The Lowdown on Quality Reviews of Administrative Law Judge (ALJ) Decisions
Congress has been somewhat critical of the Social Security Administration’s (SSA) handling of high allowance ALJs, alleging that oversight of these individuals needs to be stricter. So, today we’ll examine the options that exist for reviewing favorable ALJ decisions.
There are two types of quality reviews that an ALJ favorable decision can undergo: pre-effectuation reviews (in which an ALJ decision can be changed) and post-effectuation reviews (in which it cannot). The Office of Appellate Operations (OAO) and the Appeals Council (AC) conduct these reviews.
The AC can conduct a pre-effectuation review (a review of an ALJ favorable decision that happens before the ruling goes into effect and any benefits are paid) in two cases: (1) When the office or institution responsible for enforcing the ruling finds a clerical error that affects the claim’s outcome, the decision is contrary to existing Social Security regulations, or a part of the ruling that affects the outcome of the claim is unclear.
(2) When random and/or selective sampling yields a case in which some aspect (i.e. fact patterns or murky issue areas) renders the case more prone to error. Pre-effectuation reviews cannot target specific individuals and/or hearing offices.
The OAO conducts post-effectuation reviews. These reviews differ from pre-effectuation reviews in that they are conducted after the ALJ decision takes effect and beneficiaries have already begun receiving payments. While a post-effectuation review cannot change an ALJ decision, it can target and examine specific ALJs and/or hearing offices to ensure compliance with SSA regulations and policy.