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.

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.

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 28057.020.

2. 2. 

   Forward the folder to the FO for any appropriate action.

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.