We do not pay provisional benefits on an EXR request if the claimant previously requested
EXR for the same period of eligibility and received provisional benefits based on
that request, regardless of how many months they received provisional payments on
the previous request. However, we can pay provisional payments on a subsequent EXR
request if the claimant:
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was approved for EXR on a previous request;
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•
completed the initial reinstatement period (IRP);
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•
completed a trial work period (TWP);
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•
completed an extended period of eligibility (EPE);
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•
had their benefits later terminated due to substantial gainful activity (SGA), and
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•
filed a new request for EXR within 60 months of that termination, or we can find good
cause for late filing.
Example 1:
An individual requests EXR on March 4, 2016, and we approve the request on May 4,
2016. They receive 3 months of provisional benefits before they are re-entitled to
disability benefits. They complete their IRP, TWP and EPE. After completing the EPE,
benefits terminate due to SGA in January 2023. On April 12, 2023, the individual files
for EXR again because they are no longer performing SGA. As they completed the IRP,
TWP, and EPE on the new entitlement period, had their benefits terminated for SGA,
and then filed a new EXR request within 60 months of that termination, they are eligible
to request a subsequent EXR and receive provisional benefits.
Example 2:
An individual requests EXR on March 4, 2021, and we medically deny the request on
May 4, 2021. They received 3 months of provisional benefits. The individual refiles
for EXR on May 2023. Because we paid at least one month of provisional benefits on
the prior request, we cannot pay provisional benefits on the subsequent request.