TN 2 (02-06)

DI 13050.001 Expedited Reinstatement - Overview

A. Introduction

Public Law 106-170, the Ticket to Work and Work Incentives Improvement Act of 1999 added sections 223(i) and 1631 (p) to the Act to allow certain previously entitled individuals to request expedited reinstatement (EXR) of those disability benefits or payments under title II and Title XVI when their medical condition no longer permits them to perform substantial gainful activity (SGA) within 60 months of their prior termination. EXR is thus a safety net for those individuals who make use of SSA-administered work incentives, successfully return to work, and, consequently, lose their entitlement to, or eligibility for, Title II or Title XVI benefits and payments.

To qualify for EXR, an individual must:

  • Not be performing SGA in the month he/she applies for EXR,

  • Be unable to work at the SGA level due to his or her medical condition,

  • Have stopped performing SGA within 60 months of his or her prior termination,

  • Have his/her current medical impairment(s) be the same as or related to the original impairment(s), and

  • Be under a disability based on application of the medical improvement review standards (MIRS).

The EXR provision allows an individual to receive up to 6 months of provisional (temporary) cash benefits while SSA conducts a medical review to determine whether the individual can be reinstated to benefits. However the EXR PIA is computed as if the EPE termination never happened (see DI 13050.060B.3.) The individual may also be eligible for Medicare and/or Medicaid coverage during the provisional benefit period.

Under Title XVI, the individual's eligible spouse also may be eligible for up to 6 months of provisional payments and Medicaid coverage during the provisional benefit period.

EXR establishes a new period of disability with a new onset date. An individual reinstated under EXR is given a 24-month initial reinstatement period (IRP) (see DI 13050.066). After completing the IRP, a Title II beneficiary is provided a new trial work period (TWP) and an extended period of eligibility (EPE). If benefits are ceased again after completing the EPE, a Title II beneficiary can be reinstated through a new request for EXR, if EXR eligibility criteria are met (see DI 13050.001B.). After completing the IRP, a Title XVI recipient whose benefits cease due to work can be reinstated through a new request for EXR, if EXR eligibility criteria are met (see DI 13050.001C.).

EXR is effective January 1, 2001. No EXR benefits are payable prior to January 2001 for Title II and February 2001 for Title XVI. The individual must have a previous entitlement or eligibility termination date (normally represented by the DBC date on the MBR or the T31 date on the SSR) of February 1996 or later. Closed periods are not applicable to EXR.

B. Policy - Who Can Be Reinstated - Title II

1. Requirements

An individual who meets all of the following requirements is eligible for EXR:

  • previous entitlement to disability insurance benefits (DIB), disabled widow(er) benefits (DWB), or disabled child benefits (CDB) was terminated due to performance of SGA;

  • is not performing SGA in the month of the EXR request;

  • is unable to perform SGA because of his or her medical condition (see DI 13050.001G.);

  • the current disabling impairment(s) is the same as or related to the impairment(s) that was the basis for the previous disability entitlement (referred to as “same as or related”);

  • under a disability based on the application of the medical improvement review standards (MIRS); and

  • requests EXR within the consecutive 60-month period beginning with the month of entitlement termination. The EXR request period may be extended if the individual establishes good cause for late filing of the EXR request (see DI 13050.010A.2.).

NOTE: Even though no monthly cash benefits are paid, the expedited reinstatement provision is applicable to a Medicare Qualified Government Employee (MQGE) beneficiary.

2. Individual With Prior EXR Technical Denial

If an individual was denied EXR because he or she did not meet the requirements for EXR (not filed within 60 months, etc.) the principles of res judicata may be applied to a subsequent EXR request. Res judicata cannot be applied if any aspect of the case has changed, including laws or regulations. See GN 03101.160B. for situations in which res judicata is applicable.

3. Individual Entitled to Another Disability Benefit

If an individual requesting EXR is currently entitled to another disability benefit, the FO cannot apply collateral estoppel procedures. The DDS must make the medical determination that the impairment is the same as or related to the impairment that was the basis for the previous entitlement, and then make a determination that the individual is disabled based on the MIRS standard. Therefore, collateral estoppel procedures can not be applied.

4. Individual Entitled to Reduced RIB

See RS 00615.110B.2. if the individual became entitled to reduced RIB simultaneously with or after the EXR month of entitlement. See RS 00615.110B.3. if the individual became entitled to reduced RIB before the EXR month of entitlement.

NOTE: For retirement benefit computation purposes, the period of disability reinstated by the EXR and the EXR period are considered one period of DIB.

5. Auxiliary Reinstatement

When a wage earner is approved for EXR, an auxiliary on the original record can file for reinstatement on the record. The auxiliary must file a new application for benefits and must meet current factors of entitlement (see DI 13050.060A.2.).

C. Policy - Who Can Be Reinstated – Title XVI

1. Requirements

An individual who meets all of the following requirements is eligible for EXR:

  • previous SSI disability/blindness eligibility was terminated because of excess earned income or a combination of earned and unearned income;

  • is not performing SGA in the month of the EXR request;

  • is unable to perform SGA due to his or her medical condition (see DI 13050.001G.);

  • the current disabling impairment(s) is the same as or related to the impairment(s) that was the basis for the previous disability entitlement;

  • under a disability based on the application of the medical improvement review standards (MIRS);

  • requests EXR within the consecutive 60-month period beginning with the month of termination of eligibility to SSI payments. The EXR request period may be extended if the individual establishes good cause for late filing of the EXR request (see DI 13050.010); and

  • meets all non-medical requirements for eligibility to SSI.

2. Individual With Prior EXR Technical Denial

If an individual was denied EXR because he or she did not meet the requirements for EXR (not filed within 60 months, etc.) the principles of res judicata may be applied to a subsequent EXR request. Res judicata cannot be applied if any aspect of the case has changed, including laws or regulations. See GN 03101.160B. for situations in which res judicata is applicable.

3. Eligible Spouse

An eligible spouse can also request to be reinstated.

4. EXR Request After Prior EXR Approval

An individual must complete the 24-month initial reinstatement period (IRP) to qualify for a subsequent period of EXR entitlement. If an individual has not completed the IRP, he or she does not qualify for a subsequent period of EXR.

EXAMPLE: Mr. Smith’s Title XVI benefits were reinstated through EXR as of 3/02. Mr. Smith returns to work as of 6/03 and has earnings over the threshold amount, making him ineligible for cash benefits and 1619(b). Mr. Smith continues to work and his Title XVI benefits terminate as of 6/04 after 12 months of payment ineligibility. Mr. Smith contacts SSA in 7/05 to state that he is no longer able to perform SGA and wants to apply for EXR. Since Mr. Smith only completed 15 months of his IRP (3/02 through 5/03) he can not be reinstated under EXR.

D. Policy - Disability Based On Statutory Blindness

1. Requirements

The requirements for EXR apply to statutory blindness in the same manner they apply to disability based on other impairments (the individual's prior monthly benefits must have terminated due to SGA for Title II, or excess income/combination of earned and unearned income for Title XVI). A blind individual's work activity is evaluated under standards applicable to blind individuals in Title II (blind SGA standards) and Title XVI (blind work expenses, etc.).

2. Medical Review

To qualify for EXR, the statutorily blind individual must undergo the same medical review process as a non-blind individual. The individual must therefore undergo a same as or related determination and a MIRS review. The DIB attainment process normally used to re-entitle an individual to cash benefits in Title II is not used in EXR processing. See DI 28057.001D.

3. Over Age 55 blind beneficiaries

EXR is applicable for blind beneficiaries only if he or she completed the TWP and benefits were terminated based on SGA. If the beneficiary is currently in suspense status (see DI 10515.015B) he or she does not meet the requirements for EXR.

E. Procedure - Disability Based On Statutory Blindness

If a medical decision is needed, the FO will take the EXR request and supplemental forms and forward them to the DDS. The DDS will make an EXR decision (and then a comparability decision, if necessary, for an over age 55 individual). If approved, the FO will process the award in the same manner as other EXR cases.

F. Policy - Proper Applicant

The claimant (or someone who has the right to sign a valid request on his or her behalf) must sign the EXR request. See GN 00204.003 for instructions on who can be considered a proper applicant. See GN 00502.100 through GN 00502.107 when representative payee development is needed.

EXR requests are currently excluded from the signature alternatives described in GN 00201.015, as they are MCS and MSSICS exclusions. The paper EXR request must be signed and retained in the claims folder.

If the individual dies after a protective writing has occurred, but before the EXR request is filed, follow the instructions in GN 00204.005. If the reinstatement request is for Title XVI benefits, see SI 02101.003 for instructions on who may receive a Title XVI underpayment.

G. Policy – “Unable to Perform SGA” Determination

We will determine that an individual is unable to perform SGA due to his/her medical condition when all of the following three conditions are met:

  • The individual certifies that he/she is unable to perform SGA because of his/her medical condition. This certification is obtained when the individual submits a signed SSA-371/372/373 (see Exhibits 1 through 3 in DI 13050.105);

  • The individual does not perform SGA in the month he/she requests EXR; and

  • The individual is found by the DDS to be under a disability based on the application of the Medical Improvement Review Standards (MIRS) (see DI 13050.005A.3.).


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