reconsideration within 60 days of your denial letter to protect your rights. If your case is approved through quality review before reconsideration is finished, the reconsideration will be closed.
Can I submit new medical evidence during a quality review?
No. Quality review only examines the evidence that was in your file when the original decision was made. If you have new medical records, submit them with a reconsideration request instead.
What if quality review approves me but I already requested reconsideration?
Your case will be approved based on the quality review decision. The reconsideration will be closed because you are no longer in denied status. You do not need to do anything—Social Security will handle the administrative closure.
Is quality review the same as an appeal?
No. Quality review is an internal audit that happens randomly and automatically. An appeal is a formal process you request, like reconsideration or a hearing before an Administrative Law Judge. Quality review is separate from the appeal process.