Social Security Disability Insurance
Written by: Bruce L. Weider | 7.15.2024

Social Security Disability Five-Year Rule

Is your disability preventing you from working again? You may be eligible to regain Social Security Disability (SSDI) benefits through the Five-Year Rule. This blog post from Bruce L. Weider, PC, a Ypsilanti, Michigan disability attorney, will explain what the Five-Year Rule is and how it can help you get back on your feet.

What is Social Security Disability (SSDI)?

Social Security Disability Insurance (SSDI) offers financial support for individuals with severe disabilities that prevent them from working. To qualify, you must meet a strict definition of disability set by the Social Security Administration (SSA). This means your condition must significantly limit your ability to perform past relevant work or any work you could be qualified for, and it's expected to last at least a year or result in death. 

Additionally, you need a sufficient work history measured in "work credits" earned through Social Security taxes. The application process involves submitting your medical records and work history to the SSA for review, with an appeals process available for denials. 

If approved, you'll receive monthly benefits based on your average earnings before becoming disabled. It's important to remember that SSDI is different from SSI, a needs-based program, and that qualifying for SSDI can also make you eligible for Medicare health insurance.

What is the Five-Year Rule for SSDI?

The Five-Year Rule is a provision within the SSDI program that allows individuals who previously received benefits to restart them more easily if their condition worsens within five years of their initial benefit termination. This streamlined process is known as Expedited Reinstatement (EXR).

When Does the Five-Year Rule Apply?

The Five-Year Rule offers a chance to reclaim Social Security Disability benefits if your condition worsens significantly within five years of having them terminated. There are four key requirements: 

Prior Receipt of SSDI Benefits: You must have previously received SSDI benefits for a disability.

Benefit Termination Reason: Your benefits were terminated for either:

  • Medical Improvement: The SSA determined your medical condition had improved enough that you could return to work.
  • Return to Work: You returned to work and your earnings exceeded the "substantial gainful activity" (SGA) limit set by the SSA. This limit defines a level of work that generates a certain amount of income.

Disability Worsening Within Five Years: Your disability must have significantly worsened within five years of your benefit termination. This worsening needs to:

  • Be medically documented by your doctor.
  • Limit your ability to perform SGA, essentially preventing you from working and earning above the SGA limit.

Inability to Engage in SGA Due to Worsening Condition: The core element is that your worsened disability prevents you from engaging in SGA. This means you cannot perform any type of work, considering your age, education, and experience (with vocational rehabilitation considered), that would generate income exceeding the SGA limit.

Expedited Reinstatement (EXR) Explained

Expedited Reinstatement (EXR) is the streamlined process you can utilize under the Five-Year Rule to regain Social Security Disability Insurance (SSDI) benefits. 

Compared to a new SSDI application, EXR offers a quicker turnaround time. The SSA will primarily focus on whether your disability has worsened and meets the SSDI definition for benefit reinstatement, bypassing a more comprehensive review of your entire medical history and work history.

Limitations of the Five-Year Rule

The Five-Year Rule offers a faster way to reclaim SSDI benefits, but it's not a sure thing. Even if your disability worsens within five years of losing benefits and you meet the other requirements, the SSA will still closely examine your current condition to see if it meets their strict definition of disability for SSDI. This means you'll need strong medical evidence from your doctor that proves your condition has worsened significantly and limits your ability to work. 

The Five-Year Rule only applies to the same disability you originally received benefits for, not new ones. There's also a strict five-year time limit - if your condition worsened outside that window, you won't qualify for EXR. 

Even with a strong case, your EXR application could be denied. Don't be discouraged though, you have the right to appeal. The key takeaway is that while the Five-Year Rule can expedite the process, a successful EXR application depends on presenting clear and convincing medical evidence of your worsened disability.

Qualifying for Benefits Under the Five-Year Rule

The key to a successful EXR application under the Five-Year Rule is building a strong case that proves your disability has worsened significantly. 

Gather comprehensive medical records from your doctor that detail this worsening and how it limits your ability to work. Include any updated test results like X-rays or MRIs that support the diagnosis. 

Additionally, consider obtaining statements from therapists or other healthcare professionals who can outline your current functional limitations. 

Finally, witness statements from friends or family members can be valuable by confirming how your disability impacts your daily activities and your ability to hold a job. 

By presenting a well-rounded picture of your situation, you can significantly increase your chances of a successful EXR application.

How to Apply for an EXR under the Five-Year Rule

You can initiate an EXR application by contacting your local Social Security office or by filing online at the SSA website. However, navigating the application process and gathering the necessary evidence can be complex.

The EXR Application Process:

  1. Initiating the Application: You can initiate an EXR application by contacting your local Social Security office or filing online at the SSA website.
  2. Gathering Evidence: A strong focus should be placed on gathering evidence documenting the worsening of your condition. This evidence may include:
    • Medical records from your doctor detailing the worsening and its limitations on your ability to work.
    • Updated test results (X-rays, MRIs) that support your doctor's diagnosis.
    • Statements from therapists or other healthcare professionals outlining your current functional limitations.
    • Witness statements from family/friends who can confirm how your disability impacts your daily life and ability to work.
  3. SSA Review: The SSA will review your EXR application and the evidence you submit. Their primary focus will be on determining if your worsened condition meets the SSDI definition of disability, making you unable to engage in SGA (substantial gainful activity).

Importance of Legal Representation | Bruce L. Weider, PC

The complexities of the Five-Year Rule and the EXR process can be daunting. Here's where an experienced Ypsilanti disability lawyer like Bruce L. Weider, PC, can be a game-changer. 

Their expertise ensures your application meets all the necessary criteria, maximizing your chances of a successful return of benefits. They can also assist in gathering strong medical evidence to support your case. Furthermore, a lawyer can effectively communicate with the SSA on your behalf, advocating for your rights and ensuring your voice is heard throughout the entire process. 

Regaining your SSDI benefits can provide much-needed financial security during a challenging time. Don't hesitate to reach out to Bruce L. Weider, PC, for a free consultation to discuss your eligibility under the Five-Year Rule.

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