DI 52160.001 Expedited Reinstatement (EXR) Provisional Payments with Workers’ Compensation/Public Disability Benefit (WC/PDB)
Soc. Sec. Act, Section 223(i) , - Reinstatement of Entitlement
Certain previously entitled disabled workers may request reinstatement of disability benefits when their medical condition no longer permits them to perform substantial gainful activity (SGA) within 60 months of their prior termination. The EXR provision:
Allows a disabled worker to receive up to 6 months of provisional payments while SSA conducts a medical review to determine whether the work can be reinstated to benefits.
Establishes a new period of disability with a new onset date, but the disability insurance benefit (DIB) is computed as if the termination never occurred.
For detailed EXR information, see DI 13050.001 – Expedited Reinstatement.
A. Provisional payments
Provisional benefits are paid based on the monthly benefit payment at the time the previous entitlement terminated. However, provisional payments are increased by any intervening cost-of-living adjustments (COLAs) and applicable primary insurance amount (PIA) recomputations. If the prior monthly benefit amount was reduced due to offset, the provisional benefit amount is based on that prior reduced benefit payable.
See DI 13050.025 - Provisional Benefits - Title II.
B. Applying offset to provisional payments
Calculate the provisional benefit payment amount using the average current earnings (ACE) that applied in the T8 month. T8 is the first month of SGA after the end of the 36-month extended period of eligibility (EPE) and any applicable grace months.
NOTE: Auxiliary beneficiaries are not entitled to receive provisional payments.
If the prior payable benefit was reduced due to WC/PDB, the new provisional payment amount is based upon that prior reduced benefit payable. For the 6 month provisional payment period, pay the same reduced rate that was paid prior to the T8 month.
For information on WC/PDB offset calculation, see DI 52160.005 – Workers’ Compensation/Public Disability Benefit (PDB) Offset Data on MBR.