42 U.S.C. § 423 : US Code - Section 423: Disability insurance benefit payments

Search 42 U.S.C. § 423 : US Code - Section 423: Disability insurance benefit payments

(a) Disability insurance benefits
(1) Every individual who - 
(A) is insured for disability insurance benefits (as determined
under subsection (c)(1) of this section),
(B) has not attained retirement age (as defined in section
416(l) of this title),
(C) if not a United States citizen or national - 
(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 405(c)(2)(B)(i) of this title; or
(ii) at the time any quarters of coverage are earned - 
(I) is described in subparagraph (B) or (D) of section
1101(a)(15) of title 8,
(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
(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.
(D) has filed application for disability insurance benefits,
and
(E) is under a disability (as defined in subsection (d) of this
section)
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) of this section) 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 416(i) of this title) 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
416(l) of this title), or, subject to subsection (e) of this
section, 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
422(c)(4)(A) of this title, 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) of this
section 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
402 of this title 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.
(2) Except as provided in section 402(q) of this title and
section 415(b)(2)(A)(ii) of this title, such individual's
disability insurance benefit for any month shall be equal to his
primary insurance amount for such month determined under section
415 of this title as though he had attained age 62 in - 
(A) the first month of his waiting period, or
(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) of
this section) 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 415(b)(3) of
this title shall not include the year in which he attained age 62,
or any year thereafter.
(b) Filing application
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) of this section)
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 405(b) of this title 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.
(c) Definitions; insured status; waiting period
For purposes of this section - 
(1) An individual shall be insured for disability insurance
benefits in any month if - 
(A) he would have been a fully insured individual (as defined
in section 414 of this title) had he attained age 62 and filed
application for benefits under section 402(a) of this title on
the first day of such month, and
(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
(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
(iii) in the case of an individual (not otherwise insured
under clause (i)) who, by reason of section 416(i)(3)(B)(ii) of
this title, 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;
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 416(i)(1) of
this title). 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.
(2) The term "waiting period" means, in the case of any
application for disability insurance benefits, the earliest
period of five consecutive calendar months - 
(A) throughout which the individual with respect to whom such
application is filed has been under a disability, and
(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.
Notwithstanding the preceding provisions of this paragraph, no
waiting period may begin for any individual before January 1,
1957.
(d) "Disability" defined
(1) The term "disability" means - 
(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
(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 416(i)(1) of this title), 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.
(2) For purposes of paragraph (1)(A) - 
(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.
(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.
(C) An individual shall not be considered to be disabled for
purposes of this subchapter 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.
(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.
(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 403(f)(8) of this title, to individuals
described in subparagraph (D) thereof, if section 102 of the Senior
Citizens' Right to Work Act of 1996 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 422(c) of this title, 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 amounts to be excluded
shall be subject to such reasonable limits as the Commissioner of
Social Security may prescribe.
(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.
(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.
(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.
(6)(A) Notwithstanding any other provision of this subchapter,
any physical or mental impairment which arises in connection with
the commission by an individual (after October 19, 1980) 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.
(B) Notwithstanding any other provision of this subchapter, 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 October 19, 1980)
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) Engaging in substantial gainful activity
(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 402 of this title 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 422(c)(4)(A) of this title.
(2) No benefit shall be payable under section 402 of this title
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) of this section is not payable under
paragraph (1).
(f) Standard of review for termination of disability benefits
A recipient of benefits under this subchapter or subchapter XVIII
of this chapter 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 - 
(1) substantial evidence which demonstrates that - 
(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
(B) the individual is now able to engage in substantial
gainful activity; or
(2) substantial evidence which - 
(A) consists of new medical evidence and a new assessment of
the individual's residual functional capacity, and demonstrates
that - 
(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
(ii) the individual is now able to engage in substantial
gainful activity, or
(B) demonstrates that - 
(i) although the individual has not improved medically, he
or she has undergone vocational therapy (related to the
individual's ability to work), and
(ii) the individual is now able to engage in substantial
gainful activity; or
(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
(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 subchapter or
subchapter XVIII of this chapter 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 subchapter 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.
(g) Continued payment of disability benefits during appeal
(1) In any case where - 
(A) an individual is a recipient of disability insurance
benefits, or of child's, widow's, or widower's insurance benefits
based on disability,
(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
(C) a timely request for a hearing under section 421(d) of this
title, 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 subchapter 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 subchapter XVIII
of this chapter based on such individual's disability, continued
for an additional period beginning with the first month beginning
after January 12, 1983, 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.
(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 subchapter pursuant to such election
(for months in such additional period) shall be considered
overpayments for all purposes of this subchapter, except as
otherwise provided in subparagraph (B).
(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 404 of this title. 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).
(h) Interim benefits in cases of delayed final decisions
(1) In any case in which an administrative law judge has
determined after a hearing as provided under section 405(b) of this
title 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.
(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.
(3) Any benefits currently paid under this subchapter pursuant to
this subsection (for the months described in paragraph (1)) shall
not be considered overpayments for any purpose of this subchapter
(unless payment of such benefits was fraudulently obtained), and
such benefits shall not be treated as past-due benefits for
purposes of section 406(b)(1) of this title.
(i) Reinstatement of entitlement
(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.
(B) An individual is described in this subparagraph if - 
(i) prior to the month in which the individual files a request
for reinstatement - 
(I) the individual was entitled to benefits under this
section or section 402 of this title on the basis of disability
pursuant to an application filed therefor; and
(II) such entitlement terminated due to the performance of
substantial gainful activity;
(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
(iii) the individual's disability renders the individual unable
to perform substantial gainful activity.
(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).
(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.
(2)(A)(i) A request for reinstatement shall be filed in such
form, and containing such information, as the Commissioner may
prescribe.
(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).
(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.
(3) In determining whether an individual meets the requirements
of paragraph (1)(B)(ii), the provisions of subsection (f) of this
section shall apply.
(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.
(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.
(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 subchapter.
(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.
(iii) Benefits under this section or section 402 of this title
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).
(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.
(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:
(i) The month in which the individual dies.
(ii) The month in which the individual attains retirement age.
(iii) The third month following the month in which the
individual's disability ceases.
(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.
(6) An individual to whom benefits are payable under this section
or section 402 of this title 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 402 of
this title, to be entitled to such benefits on the basis of an
application filed therefor.
(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 405 of this title.
(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 subchapter 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 415(i) of this title.
(C)(i) Provisional benefits shall begin with the month in which a
request for reinstatement is filed in accordance with paragraph
(2)(A).
(ii) Provisional benefits shall end with the earliest of - 
(I) the month in which the Commissioner makes a determination
regarding the individual's entitlement to reinstated benefits;
(II) the fifth month following the month described in clause
(i);
(III) the month in which the individual performs substantial
gainful activity; or
(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.
(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).
(j) Limitation on payments to prisoners
For provisions relating to limitation on payments to prisoners,
see section 402(x) of this title.