If Social Security stopped your disability benefits because you made too much money, when you then stop getting too much income, you may be able to get your benefits restarted quickly without having to reapply for benefits. This is called expedited reinstatement.
Background: When You Lose Your Benefits
When you first applied for disability, you had to prove that your impairment prevented you from working at or above the substantial gainful activity level (SGA). (For 2013, SGA was defined as earning $1,040 or more a month from working.) You will eventually lose Social Security disability insurance (SSDI) if you start working above the SGA level again.
If you get SSI, you can work above the SGA level without losing benefits, but if your income goes over the SSI limit for your state, your benefits will be stopped right away.
Time Frame for Expedited Reinstatement
Expedited reinstatement (EXR) lets you restart your benefits without having to file a new application. This means that your benefits can start much faster than if you had to start the process over again.
If you were receiving Social Security disability insurance (SSDI) when you started working at the SGA level, you were given a trial work period for nine months. But if you continued working at the SGA level, the SSA assumed you were no longer disabled and your payments stopped. If your earnings fall below the SGA level again within five years, you can have your benefits restarted by applying for expedited reinstatement.
If you were receiving SSI but your income rose about the SSI income limits (even considering that Social Security does not count all of your earnings), your benefits were terminated immediately. If your income falls again below the SSI income limit within five years, you can have your benefits restarted by applying for expedited reinstatement.
If your EXR request is approved, you may be entitled to up to 12 months of retroactive benefits from the date your filed your EXR request.
Who Is Eligible for Expedited Reinstatement?
There are some basic requirements that you must meet to take advantage of expedited reinstatement. You must have:
- stopped getting payments because you made too much money when you returned to work (or for SSI, because your income rose above the income limit)
- requested the EXR within five years (60 months) of when your benefits were stopped
- stopped working because of a medical condition that is the same as, or related to, the condition for which you were originally receiving benefits, and
- not experienced a medical improvement in your condition since your initial application.
Medical improvement has a certain meaning here. When you apply for expedited reinstatement, your application will be sent to your local disability determination services (DDS). DDS is the state agency that reviews Social Security claims to see if the applicant meets Social Security's definition of disabled. This time, DDS will look at your medical records to see if you have experienced medical improvement since your initial application.
Medical improvement means that the condition on which your approval was originally based is no longer severe as it was, as it relates to your ability to work, and that you can now perform SGA. This standard is often difficult for Social Security to prove. This is good news for you because it may make it easier for you to get your EXR granted. For more information, see our article that explains the medical improvement standard.
Provisional Benefit Period
Social Security will pay you provisional benefits (cash payments) while you are waiting to see if your EXR is approved. Social Security will pay provisional benefits for up to six months, but they will be stopped before the six months is over if:
- you receive a decision about your EXR request
- you engage in substantial gainful activity (SGA), or
- you reach your full retirement age.
Even if your EXR request is denied, you usually won’t have to repay the provisional benefits.
During the provisional benefit period, you can also get health care coverage. If you were an SSI recipient, you will be covered by Medicaid. If you received SSDI, you will be covered by Medicare. If your EXR request is denied, your medical coverage will stop.
Your monthly provisional benefit amount is usually equal to the amount of your last payment before the benefits were stopped. Sometimes this amount is modified to reflect any previous overpayments or underpayments or cost of living adjustments.
If the SSA denies you provisional benefits while you await an EXR decision, you cannot officially appeal the denial. But if you are denied, you should advise the DDS that you disagree with its decision and ask that it be reviewed. Social Security will accept any new information you submit and look over the decision to make sure it was correct.
If your child, spouse, or other relative was getting benefits based on your earnings record and their benefits stopped because of your work activity, then their benefits will resume if your EXR is approved. These benefits include:
- spouse’s benefits
- divorced spouse’s benefits
- disabled child benefits, and
- parent’s benefits.
These benefits are not restarted automatically and must be requested by the beneficiary (or appropriate guardian).
Appealing a Denial of Expedited Reinstatement
The appeals process for a denial of EXR is similar to the appeals process for initial applications. If your EXR is denied, you have 60 days from the date you receive your denial letter to file a Request for Reconsideration. If your Request for Reconsideration is denied, you can ask for a hearing in front of an administrative law judge (ALJ). You have 60 days to make this request as well. If you disagree with the ALJ’s decision, you can then ask the Appeals Council to review the ALJ’s decision. For more information, see our section on disability appeals.