The Five Year Rule For Social Security Disability: What You Need To Know

Navigating the path toward obtaining Social Security Disability Insurance (SSDI) benefits can be daunting. It involves forms, deadlines, and eligibility criteria. Among those rules is something many people find confusing: The Five Year Rule for Social Security Disability. This blog post aims to shed light on this rule, offering clarity and guidance.

I. Understanding SSDI and The Five Year Rule

The Five Year Rule for Social Security Disability doesn’t relate to your initial application but plays a significant role if you try to work again while receiving SSDI benefits. It centers on something called Expedited Reinstatement (EXR).

If you start earning enough to be considered capable of substantial gainful activity, your SSDI benefits will stop. But sometimes, a return to work doesn't pan out because your condition acts up again. That's where EXR comes in, and it's closely tied to the Five Year Rule. You can apply for EXR to restart your benefits within five years of losing them due to work earnings.

Why The Five Year Rule Matters

Let’s imagine you stopped receiving SSDI because you tried to work again, but, after three years, you found you could not continue. The Five Year Rule lets you seek EXR because you’re within that five-year timeframe.

If it had been six years, you'd likely face the whole SSDI application process all over again, involving multiple forms and potentially lengthy waiting periods. Expedited Reinstatement is a much faster way to have your disability payments restored.

II. What to Do if Your Condition Worsens

If you’ve had to stop working due to your previous condition (or something closely related) and are still within five years of stopping your SSDI, don’t delay. Start the process by reaching out to your local Social Security office to begin the EXR process.

The Five Year Rule only allows for the reinstatement of SSDI benefits, not Supplemental Security Income.

III. Eligibility Criteria for Expedited Reinstatement (EXR)

While The Five Year Rule plays a critical part in eligibility for EXR, there are some other qualifying criteria. The Social Security Administration (SSA) has laid out these eligibility requirements, as well.

Meeting the Requirements

You might qualify for expedited reinstatement if you are an SSI or SSDI beneficiary and all of the following are true:

• You are no longer working because your medical condition makes working impossible. This might also include the inability to do work-related activities.
• You stopped receiving SSDI because your earnings from work meant you no longer met the substantial gainful activity threshold.
• Your disabling condition is the same (or is related to) the medical condition you had when you received SSDI.
• Less than five years have passed since you stopped receiving your benefits.

IV. Gathering Necessary Documentation

You'll want to prepare all of your paperwork ahead of time because The Five Year Rule hinges on submitting all the forms promptly. This helps speed up the process, getting your benefits restored sooner.

Required Forms

While the EXR application is faster, you still need to have all your information in order, including recent medical records from treating physicians, contact information for current employers, and bank account numbers. Here’s a table to help you navigate these forms, work history, and credit cards to ensure a smooth application process:

Additionally, recent paystubs from your employment are essential. Having them neatly organized before contacting the SSA will make things much easier.

V. The Five-Year Rule vs. The Trial Work Period

While both of these disability regulations deal with a return to work, they are completely different. Understanding both, and how they overlap, can be beneficial when thinking about returning to the workforce after a disabling medical condition. The Five-Year Rule applies to EXR, but it doesn't mean you automatically get your benefits restored the day after filing for EXR.

How Trial Work Interacts with Expedited Reinstatement

While it doesn't always happen in the same order, think of the Trial Work Period as something you might need to go through during the Five-Year Rule period. For instance, let’s say you are approved for SSDI, start receiving your monthly disability payments, and then begin working again after two years.

The Trial Work Period allows for nine months where you can earn over the Substantial Gainful Activity (SGA) limits without losing your SSDI benefits. During this nine-month window, you need to track your monthly earnings because you’ll likely need to submit work reports such as an SSA 821 (if you were employed) or an SSA 820 (if you are a gig worker or are self-employed). Paystubs might be required, too. 

This allows the SSA to calculate if your working qualifies as substantial gainful activity, potentially terminating your SSDI. If after a month or two (or the whole nine months), your condition prevents you from working above SGA limits, EXR under the Five-Year Rule will come into play, assuming all other criteria are met.

You have a qualifying disability when the SSA has deemed your condition severe enough to keep you from working. Not all medical conditions will qualify a person for disability. Information on what conditions the SSA uses to make their disability determination is on their official website.

VI. Key Considerations for Successful Reinstatement

Knowing about the rules for SSDI reinstatement is just the beginning. Putting some preparation into the process is very important.

Factors Influencing Reinstatement Success

This doesn’t involve complex legal strategies, but rather simply means being organized with your information and being prepared before contacting Social Security.

• Thorough Medical Evidence: Keep meticulous medical records that document your medical condition, how it prevents you from working, and the treatments you’ve undergone.
• Maintain Updated Contact Info: Tell Social Security about any address or phone number changes right away. Also, make sure to have your banking information ready in case you’re eligible for back payment.
• Timely Application: Don't wait. Act quickly. The sooner you apply after having to stop work, the faster your benefits can be restored, as long as you meet the EXR criteria.
• Honesty and Accuracy: Be honest and truthful in your application and documentation. Any discrepancies could delay the EXR process.
• Work Incentives: Learn about the SSA’s Work Incentives programs and see if any might apply to your situation.

VII. When EXR Doesn’t Apply

While expedited reinstatement offers a pathway for people whose SSDI was terminated, it does not apply to all situations. It is designed for people who returned to work only to be unable to continue doing so due to a medical condition. It's essentially a grace period for those who tried to work but couldn't because of their disability.

Other Reasons SSDI Stops

People may cease to receive SSDI benefits because their condition improves, their eligibility for SSDI has been reviewed and overturned, they failed to respond to an inquiry from Social Security, or for a multitude of other reasons. Those folks can’t seek an EXR but must file a new SSA 16 Application for Disability Insurance Benefits instead. The entire process for a new application is available on the Social Security Administration’s website.

The SSA has a toll-free customer service number at 1-800-772-1213. It's advisable to call early in the morning to shorten the hold time, and for general questions, you might get through quickly. But if your questions involve details of your case or the evaluation process, be prepared for a potentially extended period on hold.

IIX. FAQs about The Five Year Rule For Social Security Disability

1. What is the SSDI Five-Year Rule?

It refers to the timeframe a person who previously received SSDI benefits but lost them due to work earnings can seek to have those benefits reinstated without the full, lengthy application process. That time frame is five years.

2. What is the 5/10 Rule for Social Security Disability?

This term is sometimes used (incorrectly) when people talk about The Five-Year Rule. There is no 5/10 Rule for SSDI, however.

3. What can cause you to lose your Social Security Disability benefits?

There are several situations in which people may stop receiving their SSDI benefits. One of those involves your medical condition improving enough for you to return to work. Others involve work earnings surpassing substantial gainful activity, turning retirement age, not notifying Social Security about a change of address, dying, or your case being reviewed and then rejected for medical reasons.

4. What is the SSA disability rule?

This is a very broad term. “The SSA Disability Rule” refers to any of the thousands of laws and regulations around disability claims.

IX. Help is Available

The Five Year Rule centers on making it simpler to have your SSDI restored should you need to stop working after you've tried going back to work. This expedited process is called Expedited Reinstatement and lets people restart SSDI benefits, under certain criteria, within a five-year time frame.

While the process is possible for a layperson to complete on their own, hiring a lawyer for SSDI (Social Security Disability Insurance) can be very helpful. Having professional representation on your side can significantly increase your chances of approval by navigating the complex application process, gathering necessary medical evidence, and representing you effectively during hearings, especially if your case is complicated or involves a contested medical condition.

Since opening our first office in 1994, we have built a reputation as genuine client advocates. With offices in Wilkesboro and Winston-Salem, our team is dedicated to representing clients who are seeking Social Security Disability, nationwide. If you or a loved one has been denied Social Security or Disability benefits, contact us for a free initial consultation.

Need help deciding who to hire? Check out our blog on what to look for in your Social Security Disability lawyer.