20 CFR 404.468
This case was remanded to the Secretary of Health and Human Services by a Federal district court on June 11, 1982. Thereafter, the Appeals Council (AC) remanded the case to an administrative law judge (ALJ), who, after receiving additional evidence into the record, issued a recommended decision on February 24, 1983.
In his recommended decision, the ALJ concluded that the claimant was under a disability beginning on March 4, 1982. On March 14, 1983, the claimant's attorney objected to the ALJ's recommended decision, arguing that the claimant had been disabled on a continuous basis since September 15, 1979. After considering the evidence of record and the attorney's objections to the ALJ's recommended decision, the AC concluded that the claimant had been under a disability since September 15, 1979, which had continued without interruption through the date of that decision.
The AC also noted that while this matter was on remand to the ALJ, evidence was submitted by the claimant's attorney which revealed that, on March 4, 1982, certain felonies were committed and that the claimant was later charged with these crimes and subsequently found guilty on January 21, 1983, by verdict of a jury of the Court of Common Pleas in a county in Pennsylvania. This evidence showed that the claimant had been held in a county jail in lieu of bond since his arrest in early March 1982 for these felonies and that his confinement to that facility has continued after his conviction. On the basis of this evidence, the ALJ recommended that the claimant's disability insurance benefits should be suspended for all months, pursuant to section 223(f)(1) of the Social Security Act (the Act).
In his letter of March 14, 1983, regarding the recommended decision, the claimant's attorney raised no objection to the suspension of benefits as proposed by the ALJ. In the absence of any statement of reason as to why the claimant's benefits should not have been suspended, the AC concluded that the claimant's attorney agreed with the ALJ's proposed finding on this question.
The AC adopted the recommended decision of the ALJ, as modified by the AC's decision, and held that, based on an application filed on March 24, 1980, the claimant was entitled to a period of disability commencing on September 15, 1979, and to disability insurance benefits under the provisions of sections 216(i) and 223, respectively, of the Act. The AC also found that the claimant's disability insurance benefits were subject to suspension beginning with March 1982 pursuant to section 223(f)(1) of the Act.
On October 13, 1983, the claimant's attorney wrote to the AC stating that he had never intended in his letter of March 14, 1983, to waive his right to object to the suspension of his client's disability insurance benefits. The attorney requested a further opportunity to submit evidence on this issue. He stated that his client had been incarcerated for a number of months prior to trial and that "without question" the pre-conviction incarceration should not have barred payments for that period of time. Accordingly, the attorney requested the AC to reopen its decision of September 23, 1983, and consider the issue of whether and when his client's disability insurance benefits were subject to suspension.
In a letter dated April 30, 1984, the attorney indicated that the claimant wished to pursue his claim for benefits for the pre-trial period during which he had been detained in jail. The attorney argued that the claimant's benefits should not have been subject to suspension for the period of time during which the claimant had been a pre-trial detainee, even though the trial court had later chosen to credit this period towards the claimant's sentence.
Under section 223(f)(1) of the Act [subsequently replaced by section 202(x)(1) of the Act, as added by section 339 of Pub. L. 98-21], §404.468 of Regulations No. 4, and SSR 83-21 (C.E. 1983, p. 244), no disability insurance benefits shall be paid to any individual for any month during which such individual is confined in a jail, prison, or other penal institution or correctional facility, pursuant to his or her conviction of any offense which constituted a felony under applicable law, unless such individual is actively and satisfactorily participating in a rehabilitation program which has been specifically approved for such individual by a court of law and, as determined by the Secretary, is expected to result in such individual being able to engage in substantial gainful activity upon release and within a reasonable time.
The AC carefully considered all of the evidence of record. This evidence showed that the claimant conceded that he had been incarcerated since early March 1982 after having been arrested for certain felonies that were committed on March 4, 1982. The claimant did not deny that he had been convicted of these felonies. However, the claimant argued that, from the date of his arrest until the date of his criminal conviction, January 21, 1983, the "prisoner suspension" provisions of section 223(f)(1) should not have been applied to his case. Even though this period of pre-trial incarceration was later credited towards his sentence, the claimant contended that he should have been paid benefits for these months since they had preceded his actual conviction of the felonies and thus, during those months he had not been confined to a jail pursuant to the conviction of a felonious offense under applicable State law.
In light of the evidence of record and the claimant's contentions, the AC reexamined the position it had taken in its decision of September 23, 1983. After reviewing the matter, the AC was of the opinion that a prisoner held in a correctional facility pending trial on a felony charge is not under confinement pursuant to a conviction notwithstanding the later crediting of that period of time toward the sentence to be served. A close reading of the governing sections of the Act and regulations and of SSR 83-21 convinced the AC that benefits were to be suspended only for those months during which the claimant had been confined in jail pursuant to his actual conviction of a felony.
Accordingly, the AC reopened its decision of September 23, 1983, under the provisions of §404.987 thorough §404.989 of Regulations No. 4. The Ac found that, with respect to disability insurance benefits payable to the claimant based upon his application filed on March 24, 1980, and its earlier finding that he had become disabled on September 15, 1979, the "prisoner suspension" provisions of section 223(f)(1) of the Act and §404.468 of Regulations No. 4 did not apply to the period of confinement beginning with March 1982 and ending with December 1982, and that as a consequence, disability insurance benefits were payable for those months. The AC also found that the "prisoner suspension" provisions were applicable beginning with January 1983, the month in which the claimant was convicted of a felony and began his confinement in prison pursuant to that conviction.
In a letter dated June 19, 1984, the claimant's attorney noted that the trial court and jury had expressed their concern for the claimant's rehabilitation. He attached a letter from the attorney who had represented the claimant before the trial court. That attorney observed that the only provision placed in the claimant's sentence by the trial court consisted of a recommendation that he be incarcerated at a certain correctional institution so that he could take advantage of the mental health therapy and rehabilitation facilities apparently available at that prison. The attorney also observed that the trial court had "... no power to determine any specific rehabilitation program and [did] not even usually recommend a particular facility for confinement as was done in [the claimant's] case."
The claimant also addressed the rehabilitation issue in his unsigned and undated statement attached to his attorney's letter of March 4, 1985. He stated that he was actively enrolled on a waiting list for participation in a rehabilitation program which would be approved by the sentencing judge. The AC noted, however, that neither the claimant nor his attorney had submitted any evidence to support this allegation, and that the allegation conflicted with the information which had been provided by the claimant's defense attorney (see the quoted material in the preceding paragraph).
In this case, no evidence was presented to the AC to show that the claimant had satisfied the "vocational rehabilitation exception" to the nonpayment provision provided in the Act and regulations. There was no evidence to show that the claimant had actively and satisfactorily participated in a rehabilitation program which had been approved for him by a court of law and which could be expected to result in the claimant being able to engage in substantial gainful activity upon his release from prison and within a reasonable time. Consequently, the AC found that there was no reason to modify its earlier finding suspending the payment of disability insurance benefits beginning with January 1983.
 The provision relating to the nonpayment of disability insurance benefits for incarcerated felons was formerly contained in section 223(f)(1) of the Act, but is now contained in section 202(x)(1) of the Act, as added by section 339 of Pub. L. 98-21, effective with benefits payable for May 1983 and thereafter.
 The initial determination denying the claimant's application was issued on March 31, 1980. The letter from the claimant's attorney constituted a petition for reopening and tolled the four-year period for reopening for good cause under §404.988(b) of Regulations No. 4.
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