Appealing Disability That Was Denied In Quality Assurance

The Social Security Administration Quality Assurance System reviews approved disability claims to evaluate whether eligibility was properly determined according to the law. It is not unusual for the Quality Assurance review to overturn an approval of a disability claim which leads to benefits being cancelled.  You can appeal the denial if you believe the denial was unfair.

Appeal Process

There is an appeal process that involves four sequential steps. You must file an appeal within 60 days from the notice of denial, and the count begins 5 days after the date of the letter. 

1. Reconsideration – If you are denied benefits, you can ask for a Reconsideration by an SSA employee who was not involved in the initial claim.
2. Hearing – If your reconsideration is denied, you may then ask for a hearing before an Administrative Law Judge.  The Judge will review the original claim and the denial and may request submission of additional information.  You can have witnesses testify. The Judge will render a decision after the hearing.
3. Appeal – If the Judge denies your request to continue benefits, you can then appeal the decision with the Social Security Appeals Council. The Council can decide whether or not it wants to reopen the case.  If the Council does decide to review your case then one of three actions will take place. The Council can ask, 1) a different Administrative Law Judge to review the case, 2) the original Administrative Law Judge to reconsider his or her decision, or 3) decide as a Council to review the case and make its own decision.
4. Lawsuit – Filing a lawsuit is a last resort but one you can take if the Social Security Appeals Council denies your request. The lawsuit would be filed in federal court.

There are ten states (Alabama, Alaska, sections of California, Colorado, Louisiana, Michigan, Missouri, New Hampshire, Pennsylvania, sections of New York) that do not use have the Reconsideration step. Your appeal of a denial in those states will start with the Hearing before the Administrative Law Judge.

Consult an Attorney

If your disability claim is denied by the Social Security Quality Assurance System, it is important to contact a disability attorney immediately. You have a short timeframe in which you can appeal the finding, and the process of appeal can be quite lengthy. An attorney can advise you concerning the difficult process and assist you with building a strong defense against the denial.