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What Are Provisional Payments?
& How Long Does It Take To Get Them?

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C.L. Mike Schmidt Published by C.L. Mike Schmidt
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If you have stopped receiving SSDI benefits due to your employment, expedited reinstatement can quickly restore them without resubmitting an application.

As a disability lawyer with years of experience, I can tell you that provisional payments (also called “expedited reinstatement” or “expedited processing”) are the fastest way to get your disability benefits restarted. How long do you need to wait before receiving your provisional payments? I’ll tell you the answer in this article.

Quick Summary

  • If you receive Social Security Disability Insurance (SSDI) benefits, provisional payments may be available to you up to six months after submitting an EXR Request.
  • When figuring out a person’s monthly provisional benefit amount, Social Security considers the Primary Insurance Amount they are allowed.
  • Those qualified for provisional disability advantages are those with pre-existing impairments that impede their capacity to be gainfully employed.

What Is an Expedited Reinstatement (EXR) For SSDI?

A lawyer explaining an expedited reinstatement to a clientAn expedited reinstatement ( EXR) for SSDI is an accelerated process that allows you to restart your disability benefits without submitting a new application [1].

An EXR reduces the amount of paperwork and shortens the time until you start receiving your monthly benefits. Plus, when you submit a request for reinstatement to SSA, they may even pay you provisional benefits for up to six months.

Suppose your income has dropped below the substantial gainful activity amount for 2020, and you have applied and been approved for SSDI within the past five years. In that case, you meet social security’s definition of disabled, making you eligible for expedited reinstatement.

For instance, even if someone received approval for SSDI in 2013 and rejoined the working world in 2017 but were disabled again by 2020, they would not be able to fast-track reinstatement of their benefits. Instead, they must file a new application with updated medical records and information regarding their medical condition.

If the SSA gives its stamp of approval on the request for reinstatement, you may be eligible to receive retroactive payments for up to one year from your initial application date.

However, it is essential to remember that not all applicants will qualify for these benefits, and the availability varies depending on individual circumstances.

What Are Provisional Payments Under EXR?

A lawyer passing provisional payments to a client

Provisional payments under EXR include cash payments and Medicare or Medicaid coverage and generally don’t have to be paid back if your application is denied [2].

You may be eligible for provisional benefits if you request EXR.

Provisional payments are provided for up to six months; however, they can end faster should any of these conditions occur:

  • Social Security will notify you of the EXR decision.
  • Engage in SGA
  • Reach full retirement age

The benefits of receiving payments under EXR include the following:

  • The Initial Reinstatement Period (IRP)
  • Medicare Coverage and EXR
  • Supplemental Security Income Beneficiaries (SSI)

​​How Does Social Security Determine Provisional Payments Under EXR?

Social Security people calculating provisional paymentsSocial security determines provisional payments under EXR based on your past income and other social security benefits you’ve received in the past. They consider any changes to your earnings since the initial application and how long it has been.

For those individuals collecting Social Security Disability Insurance (SSDI) benefits, social security may issue provisional payments up to six months after submitting an EXR Request.

When determining the monthly provisional benefit amount, Social Security bases it on the Primary Insurance Amount (the highest benefit) that a worker is eligible for. 

For those receiving SSDI benefits based on their work history, Social Security may recalculate these amounts to be higher if earnings from prior termination exceed what was initially used to calculate the individual’s monthly benefit. This usually results in similar payments as they were receiving before cessation.

Provisional benefits are not paid, or are stopped if already started if it is determined the individual does not meet the requirements for EXR.
– Social Security Administration

Who Is Eligible for Provisional Disability Benefits?

Those who are eligible for provisional disability benefits include people with pre-existing conditions that interfere with their ability to work, as well as people who are already receiving Social Security benefits for a different reason.

Additionally, you should know that provisional payments are not considered insurance and cannot be used for medical bills or other expenses associated with disability.

How Long Does It Take To Get Provisional Payments?

A person receiving provisional payments in an officeProvisional payments can take up to three months from filing your expedited reinstatement request to when they begin.

This means that depending on when you submit your application, it could be anywhere from four to seven months until you receive retroactively adjusted provisional benefits. 

This wait time is determined by how long it takes for Social Security to process your request and adjust your payment amount accordingly.

The result of the provisional benefit period will be a determination from Social Security on whether or not you are eligible for disability benefits, as well as the amount that those benefits should be.

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FAQs

When Should You Choose Expedited Reinstatement and a Filing New Application?

You should choose expedited reinstatement when you get approved for disability benefits. Still, your benefit rate has changed due to a cost of living adjustment or other factors. On the other hand, you should file a new application with updated medical records when applying for benefits for the first time.

What Happens to Provisional Payments if the Person Owes Medicare Premiums?

If the person owes Medicare premiums, the government will deduct the premiums from provisional payments.

Will Existing Overpayments Affect Provisional Benefits?

Yes, existing overpayments will be deducted from the provisional benefits.

Can a Person Receive Provisional Payments if They Are Receiving SSI and Social Security Benefits?

Yes, someone can receive provisional payments and SSI and Social Security benefits. The amount you receive will be based on your substantial gainful activity. If you are receiving dependent benefits and retroactive benefits, they will not stop.   

Want to Request EXR?

The legal and administrative requirements for obtaining an EXR approval are complicated – don’t even think about submitting appeals without having the support of a qualified disability attorney. At Schmidt & Clark, LLP we offer free consultation sessions to discuss your case. Reach out today to get started.


References:

  1. https://vcu-ntdc.org/resources/WIPA_OtherResources/UnderstandingEXR2022.pdf
  2. https://www.ssa.gov/disabilityresearch/wi/exr.htm#:~:text=What%20are%20provisional%20benefits%3F,if%20we%20deny%20your%20request.

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