Effective January 1, 2001, when an individual's Social Security or SSI disability/blindness
benefits have ended because of work activity, the individual can request reinstatement
of benefits, including Medicare and Medicaid, if applicable, without filing a new
application. The basic criteria for expedited reinstatement are:
is “not able” or “becomes unable” to work at the SGA level due to his or her medical
is “not able” or “becomes unable” to perform SGA in the month of the EXR request,
stopped performing SGA within 60 months of his or her prior termination,
has a current medical impairment(s) that is the “same as or related” to the original
is under a disability based on application of the medical improvement review standard
Claimants are “not able” to perform SGA if, in the month of their EXR request, 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: Closed periods do not apply to EXR entitlement and claimants whose prior entitlement
is a closed period of disability are not eligible for EXR.
In addition, the individual may receive provisional benefits - as well as Medicare
or Medicaid - for up to six months while his/her case is being reviewed. If the individual
is found not disabled, the benefits generally would not be considered an overpayment.
(For more information on expedited reinstatement, see DI 13050.001, DI 28057.000, HI 00801.164, and HI 00801.165.)