October 23 – Expedited Reinstatement (EXR) While Appealing Termination
Question: I am working with a person who received a notice two months ago that Social Security terminated her Social Security Disability Insurance (SSDI), effective January 2017, because of work activity. The person submitted a Request for Reconsideration to appeal that termination and just received notice of a denial. She has started the Administrative Law Judge (ALJ) appeal process. Back in June of 2017 she stopped working, and she states she is unable to perform Substantial Gainful Activity (SGA) due to her disability. Can she apply for Expedited Reinstatement (EXR) right now, in case her appeal is denied?
Answer: An individual may inquire about EXR while a hearing request is pending at the ALJ on a prior termination decision or an initial claim denial. If the requirements for EXR are met the Disability Determination Service (DDS) will make the medical determination. The Social Security field office staff will contact the hearing office to request the medical records and forward the EXR request to the DDS for that medical decision.
If the EXR request is approved, the field office will notify the hearings office immediately and advise them of any pertinent issues that the approved EXR request raises (e.g., overpayment, prior period of disability ended, etc…). The hearing office will then determine if the pending hearing request can be dismissed.
Keep in mind, if Social Security denies EXR due to medical improvement, the beneficiary could lose Medicare. The beneficiary has the option of reapplying for benefits, rather than requesting EXR. Since the disability determination for initial claims uses sequential evaluation, rather than the Medical Improvement Review Standard (MIRS), a medical denial on an initial claim would not terminate Medicare entitlement. The beneficiary could also request both EXR and a new application simultaneously. The decision is complex, and the beneficiary should seek information from the Social Security Claims Representative when deciding which avenue is best.
Would you like to find out more about WIPA and your benefits? Contact your statewide WIPA Program-Project 20/20 if you have questions like our Daily Tips or want to learn more about working while receiving social security disability benefits. Call our North Augusta office at 803-279-9611 or the Ticket to Work Helpline at 1-866-968-7842. You can also complete a Contact Us or Self-referral Form.