Can a Favorable SSDI Decision Be Reversed?

Lloyd King Law Firm PLLC Oct. 19, 2022

Concept of disability insuranceIf you suddenly develop a physical or mental condition that prevents you from carrying out the full duties of your job and you’ve been paying into the Social Security Trust Fund for retirement benefits, you probably will immediately consider applying for benefits available from Social Security Disability Insurance (SSDI).   

Even if you have a long-term disability policy, the underwriting insurance company for that policy may require you to apply for SSDI, so they can offset whatever government benefits you receive and pay you less.  

Either way, it is not unlikely that you’ll be rejected on your first try for SSDI benefits, usually because a claims examiner working for the Social Security Administration (SSA), which oversees the program, determines that you didn’t fully document your disabling condition. You can request a reconsideration and if rejected again, a hearing with a Social Security Disability Judge.  

Your approval can be reversed if a group called the Disability Quality Branch (DQB) finds that an error was made in the claims review process, or it can happen after a hearing before a disability judge if the appeals council reviews the judge’s favorable decision and decides to reverse it.  

The chances of either happening are slim, but it is possible and will require you to appeal the reversal.   

If you find that your SSDI benefits’ approval has suddenly been reversed in or around Raleigh, North Carolina, contact me immediately at the Lloyd King Law Firm PLLC.   

I am a former Social Security Disability Judge, and I have years of experience dealing with every type of claim reversal, denial, request for reconsideration, and appeal. I can guide you in navigating the system to help get your reversal changed and your benefits restored. I proudly serve clients in Roanoke Rapids, Fayetteville, Greensboro, and Raleigh, North Carolina. 

How Can a Favorable Decision Be Reversed? 

The Social Security Administration doesn’t directly run its disability programs – SSDI and its low-income-earner option, Supplemental Security Income (SSI) – with the same people who handle your retirement savings account. Instead, disability claims are handled by a group known as Disability Determination Services (DDS).  

The Disability Quality Branch (DQB) is a unit within the DDS whose role is, as its title suggests, quality control. In carrying out this function, members of the DQB will review decisions made by claims examiners.   

Not all files are subject to examination, but some are randomly selected. If a review indicates that a favorable decision was made without the proper supporting evidence, or that the disability itself is not one that qualifies for SSDI, the DQB might decide to reverse the initial approval.   

The DDS is required to base its benefits’ determination on the applicable federal definition of a disability, which has two main components. The disability must last at least 12 months or until death, and the affected claimant must be unable to perform any substantial gainful activity (SGA), which in 2022 means earning more than $1,350 a month. If your disability is temporary or you earn more than $1,350 a month, you likely won’t be approved.   

A review that shows the claims examiner didn’t properly adhere to these standards could result in a reversal. A reversal can occur if your particular disability doesn’t appear in the agency’s “Blue Book,” which lists all disabling conditions that are covered by SSDI. If your condition is not in the Blue Book, it may still qualify, but you’ll have to take extra evidentiary steps to prove it meets the definition described above.  

The other time a reversal might take place is after you’ve had a hearing with an administrative law judge (ALJ), who has reviewed the available evidence and statements submitted and determined you are qualified for benefits and gives the green light. The Appeals Council, which periodically reviews the decisions of disability judges, might conclude that the judge in your case is mistaken and thus order a reversal. 

What to Do If You Receive a Reversal? 

Depending on which group makes the decision to reverse and at which point in the process your favorable decision is undone, you can weigh different options to appeal. If the DQB reverses your award of benefits after the initial phase or after a requested reconsideration, you can request a hearing before a Social Security Disability Judge.  

If the Appeals Council reverses your judge’s favorable ruling, you can request a review by the Appeals Council itself. If all else fails, you can request a Federal Court review.   

The SSA also has procedures for reopening your case. This you can do by writing the SSA or DDS, contacting your Congressional Representative, or filing a new claim. In short, a reversal can be challenged, but getting your benefits restored may require the submission of new evidence and testimony, maybe even a new claim.  

The SSA cautions, however, that: “If a claimant does not file an appeal of an administrative determination or decision in a timely manner, they may lose their rights to further review.” The deadline for filing an appeal is 60 days after receipt of the notice of denial of benefits. 

The Role of Skilled Legal Counsel 

Though reversals are pretty rare, they certainly do happen from time to time. If you find yourself in that situation – the DQB or Appeals Council has found reason to reverse your award of benefits – you need to act quickly. You will need to address the reasons stated in your reversal notification by providing the medical and job-related evidence that can challenge that reversal. 

If you’re in or near the Raleigh area of North Carolina, reach out immediately and contact me at the Lloyd King Law Firm PLLC. As a former Social Security Disability Judge and now advocate for those seeking SSDI and SSI benefits, I can help you assemble the documents and testimony needed to launch an appeal or reconsideration of the adverse decision. Let’s meet and get started immediately.