For the purposes of the exemption of work activity provision, a beneficiary will be
considered to have received title II disability cash benefits for 24 months beginning
with the first day of the first month following the 24th month for which he/she received title II disability benefits that he/she was due.
The 24 months do not have to be consecutive. For EXR cases, the 24-month requirement
will have been met when the individual completes the 24-month initial reinstatement
Any months for which the beneficiary was entitled to title II disability benefits
but did not actually receive a title II disability cash benefit will not be counted
for the 24-month requirement. For example prisoner suspense, Medicare Qualified Government
Employee (MQGE), an individual in full workers compensation offset, a childhood disability
benefit (CDB) technically entitled to a disability maximum (DMAX), and a supplemental
security income (SSI) only recipient. However, if the reason the beneficiary did not
receive a benefit was because the full payment was withheld to recover an overpayment,
to pay attorney fees, or for a garnishment order, consider the benefit received for
the purpose of the exemption of work activity provision.
Mary has been entitled to title II disability cash benefits since November 2004 (5-month
waiting period- June through October 2004). In January of 2007, Mary reports that
she has been working since December of 2004. The adjudicator determines that the TWP
months are as follows: December 2004, January 2005 through August 2005. Starting in
September of 2005, the work activity needs to be evaluated under SGA rules.
In September of 2005, Mary had not been entitled and received 24 months of cash benefits
and therefore the comparability and worth of work tests can be applied when making
the SGA determination. In this example the comparability and worth of work tests were
applied but it was determined that Mary was not working at the SGA level through the
current month-January 2007. If Mary reports any subsequent work activity for months
after January of 2007, the adjudicator will not apply the comparability and worth
of work tests, because the adjudicator has determined that Mary has been entitled
and received 24-months of benefits and the exemption of work activity provision will
apply starting in November of 2006 and continuing.
In January of 2007, Henry came into the office to inform the adjudicator that he started
his own business in January of 2007 and to file an appeal on his SGA cessation claiming
that his IRWE was not calculated correctly. He wants to know how his new business
will be evaluated because he will not be making any money in the beginning. At first
glance, Henry’s Master Beneficiary Record (MBR) would indicate the exemption of work
activity would not apply because an SGA cessation is on the record. However, Henry
is filing an appeal on that decision. If the SGA decision is re-opened and determined
not to be SGA, the exemption of work activity provision may apply. In this example,
the adjudicator re-opens the decision and determines that Henry has not performed
SGA work activity. Henry had been entitled and received title II cash disability benefits
since November of 2004. The exemption of work activity provision would apply starting
in December 2006 and the recent work activity being reported in January of 2007 would
not be evaluated under the comparability and worth of work tests.