Social Security Disability Insurance (SSDI) provides monthly benefits to individuals who can no longer work due to a disabling medical condition. To qualify for SSDI, you must have worked enough years to accumulate work credits. The Social Security Administration grants work credits according to yearly wage amounts. For people who do not have enough work credits to qualify for SSDI, the SSA’s Supplemental Security Income (SSI) is available to financially assist low-income disabled children and adults.
When a medical condition improves enough to allow an SSDI recipient to return to work, their benefits will stop as soon as they receive their first check. In some cases, they may return to work for several months only to discover symptoms of their condition returning. Or, they may injure themselves while on the job because they weren’t physically ready to return to work. Whatever the reason someone needs to restart SSDI benefits, the SSA offers “expedited reinstatement” to apply for SSDI without completing a new disability application.
What is an Expedited Reinstatement (EXR) for SSDI?
An EXR avoids filling out an entire disability application while shortening the time it takes to start getting monthly benefits. In addition, when you apply for expedited reinstatement, the SSA may approve you for provisional benefits for as long as six months.
Qualifying for SSDI initially meant you had to prove to SSA disability evaluators that you could not maintain substantial gainful activity (SGA) that gave you income of no more than $1260 per month. If you return to work and start earning over that amount, you no long qualify for SSDI. You must always notify the SSA whenever you obtain employment while getting SSDI payments.
You are eligible for EXR if your income earnings fall below the substantial gainful activity amount set for 2020 and you applied and were approved for SSDI within the last five years. For example, someone who was approved for SSDI in 2013, reentered the work force in 2017 but became disabled again in 2020, they would not be eligible for expedited reinstatement of their SSDI benefits. Instead, they would have to file a new application complete with new medical documentation and updated information about their condition. Also, if the SSA approves an EXR request, the claimant may be entitled for up to a year of retroactive payments from the date the EXR request was filed. Eligibility for retroactive benefits varies from case to case and does not apply to everyone filing an EXR request.
What Happens After You Apply for an EXR for SSDI?
The SSA will sent your EXR application to a local disability determination agency that reviews criteria establishing the definition of a disability. In addition, the agency will examine your medical documentation and doctor’s reports to determine if you have had any improvements in your condition since you first applied for SSDI. According to the SSA, a medical improvement is evidence that your condition is not as severe as it was when you initially qualified for SSDI. Medical improvement must also be substantial enough to allow you work and earn “gainful” income.
Medical improvement must be directly related to a person’s ability to remain employed and to the impairment for which you were previously receiving SSDI. For example, if you were receiving SSDI for irritable bowel syndrome, returned to work when you responded well to treatment but had to stop working due to a return of SBI, the SSA cannot deny your EXR because they state you are no longer anemic.
In most cases, the claim of a medical improvement involving an EXR is difficult to prove, especially when you have past and present medical documentation proving you have received a clinical diagnosis of your disabling condition.
What is the Provisional Benefit Period?
While waiting for an EXR to be approved, the SSA will pay temporary benefits for up to six months. However, provisional SSDI benefits will stop when you receive a decision about an EXR request or if you earn income above the substantial gainful activity amount. Provisional benefits will also be discontinued if you turn 65 years old (full retirement age) before a decision is reached. If your expedited reinstatement request is denied, you do not have to repay provisional benefits as long as no overpayments were involved.
Monthly provisional benefits are generally equal to what you were receiving while on SSDI. Occasionally, this amount is adjusted if underpayments, overpayments or cost of living increases enacted by Congress have been established since your last benefit payment. Additionally, you are also entitled to health insurance while receiving provisional benefits. SSDI recipients are usually covered by Medicare.If your EXR is denied, Medicare will stop paying for your health costs.
What About Dependent Benefits and Reinstating SSDI Benefits?
If a spouse or child was receiving SSDI or SSI based on your income and their disability benefits ceased due to your income, their benefits will resume following approval of your EXR. Be aware that the SSA does not restart spousal, disabled child or parent’s benefits automatically. Reinstatement of their benefits must be requested online, by telephone or by mail.
Can You Appeal an Expedited Reinstatement Denial?
Yes, you can appeal an EXR but the appeal must be filed within 60 days of receiving your denial letter. The document you need to send to the SSA is called a “Request for Reconsideration”. Your local disability determination agency will review your application to determine if an error was made in denying your request.
Denials of Requests for Reconsideration can be appealed within 60 days of receiving a denial letter. This appeal will be held in a courtroom where an administrative law judge (ALJ) will preside over the case. The appeals process at this point resembles the appeals process in other types of disability appeals.
If an ALJ denies your second Request for Consideration, you have another chance to appeal the denial by taking it to the Social Security Appeals Council. The Appeals Council reviews why the ALJ decided to deny your request. Sometimes, an ALJ may make a procedural or legal error that the Appeal Council will catch and overturn. They will also examine all documents included in your case. You are allowed to provide the Appeals Council additional information pertinent to your medical disability.
Once the Appeals Council is finished reviewing your Request for Consideration, they will take one of three possible actions:
- Deny the request. If this occurs you can file another appeal in Federal District Court
- Overturn the denial made by the ALJ and approve your SSDI benefits case
- Remand your appeal back to an ALJ for the purpose of having the ALJ reconsider your case. At this point, the ALJ will either issue another denial or approve your case
If the Appeals Council flatly denies your case, you cannot ask that it be sent back to the ALJ. The only option is appeal again at the federal level. An Appeals Council that remands a case to an ALJ has probably found some type of technical error or a failure on the part of the ALJ to consider all the medical evidence you provided. Remands by Appeals Council happens in about two out of every 100 disability appeals. Less than three percent of all disability appeals are approved by an Appeals Council.
How Do You Appeal an EXR at the Federal Level?
You will need to file a civil complaint at a U.S. District Court nearest your location. Civil complaints are simply concise statements describing your disability and other aspects of your case. When you file an appeal at the federal level you are essentially not suing the SSA. Instead, the defendant named in your appeal’s complaint is the current commissioner of the Social Security Administration.
The SSA cannot assist you in completing a civil complaint since the case involves the SSA Commissioner. If you do not have a disability attorney at this point in the appeals process, it is likely your civil complaint will be rejected due to legal omissions and errors. The SSA and other disability experts strongly advise anyone to hire an experienced disability lawyer who give your case the legal expertise it needs to stand a chance at being approved in a Federal District Court.
Contact Joel Thrift Today for Legal Help with Reinstating Your SSDI Benefits
The amount of paperwork and legal knowledge required to ultimately get an EXR approved is extensive and complex in nature. Don’t just start filing appeals without having a disability attorney representing your best interests throughout the appeals process. Call today to schedule an immediate consultation appointment at Joel Thrift Law Offices.