42 U.S.C. § 425
Section 425 · Additional rules relating to benefits based on disability
Current version, with additions and removals from the August 15, 1994 version.
If the Commissioner of Social Security, on the basis of information obtained by or submitted to the Commissioner, believes that an individual entitled to benefits under section 423 of this title, or that a child who has attained the age of eighteen and is entitled to benefits under section 402(d) of this title, or that a widow or surviving divorced wife who has not attained age 60 and is entitled to benefits under section 402(e) of this title, or that a widower or surviving divorced husband who has not attained age 60 and is entitled to benefits under section 402(f) of this title, may have ceased to be under a disability, the Commissioner of Social Security may suspend the payment of benefits under such section 402(d), 402(e), 402(f), or 423 of this title until it is determined (as provided in section 421 of this title) whether or not such individual's disability has ceased or until the Commissioner of Social Security believes that such disability has not ceased. In the case of any individual whose disability is subject to determination under an agreement with a State under section 421(b) of this title, the Commissioner of Social Security shall promptly notify the appropriate State of the Commissioner's action under this subsection and shall request a prompt determination of whether such individual's disability has ceased. For purposes of this subsection, the term “disability” has the meaning assigned to such term in section 423(d) of this title. Whenever the benefits of an individual entitled to a disability insurance benefit are suspended for any month, the benefits of any individual entitled thereto under subsection (b), (c), or (d) of section 402 of this title, on the basis of the wages and self-employment income of such individual, shall be suspended for such month. The first sentence of this subsection shall not apply to any child entitled to benefits under section 402(d) of this title, if he has attained the age of 18 but has not attained the age of 22, for any month during which he is a full-time student (as defined and determined under section 402(d) of this title).
Notwithstanding any other provision of this subchapter, payment to an individual of benefits based on disability (as described in the first sentence of subsection (a) of this section) shall not be terminated or suspended because the physical or mental impairment, on which the individual's entitlement to such benefits is based, has or may have ceased, if—
(1) such individual is participating in a program of vocational rehabilitation services approved by the Commissioner of Social Security, and
(2) the Commissioner of Social Security determines that the completion of such program, or its continuation for a specified period of time, will increase the likelihood that such individual may (following his participation in such program) be permanently removed from the disability benefit rolls.
(1)(A) In the case of any individual entitled to benefits based on disability, if alcoholism or drug addiction is a contributing factor material to the Commissioner's determination that such individual is under a disability, such individual shall comply with the provisions of this subsection. In any case in which an individual is required to comply with the provisions of this subsection, the Commissioner of Social Security shall include, in such individual's notification of entitlement, a notice informing such individual of such requirement.
(B) Notwithstanding any other provision of this subchapter, if an individual who is required under subparagraph (A) to comply with the provisions of this subsection is determined by the Commissioner of Social Security not to be in compliance with the provisions of this subsection, such individual's benefits based on disability shall be suspended for a period—
(i) commencing with the first month following the month in which such individual is notified by the Commissioner of Social Security of the determination of noncompliance and that the individual's benefits will be suspended, and
(ii) ending with the month preceding the first month, after the determination of noncompliance, in which such individual demonstrates that he or she has reestablished and maintained compliance with such provisions for the applicable period specified in paragraph (3).
(2)(A) An individual described in paragraph (1) is in compliance with the requirements of this subsection for a month if in such month—
(i) such individual undergoes substance abuse treatment which is appropriate for such individual's condition diagnosed as alcoholism or drug addiction and for the stage of such individual's rehabilitation and which is conducted at an institution or facility approved for purposes of this subsection by the Commissioner of Social Security, and
(ii) such individual complies in such month with the terms, conditions, and requirements of such treatment and with requirements imposed by the Commissioner of Social Security under paragraph (5).
(B) An individual described in paragraph (1) may be determined as failing to comply with the requirements of this subsection for a month only if treatment meeting the requirements of subparagraph (A)(i) is available for that month, as determined pursuant to regulations of the Commissioner of Social Security.
(3) The applicable period specified in this paragraph is—
(A) 2 consecutive months, in the case of a first determination that an individual is not in compliance with the requirements of this subsection,
(B) 3 consecutive months, in the case of the second such determination with respect to the individual, or
(C) 6 consecutive months, in the case of the third or subsequent such determination with respect to the individual.
(4) In any case in which an individual's benefit is suspended for a period of 12 consecutive months for failure to comply with treatment described in paragraph (2) of this subsection, the month following such period shall be deemed, for purposes of section 423(a)(1) of this title or subsection (d)(1)(G)(i), (e)(1), or (f)(1) of section 402 of this title (as applicable), the termination month with respect to such entitlement.
(5)(A) The Commissioner of Social Security shall provide for the monitoring and testing of individuals who are receiving benefits under this subchapter and who as a condition of payment of such benefits are required to be undergoing treatment under paragraph (1) and complying with the terms, conditions, and requirements thereof as described in paragraph (2)(A), in order to assure such compliance.
(B) The Commissioner of Social Security, in consultation with drug and alcohol treatment professionals, shall issue regulations—
(i) defining appropriate treatment for alcoholics and drug addicts who are subject to appropriate substance abuse treatment required under this subsection, and
(ii) establishing guidelines to be used to review and evaluate their compliance, including measures of the progress expected to be achieved by participants in such programs.
(C)(i) For purposes of carrying out the requirements of subparagraphs (A) and (B), the Commissioner of Social Security shall provide for the establishment of one or more referral and monitoring agencies for each State.
(ii) Each referral and monitoring agency for a State shall—
(I) identify appropriate placements, for individuals residing in such State who are entitled to benefits based on disability and with respect to whom alcoholism or drug addiction is a contributing factor material to the Commissioner's determination that they are under a disability, where they may obtain treatment described in paragraph (2)(A),
(II) refer such individuals to such placements for such treatment, and
(III) monitor compliance with the requirements of paragraph (2)(A) by individuals who are referred by the agency to such placements and promptly report failures to comply to the Commissioner of Social Security.
(D) There are authorized to be transferred from the Federal Old-Age and Survivors Insurance Trust Fund and the Federal Disability Insurance Trust Fund such sums as are necessary to carry out the requirements of this paragraph for referral, monitoring, and testing.
(6)(A) In the case of any individual who is entitled to a benefit based on disability for any month, if alcoholism or drug addiction is a contributing factor material to the Commissioner's determination that the individual is under a disability, payment of any past-due monthly insurance benefits under this subchapter to which such individual is entitled shall be made in any month only to the extent that the sum of—
(i) the amount of such past-due benefit paid in such month, and
(ii) the amount of any benefit for the preceding month under such current entitlement which is payable in such month,
does not exceed, subject to subparagraph (B), twice the amount of such individual's benefit for the preceding month (determined without applying any reductions or deductions under this subchapter).
(B)(i) In the case of an individual who is no longer currently entitled to monthly insurance benefits under this subchapter but to whom any amount of past-due benefits has not been paid, for purposes of subparagraph (A), such individual's monthly insurance benefit for such individual's last month of entitlement shall be treated as such individual's benefit for the preceding month.
(ii) For the first month in which an individual's past-due benefits referred to in subparagraph (A) are paid, the amount of the limitation provided in subparagraph (A) shall be increased by the amount of any debts of such individual related to housing which are outstanding as of the end of the preceding month and which are resulting in a high risk of homelessness for such individual.
(C) Upon the death of an individual to whom payment of past-due benefits has been limited under subparagraph (A), any amount of such past-due benefits remaining unpaid shall be treated as an underpayment for purposes of section 404 of this title.
(D) In the case of an individual who would be entitled to benefits based on disability but for termination of such benefits under paragraph (4) or (7), such individual shall be entitled to payment of past-due benefits under this paragraph as if such individual continued to be entitled to such terminated benefits.
(7)(A) Subject to subparagraph (B), in the case of any individual entitled to benefits based on disability, if—
(i) alcoholism or drug addiction is a contributing factor material to the Commissioner's determination that such individual is under a disability, and
(ii) as of the end of the 36-month period beginning with such individual's first month of entitlement, such individual would not otherwise be disabled but for alcoholism or drug addiction,
the month following such 36-month period shall be deemed, for purposes of section 423(a)(1) of this title or subsection (d)(1)(G)(i), (e)(1), or (f)(1) of section 402 of this title (as applicable), the termination month with respect to such entitlement. Such individual whose entitlement is terminated under this paragraph may not be entitled to benefits based on disability for any month following such 36-month period if, in such following month, alcoholism or drug addiction is a contributing factor material to the Commissioner's determination that such individual is under a disability.
(B) In determining whether the 36-month period referred to in subparagraph (A) has elapsed—
(i) a month shall not be taken into account unless the Commissioner of Social Security determines, under regulations of the Commissioner of Social Security, that treatment required under this subsection is available to the individual for the month, and
(ii) any month for which a suspension is in effect for the individual under paragraph (1)(B) shall not be taken into account.
(8) Monthly insurance benefits under this subchapter which would be payable to any individual (other than the disabled individual to whom benefits are not payable by reason of this subsection) on the basis of the wages and self-employment income of such disabled individual but for the provisions of paragraph (1), (4), or (7) shall be payable as though such paragraph did not apply.
(9) For purposes of this subsection, the term “benefit based on disability” of an individual means a disability insurance benefit of such individual under section 423 of this title or a child's, widow's, or widower's insurance benefit of such individual under section 402 of this title based on the disability of such individual.
If the Commissioner of Social Security, on the basis of information obtained by or submitted to the Commissioner, believes that an individual entitled to benefits under section 423 of this title, or that a child who has attained the age of eighteen and is entitled to benefits under section 402(d) of this title, or that a widow or surviving divorced wife who has not attained age 60 and is entitled to benefits under section 402(e) of this title, or that a widower or surviving divorced husband who has not attained age 60 and is entitled to benefits under section 402(f) of this title, may have ceased to be under a disability, the Commissioner of Social Security may suspend the payment of benefits under such section 402(d), 402(e), 402(f), or 423 of this title until it is determined (as provided in section 421 of this title) whether or not such individual’s disability has ceased or until the Commissioner of Social Security believes that such disability has not ceased. In the case of any individual whose disability is subject to determination under an agreement with a State under section 421(b) of this title, the Commissioner of Social Security shall promptly notify the appropriate State of the Commissioner’s action under this subsection and shall request a prompt determination of whether such individual’s disability has ceased. For purposes of this subsection, the term “disability” has the meaning assigned to such term in section 423(d) of this title. Whenever the benefits of an individual entitled to a disability insurance benefit are suspended for any month, the benefits of any individual entitled thereto under subsection (b), (c), or (d) of section 402 of this title, on the basis of the wages and self-employment income of such individual, shall be suspended for such month. The first sentence of this subsection shall not apply to any child entitled to benefits under section 402(d) of this title, if he has attained the age of 18 but has not attained the age of 22, for any month during which he is a full-time student (as defined and determined under section 402(d) of this title).
Notwithstanding any other provision of this subchapter, payment to an individual of benefits based on disability (as described in the first sentence of subsection (a) of this section) shall not be terminated or suspended because the physical or mental impairment, on which the individual’s entitlement to such benefits is based, has or may have ceased, if—
such individual is participating in a program consisting of the Ticket to Work and Self-Sufficiency Program under section 1320b–19 of this title or another program of vocational rehabilitation services, employment services, or other support services approved by the Commissioner of Social Security, and
the Commissioner of Social Security determines that the completion of such program, or its continuation for a specified period of time, will increase the likelihood that such individual may (following his participation in such program) be permanently removed from the disability benefit rolls.
The Commissioner of Social Security may require each individual who applies for or is entitled to monthly insurance benefits under subsections (d)(1)(B)(ii), (d)(6)(A)(ii), (d)(6)(B), (e)(1)(B)(ii), and (f)(1)(B)(ii) of section 402 of this title and subsection (a)(1) of section 423 of this title to provide authorization by the individual for the Commissioner to obtain from any payroll data provider (as defined in section 1320e–3(c)(1) of this title) any record held by the payroll data provider with respect to the individual whenever the Commissioner determines the record is needed in connection with a determination of initial or ongoing entitlement to such benefits.
An authorization provided by an individual under this subsection shall remain effective until the earliest of—
the rendering of a final adverse decision on the individual’s application or entitlement to benefits under this subchapter;
the termination of the individual’s entitlement to benefits under this subchapter; or
the express revocation by the individual of the authorization, in a written notification to the Commissioner.
The Commissioner of Social Security is not required to furnish any authorization obtained pursuant to this subsection to the payroll data provider.
The Commissioner shall inform any person who provides authorization pursuant to this clause of the duration and scope of the authorization.
If an individual who applies for or is entitled to benefits under this subchapter refuses to provide, or revokes, any authorization under this subsection, subsection (d) shall not apply to such individual beginning with the first day of the first month in which he or she refuses or revokes such authorization.
An individual who has authorized the Commissioner of Social Security to obtain records from a payroll data provider under subsection (c) shall not be subject to a penalty under section 1320a–8a for any omission or error with respect to such individual’s wages as reported by the payroll data provider.