Effective Dates: 9/04/2024 - Present

Identification Number:
DI 28057 TN 8
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ORDES
Title:Expedited Reinstatement
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part DI – Disability Insurance

Chapter 280 – Continuing Disability Review Cases

Subchapter 57 – Expedited Reinstatement

Transmittal No. 8, 09/04/2024

Audience

PSC: CS, DE, DEC, DTE, IES, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: BET, CR, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ORDES

Effective Date

09/04/2024

Background

The Expedited Reinstatement (EXR) workload has historically been paper-based due to Electronic Disability Collect System (EDCS) limitations. Effective March 5, 2022, FO technicians are able to process EXRs in the EDCS. In addition historically FO technicians sent the denial notice. Systems enhancements now allow DDS technicians to send the denial notice.

This transmittal incorporates new EXR instructions for FOs/DDS about the electronic processing within the EDCS.

Summary of Changes

DI 28057.001 Expedited Reinstatement (EXR) Overview

Subsection F1: Update language to reflect current electronic methods.

Subsection F2: Update DDS responsibilities to include sending the denial notice.

 

DI 28057.010 Expedited Reinstatement (EXR) Case Receipt

Subsection A: Updated language to reflect electronic and paper procedures.

Subsection B. Updated EXR classification language for DDS systems, applied gender neutral language.

 

DI 28057.020 Effectuating Determinations

Subsection A: Updated to provide an overview of the types of DDS determinations.

Subsection B: Updated the language for electronic processing and included instructions for sending the denial notice.

Subsection C: Updated language for electronic processing and included instructions for sending the denial notice.

Subsection D: Updated language for electronic processing.

Subsection E: Updated language for electronic processing and included instructions for sending the denial notice.

Subsection F: Updated to omit instructions for the FO sending the denial notice.

Subsection G: Omitted the step by step instructions for case clearance since they are reflected in section F and added instructions for paper processing.

Subsection H: Deleted this section because the FO no longer prepares the denial notice.

 

DI 28057.030 Expedited Reinstatement (EXR) Appeals

Updated title

Subsection A: Replaced the previous instruction with an overview for appeal policy previously found in DI 28057.025. We will delete DI 28057.025. Provided cross references to general appeals policy and procedures.

Subsection B: Updated this section to reflect electronic processing and consolidated the previous section D into this section. Included instruction for sending the denial notice.

Subsection C: Updated to include paper processing.

Subsection D: Moved information from this subsection into subsection B. Included information from DI 28057.035 and DI 28057.040 into this subsection and will delete those two sections of POMS.

 

DI 28057.045 Expedited Reinstatement and Initial Claim Filed for the Same Benefit

Subsection A: Updated for gender neutral language. and overall readability.

Subsection B: Replaced this subsection with an overview of FO responsibilities.

Subsection C: Included processing instructions that were previously found in subsection D. Included instructions to upload documents into eView.

DI 28057.001 Expedited Reinstatement (EXR) Overview

A. Introduction to EXR

The Ticket to Work and Work Incentives Improvement Act of 1999 added sections 223(i) and 1631(p) to the Social Security Act (Act) to allow previously entitled beneficiaries, whose entitlement ended due to work, (February 1996 or later) to request EXR of disability benefits or payments under Title II and Title XVI. EXR benefits became payable in January 2001 for Tittle II and February 2001 for Title XVI. A previously entitled beneficiary may become eligible for EXR if their medical condition no longer permits them to perform substantial gainful activity (SGA) within 60 months of their prior termination. EXR establishes a new period of disability with a new month of entitlement. EXR allows a claimant to receive up to 6 months of provisional benefits while the Social Security Administration (SSA) conducts a medical review to determine if the claimant qualifies for reinstatement of benefits. The claimant may also be eligible for Medicare or Medicaid coverage during the provisional benefit period.

B. Policy for Title II and Title XVI EXR eligibility

Effective April 17, 2017, new rules allow previously entitled beneficiaries to apply for EXR in the same month they stop performing SGA. Provisional benefits will begin the month after the request for EXR if the claimant stops performing SGA in the month of the EXR request. For requests filed prior to April 17, 2017, field office (FO) technicians must deny the request for EXR if the claimant performed SGA in the month of the EXR request.

1. Requirements for EXR eligibility

Previously entitled beneficiaries, whose entitlement ended due to work, are eligible for EXR if they meet all of the following requirements:

  • •

    are “not able” or “becomes unable” to work at the

  • •

    are “not able” or “becomes unable” to perform SGA in the month of the EXR request,

  • •

    stopped performing SGA within 60 months of their prior termination,

  • •

    have a current medical impairment(s) that is the “same as or related” to the original impairment(s), and

  • •

    are under a disability based on application of the medical improvement review standard (MIRS).

Claimants are “not able” to perform SGA if, in the month of their EXR request or the following month, they do not work, or their work is not SGA.

Claimants “become unable” to perform SGA if, in the month of their EXR request, their work is SGA, but they stop performing SGA by the day they file their request. To meet the requirement of having become unable to perform SGA, they must also not perform SGA in the month following the EXR request.

NOTE: Claimants whose prior entitlement is a closed period of disability are not eligible for EXR.

C. Title II EXR policy

1. EXR requirements

Claimants previously entitled to disability insurance benefits (DIB), disabled widow(er) benefits (DWB), or an unmarried childhood disability benefit (CDB) whose monthly benefits terminated due to their own SGA must meet the requirements listed in DI 28057.001B in this section to be eligible for EXR.

NOTE: The EXR provision is applicable to a Medicare Qualified Government Employee (MQGE) beneficiary, which allows reinstatement of Medicare, even though we do not pay monthly benefits.

2. Claimant with prior EXR technical denial

If we deny a request for EXR for failure to meet the non-medical requirements for EXR (not filed within 60 months, etc.) we may apply the principles of res judicata to a subsequent request. Res judicata does not apply if any aspect of the case has changed, including laws or regulations. For situations in which res judicata is applicable, see GN 03101.160B.

3. Claimant entitled to another disability benefit

If a claimant requesting EXR is currently entitled to another disability benefit, do not apply collateral estoppel procedures to approve the EXR request. The Disability Determination Services (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 claimant is disabled based on the Medical Improvement Review Standards (MIRS).

4. Claimant entitled to reduced retirement insurance benefits (RIB)

If the claimant became entitled to reduced RIB simultaneously with or after the EXR month of entitlement (MOE), see RS 00615.110B.2.

If the claimant became entitled to reduced RIB before the EXR MOE, see RS 00615.110B.3.

NOTE: For retirement benefit computation purposes, consider the period of disability and the EXR period to be one period of DIB.

5. Auxiliary reinstatement

When we approve a number holder’s request 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 continue to meet initial entitlement requirements, per DI 13050.060A.2.

D. Title XVI EXR policy

1. EXR requirements

A previously entitled recipient whose monthly benefits terminated due to excess earned income (or a combination of earned and unearned income) must meet all requirements listed under DI 28057.001B in this section, and must meet all non-medical Title XVI requirements to be eligible for EXR.

2. Claimant with prior EXR technical denial

If we deny a request for EXR for failure to meet the non-medical requirements for EXR (not filed within 60 months, etc.), we may apply the principles of res judicata to a subsequent request. Res judicata does not apply if any aspect of the case has changed, including laws or regulations. For situations in which res judicata is applicable, see GN 03101.160B.

3. Eligible spouse

An eligible spouse can also request reinstatement, and may be eligible for up to 6 months of provisional benefits and Medicaid coverage during the provisional benefit period.

4. EXR request after prior EXR approval

A claimant must complete the 24-month initial reinstatement period (IRP) to qualify for a subsequent period of EXR entitlement. The IRP is completed when the individual has received a total of 24 months of payable benefits. If a claimant has not completed the IRP, they do not qualify for a subsequent period of EXR.

E. EXR policy for disability based on statutory blindness

1. EXR requirements

Evaluate a blind claimant’s work activity under standards applicable to claimants with statutory blindness in Title II (blind SGA standards) and Title XVI (blind work expenses) see DI 10515.000 and SI 00820.535.

2. Medical review

To qualify for EXR, the statutorily blind claimant must undergo the same medical review process as a non-blind disabled individual. The claimant must undergo a “same as or related determination,” and a MIRS review. The DDS will make an EXR determination and then a comparability determination, if necessary, for a claimant over age 55. If approved, the FO will process the award in the same manner as other EXR cases. Do not use the DIB attainment process normally used to re-entitle a claimant to cash benefits in Title II in EXR processing. For more information on DIB attainment, see DI 13010.135 and DI 41005.010.

3. Statutory blind beneficiaries over age 55

EXR is applicable for blind claimants only if they completed the trial work period (TWP) and their benefits terminated based on SGA. If the claimant is currently in suspense status, they do not meet the requirements for EXR, see DI 10515.015B.

F. Overview of component responsibilities

1. FO responsibilities

The FO is responsible for taking the following actions:

  • •

    Discuss the criteria for reinstatement with the claimant and provide a comparison of the possible effects of requesting EXR versus filing a new initial claim. For complete instructions on EXR versus a new claim, see DI 13050.020. For complete EXR interview instructions, see DI 13050.045 and DI 13050.050.

  • •

    Assist the claimant with the request for reinstatement and determine whether the claimant meets the applicable non-medical criteria.

  • •

    Obtain necessary forms as instructed in DI 13050.045 and DI 13050.050.

  • •

    Obtain the prior medical folder if the prior determination was not electronic.

  • •

    Initiate provisional benefits using the Post Entitlement Online System (POS) (if applicable) for Title II, or by establishing a start-date record for Title XVI. For complete provisional benefit instructions, see DI 13050.025 and DI 13050.030.

  • •

    For Title II , the FO identifies all SGA and non-SGA months in the 12-month period prior to the month of filing or from the Benefit Termination Month (BTM), whichever is later, in item 2C of the Continuing Disability Review/Post Entitlement (CDR/PE) section on the SSA-823.

  • •

    If the claimant meets all the non-medical requirements for EXR, the FO sends the case to the DDS for a medical determination.

  • •

    Establish the EXR on the Disability Control File (DCF).

  • •

    If the claimant does not meet the non-medical requirements for EXR, and the claimant insists on filing for EXR, the FO issues a technical denial. For technical denial instructions, see DI 13050.065.

  • •

    If the DDS denies the EXR, terminate provisional benefits if not currently being paid.

  • •

    If the DDS allows the EXR:

    1. 1. 

      For Title II, the FO processes an Electronic Form 101 (EF101) per DI 13050.060B, and forwards it to the Program Center (PC) for processing; and

    2. 2. 

      For Title XVI, the FO terminates the record, stops provisional benefits, and then start-date a new EXR record. For complete EXR award instructions, see DI 13050.060 and DI 13050.061.

2. DDS responsibilities

The DDS reviews the medical evidence and determines if the claimant's current impairment is the “same as or related” to the impairment that led to the previous entitlement to benefits, using the comparison point decision (CPD). If a “same as or related impairment” exists, the DDS determines whether the claimant is disabled based on the MIRS.

The DDS determines the EXR month of entitlement in allowance determination.

The DDS prepares a Form SSA-832 (Title XVI Cessation or Continuance of Disability Determination and Transmittal), or Form SSA-833 (Title II Cessation or Continuance of Disability Determination and Transmittal) to document the determination and returns the file to the FO. In addition, the DDS prepares and sends the denial notice containing a personalized explanation to the claimant,before returning the case to the FO.

If the DDS allows the EXR, the DDS returns the case to the FO. For complete instructions on DDS EXR claims processing, see DI 28057.000.

NOTE: The determination that an impairment is "the same as or related to" is a medical determination that can be made only by the DDS.

3. PC responsibilities

The PCs process all EXR awards for Title II benefits through the District Office Final Authorization (DOFA) procedures. The PC takes the following actions:

  • •

    Terminate provisional benefits, if necessary, and adjust the benefits payable for provisional benefits paid,

  • •

    Adjudicate Medicare entitlement as appropriate, and

  • •

    Prepare and send the appropriate award and overpayment notices. For PC EXR procedures, see subchapter SM 00856.000 and section DI 13050.095.

NOTE: The DCF controls EXR requests from the time of the request through adjudication. It is important to initiate the EXR event on the DCF and show the transfer of the case between the FO, DDS, and PC to control the cases accurately, and to provide accurate management information. Further, controlling the EXR case through the DCF helps ensure the accuracy of future actions during the Initial Reinstatement Period (IRP), TWP, and EPE (if applicable).

DI 28057.010 Expedited Reinstatement (EXR) Case Receipt

A. Procedure for EXR Case Identification

The field office (FO) establishes EXRs and EXR appeals in the Electronic Disability Collect System (EDCS) and transfers the case to Disability Determination Services (DDS). When transferred to DDS, the DDS Disability Folder Selection screen will identify the case level of "EXR Initial" or "EXR Recon".

NOTE: Paper EXR cases are identified by the flag (refer to exhibit 4 in DI 13050.105C) placed on top of the paper folder. The flag will state,"Expedited Reinstatement Case-Priority Handling".

The EXR request must include the following:

  1. 1. 

    Expedited Reinstatement Request form SSA-371, Request for Reinstatement for Title II; or SSA-372, Request for Reinstatement for Title XVI.

    NOTE : The SSA-371 now includes the Medicare acknowledgement statement;

  2. 2. 

    The appropriate Title II or Title XVI paper application (SSA-16-BK, SSA-10-BK, SSA-4-BK, SSA-8000-BK);

  3. 3. 

    The FO completes the SSA-454-BK, Report of Continuing Disability Interview, SSA-3367, Disability Report-Field Office, and SSA-827, Authorization for Source to Release Information to the Social Security Administration in EDCS;

  4. 4. 

    SSA-820-BK or SSA-821-BK:

    • •

      For Title II, the FO uses these forms to develop and document all work activity in the 12-month retroactive period, or from the Benefit Termination Month (BTM), whichever is later. They use initial claim policy rules to evaluate earned wages per DI 10505.005D.

    • •

      For Title XVI, the FO uses these forms to develop and document all work activity beginning with the month of filing.

  5. 5. 

    SSA-823- Report for SGA Determination. The click and sign feature in Uniforms can be used to complete form SSA-823. In Item 2C under Continuing Disability Review/Post-Entitlement (CDR/PE), documents the following:

    • •

      For Title II cases, the FO documents the month of EXR filing (and protective fling date if applicable), prior termination month, and the SGA determination for each month in the retroactive period. If possible, retro-activity prior to the month of filing exists, indicate in the remarks, "possible retro-activity exists prior to the month of filing".

    • •

      If there is SGA in all months of the 12-month retroactive period and in the month of filing, the first possible MOE is the month following the month of filing. In this situation, annotate the remarks of the SSA-823 with “SGA in the month of filing, First possible MOE is MM/YY”.

      NOTE: Document first possible month of entitlement regardless in MM/YY format regardless of SGA.

      NOTE: The retroactive period does not include months prior to the BTM. Therefore, if the BTM is fewer than 12 months before the request for EXR, do not provide SGA and non-SGA determinations for months prior to the BTM. If SGA work stopped prior to the BTM, review the prior termination decision, and determine if reopening is appropriate.

    • •

      For Title XVI cases, the FO documents the month of filing, and the SGA determination for the month of the EXR filing to present. If there is SGA in the month of filing, add the remark "SGA in the month of filing, First possible MOE IS MM/YY". NOTE: Document first possible month of entitlement in MM/YY format regardless of SGA.

  6. 6. 

    SSA-8240- Request wage and employment information authorization and record it in the Wage and Employment Information Authorization (WEIA) application per, GN 00204.150C; and

  7. 7. 

    The FO documents the comparison point decision (CPD), the month benefits terminated due to work, the established onset date from the previous entitlement, and the EXR filing date in EDCS.

    NOTE: If the CPD is electronic, the FO may transfer the EXR request to the servicing DDS. If the CPD folder is paper, the FO must wait for the receipt of the paper CPD folder before transferring the EXR request to the servicing DDS. DDS will need the comparison point decision (CPD) folder to make the EXR medical determination. If the CPD folder is paper, follow folder retrieval instructions in DI 13015.030 through DI 13015.250, and DI 40525.020 through DI 40525.150. If you are unable to locate the CPD folder, follow instructions in DI 13015.080 and DI 13015.090. If the CPD folder was processed in EDCS, you will be able to "link" it to the EXR case when you create it in EDCS.

NOTE: These forms will be completed in Uniforms within EDCS (if available) and stored in the electronic file

B. Procedure for case receipt

1. Case receipt

DDS technicians will receipt the case as an initial CDR Type of Expedited Reinstatement. The TYP in the National Determination Services System (NDDSS) will show as "CD" with a continuing disability type (CDT) code of "5". The CDT code distinguishes the claim as an EXR rather than a medical CDR. Coding the claim correctly also allows the Office of Disability Determinations (ODD) to identify it as an EXR when counting clearances at the end of the fiscal year.

2. Multiple actions pending

If the EXR action is received simultaneously with an initial claim action on the same individual, for the same benefit, follow locally established receipt and clearance procedures. Depending on variations in adjudicative protocols and system limitations that may preclude controlling multiple actions on the same title and SSN, establish manual control processes as needed. It may be possible to sequentially establish the actions if adjudicative time frames vary (for example, receipt the EXR action, complete that action in the system, then receipt the initial claim action and complete the initial claim), see DI 28057.045.

DI 28057.020 Effectuating Expedited Reinstatement (EXR) Determinations

A. Background

The disability determination services (DDS) make one of the following determinations on a request for EXR:

  1. 1. 

    Unfavorable determination for not "same as or related"; or

  2. 2. 

    Unfavorable determination due to medical improvement (MIRS); or

  3. 3. 

    Unfavorable determination due to failure to cooperate; or

  4. 4. 

    Favorable determination under MIRS.

    NOTE: For paper cases, DDS sends the folder to the field office (FO) upon determination.

B. Procedure for a not “same as or related” determination

If the impairment is not the same as or related to that of the individual's most recent disability entitlement the individual is not eligible for EXR. Deny the request for EXR by taking the following actions:

  1. 1. 

    Document that the alleged impairment is not the same as or related to the comparison point decision (CPD) impairment.

  2. 2. 

    Complete an SSA-832-C3/U3 or an SSA-833-C3/U3 per DI 28057.020F.

  3. 3. 

    Prepare and send the denial notice. Include a personalized explanation with the rationale for the finding.

  4. 4. 

    Close out the EXR in Disability Case Processing System (DCPS). The National Disability Determination Services System will show a System Override code of "N."

  5. 5. 

    Scan all documentation in the electronic folder.

    NOTE: The "not the same as or related" decision is made after the evidence is obtained.

C. Procedure for an unfavorable medical determination under medical improvement review standard (MIRS)

If the individual has experienced medical improvement related to the ability to work and the individual is capable of engaging in substantial gainful activity (SGA), determine the individual is not eligible for EXR. Take the following actions:

  1. 1. 

    Complete an SSA-832-C3/U3 or an SSA-833-C3/U3 per DI 28057.020F.

  2. 2. 

    Prepare and send the denial notice. Include the personalized explanation with the rationale for the finding.

  3. 3. 

    Close out the EXR in DCPS. NDDSS will show a System Override code of "N".

  4. 4. 

    Alert the FO using an electronic folder (EF) message in eView when a beneficiary is concurrently entitled. The FO must initiate a medical CDR on the other title. For paper cases, put all remarks on the routing slip.

  5. 5. 

    Scan all documentation in the electronic folder.

D. Procedure for a favorable determination under MIRS

If no medical improvement related to the ability to work has occurred, find the individual eligible for EXR. Take the following actions:

  1. 1. 

    Determine the appropriate month of entitlement (refer to DI 28057.015E).

  2. 2. 

    Complete an SSA-832-C3/U3 or an SSA-833-C3/U3 per DI 28057.020F; and

  3. 3. 

    Close out the EXR in DCPS. NDDSS will show a System Override code of "N".

  4. 4. 

    Scan all documentation in the electronic folder.

    NOTE: The program center (PC) issues the award notice.

E. Procedure for failure to cooperate

If the individual does not cooperate, follow the Failure to Cooperate procedures in DI 28075.005 and take the following actions:

1. Complete the SSA-832-C3/U3 or an SSA-833-C3/U3, per DI 28057.020F; and

2. Prepare and send the denial notice. Include the personalized explanation with the rationale for the finding.

3. Close out the EXR in DCPS. NDDSS will show a System Override code of "N".

4. Scan all documentation in the electronic folder.

F. Procedure for completion of forms SSA-832-C3/U3 and SSA-833-C3/U3

Document the EXR determination on forms SSA 832-C3/U3 or SSA-833-C3/U3 with DI 28084.000 except as follows for EXR determinations:

  1. 1. 

    Item 5: Enter the established onset date from the most recent period of entitlement ( SSA-831).

  2. 2. 

    Item 9:

    • •

      If the individual is under a disability, check block A.

    • •

      If the individual is not under a disability or the impairment is not the “same as or related”, check both blocks B and C. The date for both is the date of the EXR request.

  3. 3. 

    Item 10: Check block D, “Other”

  4. 4. 

    Item 11:

    • •

      Title II Cases: For a determination that the current impairment is not the “same as or related to” the CPD impairment, show code 28.

    • •

      Title XVI Cases: For a determination that the current impairment is not the “same as or related to” the CPD impairment, show code 61.

    • •

      For a determination that the individual is not under a disability based on MIRS, use the codes for a CDR MIRS cessation, see DI 28084.015.

  5. 5. 

    Item 20: Enter WRM code of 31 (defined as “Expedited Reinstatement”).

  6. 6. 

    Item 24: Enter remark, “Expedited Reinstatement”. For cases where the individual is found to be under a disability, also enter “MOE MMYY”. This date is the new EXR month of entitlement date for Title II cases or the new month of eligibility for reinstatement in Title XVI cases. This is based upon the individual's disability and the work determination on the SSA-823.

    • •

      Review the remarks section of the SSA-454 for the month of the EXR request; and

    • •

      Review the SSA-823 for the SGA determination and identification of the earliest possible month of non-SGA in the 12-month retroactive period. See DI 28057.015E. for determining the Title II month of entitlement, and DI 28057.015F. for determining the Title XVI month of entitlement.

  7. 7. 

    Item 29: Leave blank.

G. Procedure for paper case clearance

Most EXR cases are electronic, however, for any paper cases, follow these procedures to clear the case:

  1. 1. 

    If the determination is to deny the EXR request, add a remarks to route the slip, "Terminate provisional payments"; If the determination is favorable, fax the EXR determination (SSA-832/833) to the FO, so the FO can initiate necessary non-medical development, see DI 11010.340.

  2. 2. 

    Forward the folder to the FO under cover of a route slip and note any appropriate action.

DI 28057.030 Expedited Reinstatement (EXR) Appeals

A. Background for EXR appeals

A request for EXR involves two types of determinations: a provisional benefit determination and an EXR determination.

1. Provisional benefits determinations are not subject to administrative and judicial reviews (appeals), see DI 13050.025.

2. EXR technical and medical determinations are initial determinations subject to the administrative and judicial(appeals) review process, see DI 13050.065, GN 03101.070 and SI 04010.010. For the policy for EXR appeals , see DI 13050.085.

B. DDS reconsideration process

Although the medical review standard and forms used in EXR appeals is the same as for continuing disability reviews (CDR), the CDR Disability Hearing Unit (DHU) procedure is not applicable to EXR determinations. DDS technicians receipt the case as a disability hearing CDR with a CDR Type of Expedited Reinstatement. The TYP in the National Determination Services System (NDDSS) show as “DH”, with a continuing disability type (CDT) code of “5”. The CDT code distinguishes the claim as an EXR rather than a medical CDR.

To process the EXR appeal, take the following actions:

  1. 1. 

    Follow the procedures for regular initial claim appeals in DI 27001.000.

  2. 2. 

    Make a medical determination using the instructions contained in section DI 28057.015 .

  3. 3. 

    Complete the SSA-832-C3/U3 or SSA-833C3/U3 per DI 28057.020F.

  4. 4. 

    Close out the EXR in DCPS. The National Disability Determination Services System (NDDS) will show a system override code of "N."

  5. 5. 

    Prepare and send the denial notice.

  6. 6. 

    Scan all documentation in the electronic folder.

C. Procedure for paper case clearance

Take the following steps to clear a paper EXR reconsideration case:

  1. 1. 

    If the determination is favorable, fax the EXR approval to the FO, so the FO can initiate necessary non-medical development, see DI 11010.340. If the determination is unfavorable see DI 28057.030G.

  2. 2. 

    Forward the folder to the FO for any appropriate action.

D. Hearings and Appeals Council (AC) review

If the individual disagrees with the reconsideration determination, the FO processes the hearing request per DI 13050.085D and DI 12010.001. If the individual disagrees with the determination made by an ALJ, the FO processes the request for AC review per DI 13050.085E and DI 12020.000.

DI 28057.045 Expedited Reinstatement and Initial Claim Filed for the Same Benefit

A. Background

Most individuals who meet the requirements for EXR also meet the requirements to file a new initial claim. The field office (FO) technician discuss the filing considerations in DI 13050.020. The individual must decide which claim they wish to pursue. While an individual may insist on filing both a new initial claim and a request for EXR at the same time, we can only process one claim allowance.

B. Field Office (FO) procedures for sending the cases to the Disability Determination Services (DDS)

Due to systems limitation, an EXR and an initial claim with the same claim type are multiple pending cases (MPC's) and are excluded from processing in Electronic Disability Collect System (EDCS). The FO takes the following actions to process the case:

  • •

    Establish initial claim in EDCS.

  • •

    Add a message to EDCS indicating that a paper EXR exists.

  • •

    Upload any documents that apply to both the electronic and the paper claim in eView.

  • •

    Create a modular disability folder (MDF) for the EXR.

  • •

    File the documents that pertain solely to the EXR in the MDF.

  • •

    Update the paper folder indicator (PFI) in EDCS stating that a paper folder has been created for this filing, see DI 81010.085;

  • •

    Transfer EDCS to DDS.

  • •

    Print an EDCS routing form for the MDF; add remarks “EDCS exclusion-associate with EDCS case transferred on MM/DD/YYYY".

  • •

    Mail the paper MDF to DDS.

NOTE : EXRs and initial claims with different claim types can be loaded as an MPC in EDCS. For example, an EXR Childhood Disability Benefit (CDB) claim and an initial disability (DIB) claim can be loaded into EDCS as an MPC. If the EXR claim is filed simultaneously with an initial claim on the same individual, for the same benefit, follow locally established DDS receipt and clearance procedures. It may be possible to sequentially complete the actions (for example, receipt the EXR, complete that claim in the system, then receipt the initial claim and complete the initial claim). If the EXR and initial claim for the same benefit must be processed simultaneously rather than sequentially, the EXR claim is an EDCS exclusion and must revert to paper processing.

C. DDS procedures for case processing

When DDS receives the cases from the FO, process as follows:

  • •

    Adjudicate the initial application or reconsideration following normal procedures per DI 26500.000. Adjudicate the EXR request or reconsideration following DI 28057.020.

  • •

    Print documentation that pertains solely to the excluded claim (for example, SSA-831 and determination notice), and associate these items in the MDF for FO adjudication after making a determination.

  • •

    Upload any documents that apply to both the electronic and the paper claim in eView.

  • •

    Return the electronic and paper portions of the case to the FO.


DI 28057 TN 8 - Expedited Reinstatement - 9/04/2024