Disability Insurance Benefits
SEC. 223.
[42 U.S.C. 423] (a)(1)
Every individual who—
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(A) is insured for disability insurance benefits (as determined
under subsection (c)(1)),
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(B) has not attained retirement age (as defined in section 216(l)),
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(C) if not a United States citizen or national—
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(i) has been assigned a social security account number that
was, at the time of assignment, or at any later time, consistent
with the requirements of subclause (I) or (III) of section 205(c)(2)(B)(i);
or
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(ii) at the time any quarters of coverage are earned—
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(I) is described in subparagraph (B) or (D) of section 101(a)(15)
of the Immigration and Nationality Act[246],
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(II) is lawfully admitted temporarily to the United States for business
(in the case of an individual described in such subparagraph (B))
or the performance as a crewman (in the case of an individual described
in such subparagraph (D)), and
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(III) the business engaged in or service as a crewman performed
is within the scope of the terms of such individual's admission
to the United States.
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(D) has filed application for disability insurance benefits,
and
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(E) is under a disability (as defined in subsection (d))
shall be entitled to a disability insurance benefit (i) for
each month beginning with the first month after his waiting period
(as defined in subsection (c)(2)) in which he becomes so entitled
to such insurance benefits, or (ii) for each month beginning with
the first month during all of which he is under a disability and in
which he becomes so entitled to such insurance benefits, but only
if he was entitled to disability insurance benefits which terminated,
or had a period of disability (as defined in section 216(i)) which
ceased, within the 60-month period preceding the first month in
which he is under such disability, and ending with the month preceding
whichever of the following months is the earliest: the month in
which he dies, the month in which he attains retirement age (as defined
in section 216(l)), or, subject to subsection (e), the termination
month. For purposes of the preceding sentence, the termination month
for any individual shall be the third month following the month
in which his disability ceases; except that, in the case of an individual
who has a period of trial work which ends as determined by application
of section 222(c)(4)(A), the termination month shall be the earlier
of (I) the third month following the earliest month after the end
of such period of trial work with respect to which such individual is
determined to no longer be suffering from a disabling physical or
mental impairment, or (II) the third month following the earliest
month in which such individual engages or is determined able to
engage in substantial gainful activity, but in no event earlier
than the first month occurring after the 36 months following such
period of trial work in which he engages or is determined able to engage
in substantial gainful activity. No payment under this paragraph
may be made to an individual who would not meet the definition of
disability in subsection (d) except for paragraph (1)(B) thereof
for any month in which he engages in substantial gainful activity,
and no payment may be made for such month under subsection (b),
(c), or (d) of section 202 to any person on the basis of the wages
and self-employment income of such individual. In the case of a deceased
individual, the requirement of subparagraph (C) may be satisfied
by an application for benefits filed with respect to such individual
within 3 months after the month in which he died.
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(2) Except as provided in section 202(q) and section 215(b)(2)(A)(ii), such
individual's disability insurance benefit for any month shall be
equal to his primary insurance amount for such month determined
under section 215 as though he had attained age 62 in—
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(A) the first month of his waiting period, or
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(B) in any case in which clause (ii) of paragraph (1) of this
subsection is applicable, the first month for which he becomes entitled
to such disability insurance benefits,
and as though he had become entitled to old-age insurance benefits
in the month in which the application for disability insurance benefits
was filed and he was entitled to an old-age insurance benefit for
each month for which (pursuant to subsection (b)) he was entitled
to a disability insurance benefit. For the purposes of the preceding
sentence, in the case of an individual who attained age 62 in or
before the first month referred to in subparagraph (A) or (B) of
such sentence, as the case may be, the elapsed years referred to
in section 215(b)(3) shall not include the year in which he attained
age 62, or any year thereafter.
Filing of Application
(b)
An application for disability insurance benefits
filed before the first month in which the applicant satisfies the
requirements for such benefits (as prescribed in subsection (a)(1))
shall be deemed a valid application (and shall be deemed to have
been filed in such first month) only if the applicant satisfies the
requirements for such benefits before the Commissioner of Social
Security makes a final decision on the application and no request
under section 205(b) for notice and opportunity for a hearing thereon
is made, or if such a request is made, before a decision based upon
the evidence adduced at the hearing is made (regardless of whether
such decision becomes the final decision of the Commissioner of
Social Security). An individual who would have been entitled to
a disability insurance benefit for any month had he filed application
therefor before the end of such month shall be entitled to such
benefit for such month if such application is filed before the end
of the 12th month immediately succeeding such month.
Definitions of Insured Status and Waiting Period
(c)
For purposes of this section—
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(1) An individual shall be insured for disability insurance
benefits in any month if—
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(A) he would have been a fully insured individual (as defined
in section 214) had he attained age 62 and filed application for
benefits under section 202(a) on the first day of such month, and
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(B)(i) he had not less than 20 quarters of coverage during the
40-quarter period which ends with the quarter in which such month occurred,
or
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(ii) if such month ends before the quarter in which he attains
(or would attain) age 31, not less than one-half (and not less than
6) of the quarters during the period ending with the quarter in
which such month occurred and beginning after he attained the age
of 21 were quarters of coverage, or (if the number of quarters in
such period is less than 12) not less than 6 of the quarters in
the 12-quarter period ending with such quarter were quarters of
coverage, or
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(iii) in the case of an individual (not otherwise insured under clause
(i)) who, by reason of section 216(i)(3)(B)(ii), had a prior period
of disability that began during a period before the quarter in which
he or she attained age 31, not less than one-half of the quarters
beginning after such individual attained age 21 and ending with the
quarter in which such month occurs are quarters of coverage, or (if
the number of quarters in such period is less than 12) not less than
6 of the quarters in the 12-quarter period ending with such quarter
are quarters of coverage;
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except that the provisions of subparagraph (B) of this paragraph
shall not apply in the case of an individual who is blind (within
the meaning of “blindness” as defined in section 216(i)(1)). For purposes of subparagraph (B) of this paragraph,
when the number of quarters in any period is an odd number, such
number shall be reduced by one, and a quarter shall not be counted
as part of any period if any part of such quarter was included in
a period of disability unless such quarter was a quarter of coverage.
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(2) The term “waiting period” means, in the
case of any application for disability insurance benefits, the earliest
period of five consecutive calendar months—
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(A) throughout which the individual with respect to whom such application
is filed has been under a disability, and
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(B)(i) which begins not earlier than with the first day of the
seventeenth month before the month in which such application is
filed if such individual is insured for disability insurance benefits
in such seventeenth month, or (ii) if he is not so insured in such
month, which begins not earlier than with the first day of the first
month after such seventeenth month in which he is so insured.
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Notwithstanding the preceding provisions of this paragraph,
no waiting period may begin for any individual before January 1,
1957.
Definition of Disability
(d)(1)
The term “disability” means—
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(A) inability to engage in any substantial gainful activity
by reason of any medically determinable physical or mental impairment
which can be expected to result in death or which has lasted or
can be expected to last for a continuous period of not less than
12 months; or
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(B) in the case of an individual who has attained the age of
55 and is blind (within the meaning of “blindness” as
defined in section 216(i)(1)), inability by reason of such blindness
to engage in substantial gainful activity requiring skills or abilities
comparable to those of any gainful activity in which he has previously
engaged with some regularity and over a substantial period of time.
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(2) For purposes of paragraph (1)(A)—
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(A) An individual shall be determined to be under a disability
only if his physical or mental impairment or impairments are of
such severity that he is not only unable to do his previous work
but cannot, considering his age, education, and work experience,
engage in any other kind of substantial gainful work which exists
in the national economy, regardless of whether such work exists
in the immediate area in which he lives, or whether a specific job
vacancy exists for him, or whether he would be hired if he applied
for work. For purposes of the preceding sentence (with respect to
any individual), “work which exists in the national economy” means
work which exists in significant numbers either in the region where
such individual lives or in several regions of the country.
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(B) In determining whether an individual's physical or mental impairment
or impairments are of a sufficient medical severity that such impairment
or impairments could be the basis of eligibility under this section,
the Commissioner of Social Security shall consider the combined
effect of all of the individual's impairments without regard to whether
any such impairment, if considered separately, would be of such
severity. If the Commissioner of Social Security does find a medically
severe combination of impairments, the combined impact of the impairments
shall be considered throughout the disability determination process.
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(C) An individual shall not be considered to be disabled for
purposes of this title if alcoholism or drug addiction would (but
for this subparagraph) be a contributing factor material to the
Commissioner's determination that the individual is disabled.
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(3) For purposes of this subsection, a “physical or
mental impairment” is an impairment that results from anatomical,
physiological, or psychological abnormalities which are demonstrable
by medically acceptable clinical and laboratory diagnostic techniques.
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(4)(A) The Commissioner of Social Security shall by regulations
prescribe the criteria for determining when services performed or
earnings derived from services demonstrate an individual's ability
to engage in substantial gainful activity. No individual who is
blind shall be regarded as having demonstrated an ability to engage
in substantial gainful activity on the basis of earnings that do
not exceed an amount equal to the exempt amount which would be applicable
under section 203(f)(8), to individuals described in subparagraph
(D) thereof, if section 102 of the Senior Citizens' Right to Work
Act of 1996[247] had not been enacted. Notwithstanding the provisions
of paragraph (2), an individual whose services or earnings meet such
criteria shall, except for purposes of section 222(c), be found
not to be disabled. In determining whether an individual is able
to engage in substantial gainful activity by reason of his earnings,
where his disability is sufficiently severe to result in a functional
limitation requiring assistance in order for him to work, there
shall be excluded from such earnings an amount equal to the cost
(to such individual) of any attendant care services, medical devices,
equipment, prostheses, and similar items and services (not including
routine drugs or routine medical services unless such drugs or services
are necessary for the control of the disabling condition) which
are necessary (as determined by the Commissioner of Social Security
in regulations) for that purpose, whether or not such assistance
is also needed to enable him to carry out his normal daily functions;
except that the amount to be excluded shall be subject to such reasonable
limits as the Commissioner of Social Security may prescribe.
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(B) In determining under subparagraph (A) when services performed
or earnings derived from services demonstrate an individual's ability
to engage in substantial gainful activity, the Commissioner of Social
Security shall apply the criteria described in subparagraph (A) with
respect to services performed by any individual without regard to the
legality of such services.
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(5)(A) An individual shall not be considered to be under a disability unless
he furnishes such medical and other evidence of the existence thereof
as the Commissioner of Social Security may require. An individual's
statement as to pain or other symptoms shall not alone be conclusive evidence
of disability as defined in this section; there must be medical
signs and findings, established by medically acceptable clinical
or laboratory diagnostic techniques, which show the existence of
a medical impairment that results from anatomical, physiological,
or psychological abnormalities which could reasonably be expected
to produce the pain or other symptoms alleged and which, when considered
with all evidence required to be furnished under this paragraph
(including statements of the individual or his physician as to the
intensity and persistence of such pain or other symptoms which may
reasonably be accepted as consistent with the medical signs and findings),
would lead to a conclusion that the individual is under a disability.
Objective medical evidence of pain or other symptoms established
by medically acceptable clinical or laboratory techniques (for example,
deteriorating nerve or muscle tissue) must be considered in reaching
a conclusion as to whether the individual is under a disability.
Any non-Federal hospital, clinic, laboratory, or other provider
of medical services, or physician not in the employ of the Federal
Government, which supplies medical evidence required and requested
by the Commissioner of Social Security under this paragraph shall
be entitled to payment from the Commissioner of Social Security
for the reasonable cost of providing such evidence.
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(B) In making any determination with respect to whether an individual
is under a disability or continues to be under a disability, the
Commissioner of Social Security shall consider all evidence available
in such individual's case record, and shall develop a complete medical history
of at least the preceding twelve months for any case in which a determination
is made that the individual is not under a disability. In making
any determination the Commissioner of Social Security shall make
every reasonable effort to obtain from the individual's treating physician
(or other treating health care provider) all medical evidence, including
diagnostic tests, necessary in order to properly make such determination,
prior to evaluating medical evidence obtained from any other source
on a consultative basis.
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(6)(A) Notwithstanding any other provision of this title, any
physical or mental impairment which arises in connection with the
commission by an individual (after the date of the enactment of
this paragraph[248]) of an offense which constitutes a felony under
applicable law and for which such individual is subsequently convicted,
or which is aggravated in connection with such an offense (but only
to the extent so aggravated), shall not be considered in determining
whether an individual is under a disability.
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(B) Notwithstanding any other provision of this title, any physical
or mental impairment which arises in connection with an individual's
confinement in a jail, prison, or other penal institution or correctional
facility pursuant to such individual's conviction of an offense
(committed after the date of the enactment of this paragraph) constituting
a felony under applicable law, or which is aggravated in connection
with such a confinement (but only to the extent so aggravated),
shall not be considered in determining whether such individual is
under a disability for purposes of benefits payable for any month
during which such individual is so confined.
(e)(1)
No benefit shall be payable under subsection
(d)(1)(B)(ii), (d)(6)(A)(ii), (d)(6)(B), (e)(1)(B)(ii), or (f)(1)(B)(ii)
of section 202 or under subsection (a)(1) of this section to an
individual for any month, after the third month, in which he engages
in substantial gainful activity during the 36-month period following
the end of his trial work period determined by application of section 222(c)(4)(A).
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(2) No benefit shall be payable under section 202 on the basis
of the wages and self-employment income of an individual entitled
to a benefit under subsection (a)(1) of this section for any month
for which the benefit of such individual under subsection (a)(1)
is not payable under paragraph (1).
Standard of Review for Termination of Disability Benefits
(f)
A recipient of benefits under this title
or title XVIII based on the disability of any individual may be
determined not to be entitled to such benefits on the basis of a
finding that the physical or mental impairment on the basis of which
such benefits are provided has ceased, does not exist, or is not
disabling only if such finding is supported by—
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(1) substantial evidence which demonstrates that—
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(A) there has been any medical improvement in the individual's impairment
or combination of impairments (other than medical improvement which
is not related to the individual's ability to work), and
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(B) the individual is now able to engage in substantial gainful
activity; or
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(2) substantial evidence which—
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(A) consists of new medical evidence and a new assessment of
the individual's residual functional capacity, and demonstrates
that—
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(i) although the individual has not improved medically, he or
she is nonetheless a beneficiary of advances in medical or vocational therapy
or technology (related to the individual's ability to work), and
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(ii) the individual is now able to engage in substantial gainful activity,
or
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(B) demonstrates that—
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(i) although the individual has not improved medically, he or
she has undergone vocational therapy (related to the individual's
ability to work), and
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(ii) the individual is now able to engage in substantial gainful activity;
or
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(3) substantial evidence which demonstrates that, as determined
on the basis of new or improved diagnostic techniques or evaluations,
the individual's impairment or combination of impairments is not
as disabling as it was considered to be at the time of the most
recent prior decision that he or she was under a disability or continued
to be under a disability, and that therefore the individual is able
to engage in substantial gainful activity; or
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(4) substantial evidence (which may be evidence on the record
at the time any prior determination of the entitlement to benefits
based on disability was made, or newly obtained evidence which relates
to that determination) which demonstrates that a prior determination
was in error.
Nothing in this subsection shall be construed to require a determination
that a recipient of benefits under this title or title XVIII based
on an individual's disability is entitled to such benefits if the
prior determination was fraudulently obtained or if the individual
is engaged in substantial gainful activity, cannot be located, or
fails, without good cause, to cooperate in a review of the entitlement to
such benefits or to follow prescribed treatment which would be expected
to restore his or her ability to engage in substantial gainful activity.
In making for purposes of the preceding sentence any determination
relating to fraudulent behavior by any individual or failure by
any individual without good cause to cooperate or to take any required
action, the Commissioner of Social Security shall specifically take
into account any physical, mental, educational, or linguistic limitation
such individual may have (including any lack of facility with the
English language). Any determination under this section shall be
made on the basis of all the evidence available in the individual's
case file, including new evidence concerning the individual's prior
or current condition which is presented by the individual or secured
by the Commissioner of Social Security. Any determination made under
this section shall be made on the basis of the weight of the evidence
and on a neutral basis with regard to the individual's condition,
without any initial inference as to the presence or absence of disability
being drawn from the fact that the individual has previously been
determined to be disabled. For purposes of this subsection, a benefit
under this title is based on an individual's disability if it is
a disability insurance benefit, a child's, widow's, or widower's
insurance benefit based on disability, or a mother's or father's
insurance benefit based on the disability of the mother's or father's
child who has attained age 16.
Continued Payment of Disability Benefits During Appeal
(g)(1)
In any case where—
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(A) an individual is a recipient of disability insurance benefits,
or of child's, widow's, or widower's insurance benefits based on
disability,
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(B) the physical or mental impairment on the basis of which
such benefits are payable is found to have ceased, not to have existed,
or to no longer be disabling, and as a consequence such individual
is determined not to be entitled to such benefits, and
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(C) a timely request for a hearing under section 221(d), or
for an administrative review prior to such hearing, is pending with
respect to the determination that he is not so entitled,
such individual may elect (in such manner and form and within
such time as the Commissioner of Social Security shall by regulations
prescribe) to have the payment of such benefits, the payment of
any other benefits under this title based on such individual's wages
and self-employment income, the payment of mother's or father's
insurance benefits to such individual's mother or father based on
the disability of such individual as a child who has attained age
16, and the payment of benefits under title XVIII based on such
individual's disability, continued for an additional period beginning
with the first month beginning after the date of the enactment of
this subsection[249] for which (under such determination) such
benefits are no longer otherwise payable, and ending with the earlier
of (i) the month preceding the month in which a decision is made after
such a hearing, or (ii) the month preceding the month in which no
such request for a hearing or an administrative review is pending.
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(2)(A) If an individual elects to have the payment of his benefits
continued for an additional period under paragraph (1), and the
final decision of the Commissioner of Social Security affirms the
determination that he is not entitled to such benefits, any benefits
paid under this title pursuant to such election (for months in such
additional period) shall be considered overpayments for all purposes
of this title, except as otherwise provided in subparagraph (B).
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(B) If the Commissioner of Social Security determines that the
individual's appeal of his termination of benefits was made in good
faith, all of the benefits paid pursuant to such individual's election
under paragraph (1) shall be subject to waiver consideration under
the provisions of section 204. In making for purposes of this subparagraph
any determination of whether any individual's appeal is made in
good faith, the Commissioner of Social Security shall specifically
take into account any physical, mental, educational, or linguistic
limitation such individual may have (including any lack of facility
with the English language).
Interim Benefits in Cases of Delayed Final Decisions
(h)(1)
In any case in which an administrative
law judge has determined after a hearing as provided under section 205(b) that an individual is entitled to disability insurance benefits
or child's, widow's, or widower's insurance benefits based on disability
and the Commissioner of Social Security has not issued the Commissioner's
final decision in such case within 110 days after the date of the
administrative law judge's determination, such benefits shall be
currently paid for the months during the period beginning with the
month preceding the month in which such 110-day period
expires and ending with the month preceding the month in which such
final decision is issued.
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(2) For purposes of paragraph (1), in determining whether the
110-day period referred to in paragraph (1) has elapsed, any period
of time for which the action or inaction of such individual or such
individual's representative without good cause results in the delay
in the issuance of the Commissioner's final decision shall not be
taken into account to the extent that such period of time exceeds
20 calendar days.
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(3) Any benefits currently paid under this title pursuant to
this subsection (for the months described in paragraph (1)) shall
not be considered overpayments for any purpose of this title (unless
payment of such benefits was fraudulently obtained), and such benefits
shall not be treated as past-due benefits for purposes of section 206(b)(1).
Reinstatement of Entitlement
(i)(1)(A)
Entitlement to benefits described in
subparagraph (B)(i)(I) shall be reinstated in any case where the
Commissioner determines that an individual described in subparagraph
(B) has filed a request for reinstatement meeting the requirements
of paragraph (2)(A) during the period prescribed in subparagraph (C).
Reinstatement of such entitlement shall be in accordance with the
terms of this subsection.
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(B) An individual is described in this subparagraph if—
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(i) prior to the month in which the individual files a request
for reinstatement—
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(I) the individual was entitled to benefits under this section or
section 202 on the basis of disability pursuant to an application
filed therefor; and
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(II) such entitlement terminated due to the performance of substantial
gainful activity;
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(ii) the individual is under a disability and the physical or
mental impairment that is the basis for the finding of disability
is the same as (or related to) the physical or mental impairment
that was the basis for the finding of disability that gave rise
to the entitlement described in clause (i); and
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(iii) the individual's disability renders the individual unable
to perform substantial gainful activity.
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(C)(i) Except as provided in clause (ii), the period prescribed
in this subparagraph with respect to an individual is 60 consecutive
months beginning with the month following the most recent month
for which the individual was entitled to a benefit described in
subparagraph (B)(i)(I) prior to the entitlement termination described
in subparagraph (B)(i)(II).
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(ii) In the case of an individual who fails to file a reinstatement request
within the period prescribed in clause (i), the Commissioner may
extend the period if the Commissioner determines that the individual
had good cause for the failure to so file.
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(2)(A)(i) A request for reinstatement shall be filed in such
form, and containing such information, as the Commissioner may prescribe.
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(ii) A request for reinstatement shall include express declarations
by the individual that the individual meets the requirements specified
in clauses (ii) and (iii) of paragraph (1)(B).
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(B) A request for reinstatement filed in accordance with subparagraph
(A) may constitute an application for benefits in the case of any individual
who the Commissioner determines is not entitled to reinstated benefits
under this subsection.
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(3) In determining whether an individual meets the requirements
of paragraph (1)(B)(ii), the provisions of subsection (f) shall
apply.
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(4)(A)(i) Subject to clause (ii), entitlement to benefits reinstated
under this subsection shall commence with the benefit payable for
the month in which a request for reinstatement is filed.
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(ii) An individual whose entitlement to a benefit for any month would
have been reinstated under this subsection had the individual filed
a request for reinstatement before the end of such month shall be
entitled to such benefit for such month if such request for reinstatement
is filed before the end of the twelfth month immediately succeeding
such month.
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(B)(i) Subject to clauses (ii) and (iii), the amount of the
benefit payable for any month pursuant to the reinstatement of entitlement under
this subsection shall be determined in accordance with the provisions
of this title.
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(ii) For purposes of computing the primary insurance amount
of an individual whose entitlement to benefits under this section
is reinstated under this subsection, the date of onset of the individual's disability
shall be the date of onset used in determining the individual's
most recent period of disability arising in connection with such
benefits payable on the basis of an application.
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(iii) Benefits under this section or section 202 payable for
any month pursuant to a request for reinstatement filed in accordance with
paragraph (2) shall be reduced by the amount of any provisional
benefit paid to such individual for such month under paragraph (7).
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(C) No benefit shall be payable pursuant to an entitlement reinstated under
this subsection to an individual for any month in which the individual
engages in substantial gainful activity.
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(D) The entitlement of any individual that is reinstated under
this subsection shall end with the benefits payable for the month
preceding whichever of the following months is the earliest:
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(i) The month in which the individual dies.
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(ii) The month in which the individual attains retirement age.
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(iii) The third month following the month in which the individual's
disability ceases.
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(5) Whenever an individual's entitlement to benefits under this
section is reinstated under this subsection, entitlement to benefits
payable on the basis of such individual's wages and self-employment
income may be reinstated with respect to any person previously entitled
to such benefits on the basis of an application if the Commissioner
determines that such person satisfies all the requirements for entitlement
to such benefits except requirements related to the filing of an
application. The provisions of paragraph (4) shall apply to the
reinstated entitlement of any such person to the same extent that
they apply to the reinstated entitlement of such individual.
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(6) An individual to whom benefits are payable under this section
or section 202 pursuant to a reinstatement of entitlement under
this subsection for 24 months (whether or not consecutive) shall,
with respect to benefits so payable after such twenty-fourth
month, be deemed for purposes of paragraph (1)(B)(i)(I) and the
determination, if appropriate, of the termination month in accordance
with subsection (a)(1) of this section, or subsection (d)(1), (e)(1),
or (f )(1) of section 202, to be entitled to such benefits on the basis
of an application filed therefor.
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(7)(A) An individual described in paragraph (1)(B) who files
a request for reinstatement in accordance with the provisions of
paragraph (2)(A) shall be entitled to provisional benefits payable
in accordance with this paragraph, unless the Commissioner determines
that the individual does not meet the requirements of paragraph
(1)(B)(i) or that the individual's declaration under paragraph (2)(A)(ii)
is false. Any such determination by the Commissioner shall be final
and not subject to review under subsection (b) or (g) of section 205.
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(B) The amount of a provisional benefit for a month shall equal
the amount of the last monthly benefit payable to the individual
under this title on the basis of an application increased by an
amount equal to the amount, if any, by which such last monthly benefit
would have been increased as a result of the operation of section 215(i).
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(C)(i) Provisional benefits shall begin with the month in which
a request for reinstatement is filed in accordance with paragraph
(2)(A).
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(ii) Provisional benefits shall end with the earliest of—
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(I) the month in which the Commissioner makes a determination
regarding the individual's entitlement to reinstated benefits;
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(II) the fifth month following the month described in clause (i);
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(III) the month in which the individual performs substantial gainful
activity; or
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(IV) the month in which the Commissioner determines that the
individual does not meet the requirements of paragraph (1)(B)(i)
or that the individual's declaration made in accordance with paragraph
(2)(A)(ii) is false.
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(D) In any case in which the Commissioner determines that an
individual is not entitled to reinstated benefits, any provisional
benefits paid to the individual under this paragraph shall not be
subject to recovery as an overpayment unless the Commissioner determines
that the individual knew or should have known that the individual
did not meet the requirements of paragraph (1)(B).
Limitation on Payments to Prisoners
(j)
For provisions relating to limitation on
payments to prisoners, see section 202(x).