SSA “Quality” Review By QRB

Thursday, October 24th, 2013

For many years, the Social Security Administration (“SSA”) has reviewed about 1% of the decisions made on Social Security Disability (“SSD”) applications. That percentage significantly increased about two years ago when the SSA enacted new procedures for Appeals Council “own motion review” cases by the Appeals Council’s Quality Review Branch (“QRB”). During the past two years, I have seen a five fold increase in the number of cases subjected to “quality” review.

The QRB only reviews favorable and partially favorable decisions by Administrative Law Judges (“ALJs”). There is no explanation why the QRB is not concerned about the quality of unfavorable decisions, which shows that the intent of the new rules is simply to increase the number of denied claims. It is unclear if the QRB is randomly sampling decisions, or targeting ALJ’s who have higher rates for approving SSD decisions.

On December 14, 2012, the QRB sent me a letter stating that if I failed to provide additional evidence to support an ALJ’s October 18, 2012 fully favorable decision, then the QRB would reverse it. On December 17, 2012, I sent a detailed letter explaining that I refused on the grounds that the decision was amply supported by objective evidence. On June 6, 2013, because a half year later the QRB still had failed to act, I asked the QRB to stop wasting everyone’s time, and either to confirm the ALJ’s decision so the claimant could get paid, or reverse the ALJ’s decision so I could appeal to federal court.

On July 29, 2013, instead of reversing the ALJ’s fully favorable decision, the QRB remanded it. Today, without a hearing, the ALJ issued a fully favorable decision. The QRB procedure was a colossal waste of time and money.

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