If you have been approved for Social Security Disability Insurance (SSDI) benefits, you may be wondering, can a fully favorable decision be reversed? Unfortunately, the answer is yes.

The Disability Quality Branch (DQB) or the Appeals Council can review decisions made by the Disability Determination Services (DDS) or an Administrative Law Judge (ALJ) and reverse them. The percentage of cases pulled for review is small, but the chance of a disability approval being overturned could result in an applicant not being considered disabled and not entitled to benefits.

Have an immediate concern about a fully favorable decision being reversed? Get all the legal answers and information you need about your case by contacting us today!

The Review Process for a Fully Favorable Decision

There are different levels of quality review for disability benefits. It is important to understand how those quality review procedures have the potential to affect your disability claim.

Although it is not common that your case would be selected for review, there is a possibility it can occur whether it is favorable or unfavorable. The DQB selects random cases for quality review and the Appeals Council can review decisions of an ALJ.

Essentially, the DQB provides quality control for the system and is responsible for making sure that examiners follow the correct procedures and policies in determining whether a claim should be approved.

They pull cases at random, which can be broken down as currently in processing, have been accepted, and claims which have been denied. The DQB works to ensure that the DDS determination was made correctly and that examiners follow all policies and procedures when making decisions whether to approve or deny SSDI benefits.

Furthermore, the DBQ could spend between a few weeks to several months to fully review your case. Ultimately, the time spent depends on the complexity of the case. Their review focuses on these areas:

  • How reliable and accurate the information was provided from medical providers
  • The completeness of an applicant’s records and application
  • Any additional data and information provided by the parties involved

It is difficult to predict whether a case will be approved or denied after review because it depends on individual case scenarios.

What Actions to Take if Notified of a Disability Review

When either the DBQ or the Appeals Council decides to review a case on their own, you will be notified of their projected actions. Then, after reviewing the initial approval decision made by DDS disability examiners, they can choose to deny the benefits that were granted.

In the past, the DQB has denied disability claims that were previously approved for different reasons. In some cases, the Appeals Council can find the ALJ made an error and reverse the decision.

Regardless of who reviews your case, make sure your case file is accurate and contains all the information required. An applicant can also submit additional evidence or share any information to support the initial decision. Furthermore, if your claim is denied after a fully favorable decision, you still have the right to appeal your claim.

Find Support From Crest SSD

Although it is unlikely that your fully favorable decision gets selected for review and then denied by the DBQ or Appeals Council, in some cases it does happen. To better understand the SSDI process or appeal one of their decisions, the best thing you can do is seek advice from a disability representative.

Crest SSD is committed to helping individuals like you make the best decisions for them and their families. And, wanting to know whether a fully favorable decision can be reversed may not be your only question about disability benefits. Reach out to us today to discuss this concern and any other concerns you may have.

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