Where Denials Go After the Initial Decision
When the Disability information Services (DDS) office in your state denies your SSDI claim, the case does not automatically go to quality control. Instead, a quality control review happens only if your case is randomly selected — or if you request reconsideration, which sends it back to DDS for a fresh look by a different examiner.
The Social Security Administration runs a quality control program that checks a sample of decisions made by DDS examiners. This program exists to catch errors, inconsistencies, and cases where the evidence did not support the denial. However, being selected for quality control is not something you request or control. It is a separate process from your right to challenge the denial.
Understanding the difference between quality control review and reconsideration matters because they follow different timelines and rules. Quality control is an internal SSA check on DDS work. Reconsideration is your formal right to have the case reviewed again, and it is the step you take if you disagree with the denial.
Key Takeaways
- Quality control review is a random internal check by SSA on DDS decisions, not a process you trigger by requesting it.
- If your case is selected for quality control, SSA will notify you by mail, and the review may take several weeks to complete.
- Quality control can result in the decision being upheld, reversed, or sent back to DDS for more work — but this is separate from your right to request reconsideration.
- You do not have to wait for quality control to challenge a denial; you can request reconsideration within 60 days of the denial notice.
- Reconsideration is a faster path to appeal than waiting for a random quality control selection, which may never happen.
How the Quality Control Process Works
SSA's Office of Quality Review (OQR) selects cases for review based on statistical sampling. The selection is not based on the type of disability, the state, or how recent the decision is. A case can be selected weeks or months after the initial denial. When a case is chosen, OQR sends notice to both you and the DDS office that made the original decision.
During quality control review, an SSA quality control examiner — who is different from the DDS examiner who made the denial — looks at the entire file. They check whether the DDS examiner followed the correct legal standards, whether the medical evidence was properly evaluated, and whether the decision was supported by the facts. The quality control examiner has the authority to agree with the denial, reverse it, or send the case back to DDS with instructions to do additional work.
The timeline for quality control review is not fixed. Most reviews take four to eight weeks, but some take longer if the examiner needs to request additional records or clarification from DDS. You will receive written notice of the outcome by mail.
What Quality Control Review Can and Cannot Do
Quality control review can reverse a denial and approve your claim. If the quality control examiner finds that the DDS decision was wrong — for example, if the medical evidence actually supported a finding of disability but was misread — the examiner can overturn the denial and send your case to DDS for approval processing.
Quality control can also send the case back to DDS with specific instructions. This might happen if the quality control examiner finds that DDS did not obtain all necessary medical records, did not order a consultative examination when one was needed, or did not properly explore the legal standard for your condition. DDS then has to complete the additional work and make a new decision.
Quality control cannot approve your claim on its own authority if it finds the denial was correct. If the quality control examiner agrees with the DDS denial, that decision stands. You would then need to request reconsideration or file an appeal to move forward.
Quality Control Selection Is Random, Not may provide
Not every denied claim is selected for quality control review. SSA samples a percentage of DDS decisions each year, but the exact percentage varies. Some denied claims are never reviewed by quality control. This means you cannot rely on quality control to challenge your denial — you need to take action yourself.
The random nature of quality control selection is why reconsideration is the standard path for appealing a denial. Reconsideration is your right, and you control when it happens. You do not have to wait and hope your case is selected for quality control.
Reconsideration vs. Quality Control: Which Path to Take
If you disagree with a denial, you should request reconsideration within 60 days of receiving the denial notice. Reconsideration sends your case back to DDS, where a different examiner reviews it from the beginning. This is a formal appeal step that you initiate, and it is faster and more reliable than waiting for quality control selection.
You request reconsideration by completing Form SSA-561-U2 (Request for Reconsideration) and submitting it to your local Social Security office or by mail to the DDS office that made the denial. The address is on your denial notice. Reconsideration typically takes 60 to 90 days.
Quality control review, by contrast, happens only if your case is randomly selected. You cannot request it. If you are selected, you will be notified, but you should not count on this happening. The safest approach is to request reconsideration if you believe the denial was wrong.
What Happens If Quality Control Finds an Error
If a quality control examiner finds that the DDS denial was based on an error — such as misreading medical records, failing to follow the correct legal standard, or not obtaining necessary evidence — the examiner can reverse the decision. The case is then sent back to DDS for approval processing. You will receive notice of the reversal and information about next steps.
If the quality control examiner finds that DDS did not complete the evaluation properly, the case goes back to DDS with instructions to finish the work. For example, if DDS did not order a consultative examination (a medical exam paid for by SSA) when one was needed, quality control can require DDS to order one. DDS then makes a new decision based on the complete record.
If the quality control examiner agrees with the denial, you have the right to request reconsideration if you have not already done so, or to file an appeal to the Appeals Council if you have exhausted reconsideration.
Timeline: From Denial to Quality Control Outcome
| Stage | Timeline | What Happens |
|---|---|---|
| Initial DDS Decision | Typically 60–90 days from process | DDS examiner reviews your file and makes a denial or approval decision |
| Denial Notice Sent | Within 5 business days of decision | You receive written notice of the denial and your appeal rights |
| Quality Control Selection (if selected) | Weeks to months after denial | SSA randomly selects your case for review; you receive notice by mail |
| Quality Control Review | 4–8 weeks (can be longer) | Quality control examiner reviews the file and makes a information |
| Quality Control Outcome Notice | Within 5 business days of decision | You receive written notice of the outcome and any next steps |
Frequently Asked Questions
Can I request quality control review if my claim was denied?
No. Quality control selection is random and controlled by SSA. You cannot request it. However, you can request reconsideration within 60 days of your denial notice, which sends your case to a different DDS examiner for a fresh review. Reconsideration is the standard way to challenge a denial.
If my case is selected for quality control, does that mean my denial will be reversed?
Not necessarily. Quality control review means an SSA examiner will check whether the DDS decision was correct. The quality control examiner may agree with the denial, reverse it, or send it back to DDS for more work. Selection for quality control does not may provide a reversal.
How long does quality control review take?
Most quality control reviews take four to eight weeks from the time your case is selected. Some take longer if additional records are needed. You will receive written notice of the outcome by mail when the review is complete.
What should I do while waiting to see if my case is selected for quality control?
Do not wait. Request reconsideration within 60 days of your denial notice. Reconsideration is your right and is faster than hoping for random quality control selection. You can request reconsideration by submitting Form SSA-561-U2 to your local Social Security office or the DDS office that denied your claim.
If quality control reverses my denial, when will I receive benefits?
After quality control reverses a denial, your case goes to DDS for approval processing. DDS will then process your claim for payment. The exact timeline depends on your state and DDS workload, but you should receive written notice of approval and information about when payments will begin.