A Quality Review Denial Means Social Security Looked at Your Case Again
When Social Security denies your SSDI claim after a quality review, it means the agency re-examined your case after an initial denial and decided the first decision was correct. A quality review is not a new hearing or a second chance to present evidence—it is Social Security's own internal check to make sure the person who denied your claim followed the rules correctly.
The quality review process happens automatically for some denials. Social Security staff pull a sample of denied cases and review them to catch mistakes. If the reviewer agrees with the original denial, your case stays denied. If they find an error, they may overturn it. When you receive a denial letter that says "quality review," it means this internal check has been completed and the decision stands.
This is different from an appeal. You did not ask for a quality review, and you cannot request one. It happened behind the scenes at Social Security. The letter you receive will tell you what to do next if you disagree.
Key Takeaways
- A quality review denial means Social Security checked its own work and found no error in the original decision.
- You cannot request a quality review yourself—it is something Social Security does internally on a sample of cases.
- After a quality review denial, you have the right to file a reconsideration request or ask for a hearing before an administrative law judge.
- The time limit to appeal is 60 days from the date on your denial letter, so check the date when ready.
- You can submit new medical evidence or new information about your work history when you appeal.
Why Social Security Conducts Quality Reviews
Social Security runs quality reviews to monitor the accuracy of decisions made by disability examiners and judges. The agency has a legal obligation to make sure denials are correct. When a case is selected for quality review, a different reviewer—usually someone with more experience—looks at the entire file to see if the original decision followed Social Security's rules.
The reviewer checks whether the examiner correctly evaluated your medical evidence, whether they properly considered your age and work history, and whether they applied the law correctly. If the reviewer finds that the original decision was wrong, they can overturn it and approve your claim. If they agree the denial was correct, the case stays denied and you receive a new denial letter.
Quality reviews happen on a small percentage of cases. You will not know your case was selected until you receive the letter. The letter will say something like "We reviewed your case again" or "Quality review completed."
What the Denial Letter Will Tell You
Your quality review denial letter will explain why Social Security still believes you do not meet the rules for SSDI. The letter must include the specific reason for the denial—for example, that your condition is not severe enough, that you can still work, or that your condition will not last long enough to may have access to.
The letter will also tell you how much time you have to appeal and what your options are. Social Security must give you at least 60 days from the date on the letter to take your next step. This important date is firm. If you miss it, you lose the right to appeal unless you have a very good reason for the delay.
Read the letter carefully and look for the specific medical or work-related reason they gave for the denial. This reason is what you will need to address if you decide to appeal. Keep the letter and the date it was sent—you will need both.
Your Options After a Quality Review Denial
You have two main paths forward after a quality review denial. You can file a reconsideration request, which sends your case to a different examiner at Social Security. Or you can skip reconsideration and ask for a hearing before an administrative law judge, which is a judge who works for Social Security but is independent from the disability office that denied you.
Many people skip reconsideration and go straight to a hearing because reconsideration has a low approval rate—roughly one in ten cases. A hearing gives you the chance to present new evidence, answer questions from the judge, and sometimes bring a representative or witness. Hearings take longer (usually several months to a year) but have a higher approval rate than reconsideration.
You do not have to choose right away. You have 60 days from the date on your denial letter to decide. If you want to file reconsideration, you can do that first. If reconsideration is denied, you can then request a hearing. Or you can skip reconsideration entirely and request a hearing from the start.
What New Evidence You Can Submit
When you appeal a quality review denial, you can submit medical records, test results, or letters from your doctors that you did not have when you first applied. You can also submit information about your work history, statements from people who know your condition, or anything else that shows why you cannot work.
New evidence is often the reason an appeal succeeds. If your condition has gotten worse since the original denial, new medical records can show that. If you have had more tests or seen a specialist, those records matter. If you have tried to work and had to stop because of your condition, that information is relevant.
Do not assume Social Security has all your medical records. Doctors' offices do not always send records to Social Security automatically. If you have seen a doctor since you applied, contact that office and ask them to send your records directly to Social Security. Include a cover letter with your case number and explain why the new evidence is important.
Filing a Reconsideration Request
To file for reconsideration, you must contact Social Security within 60 days of the date on your denial letter. You can file online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You do not need a form—you just need to tell Social Security you want reconsideration.
When you file, tell Social Security that you want your case reconsidered and that you have new information or evidence to submit. If you have new medical records, send them with your request or mail them to Social Security as soon as possible after you file. Include your case number on everything you send.
Reconsideration usually takes two to three months. Social Security will send you a letter with the result. If reconsideration is denied, you will have another 60 days to request a hearing before a judge.
Requesting a Hearing Before a Judge
A hearing before an administrative law judge is your best chance to reverse a denial. The judge will review your entire case, look at any new evidence you submit, and may ask you questions about your medical condition and your ability to work. You can bring a representative—a lawyer, a non-lawyer advocate, or a family member—to speak for you or help you prepare.
To request a hearing, contact Social Security within 60 days of your reconsideration denial (or within 60 days of your original quality review denial if you skip reconsideration). You can file online, by phone, or in person. Tell Social Security you want a hearing before an administrative law judge.
The hearing office will send you a notice telling you the date and time of your hearing. Hearings usually happen by video or phone, though you can request an in-person hearing. You will have a chance to present evidence, answer questions, and explain why you cannot work. The judge will make a decision within a few weeks to a few months after the hearing.
Working With a Representative
You can hire a lawyer or a non-lawyer representative to help you with your appeal. A representative can gather medical evidence, prepare you for a hearing, and present your case to the judge. Many representatives work on a contingency fee, meaning they only get paid if you win—and Social Security limits what they can charge.
If you win your case, Social Security will pay your representative up to 25 percent of your back pay (the money owed from when you became disabled), up to a maximum of $7,200. You do not pay anything out of pocket. Your representative must be approved by Social Security, which you can verify on the Office of Hearings Operations website.
Finding a representative is not required, but many people find it helpful, especially for a hearing. If you cannot afford a lawyer, you may be able to find a non-profit organization in your area that helps with disability cases for free or low cost.
Frequently Asked Questions
Can I appeal a quality review denial more than once?
Yes. After a quality review denial, you can file for reconsideration, and if that is denied, you can request a hearing. After the hearing, if the judge denies you, you can appeal to the Appeals Council. The process can take years, but you have multiple chances to present your case.
Do I have to file for reconsideration before I can request a hearing?
No. You can skip reconsideration and go straight to a hearing if you want. Many people do this because reconsideration has a low approval rate. You still have 60 days from the date on your denial letter to make this choice.
What if I miss the 60-day important date to appeal?
If you miss the important date, you lose your right to appeal unless you have a good reason for the delay. Social Security may grant an extension if you were ill, did not receive the letter, or had another serious circumstance. Contact Social Security when ready and explain why you missed the important date.
Will submitting new medical evidence help my appeal?
Often yes. If your condition has worsened, if you have seen a new doctor, or if you have test results you did not have before, new medical evidence can change the outcome. Make sure the evidence clearly shows why you cannot work, not just that you have a medical condition.
How long does a hearing take from start to finish?
From the time you request a hearing to the time the judge makes a decision usually takes six months to a year, sometimes longer. The hearing itself may last 15 minutes to an hour depending on your case. After the hearing, the judge typically issues a decision within a few weeks to a few months.