What Happens After You Apply? Understanding the Approval Process for Presumptive Disability Benefits

What Are Presumptive Disability Benefits?

Presumptive disability benefits are payments made to individuals who have conditions severe enough that they will likely qualify for Supplemental Security Income (SSI). SSI applications can take three to six months to process and approve, leaving disabled individuals unable to pay their bills and support themselves. Presumptive disability payments are used as interim payments to keep disabled individuals afloat as they wait for their SSI benefits to kick in.

Presumptive disability benefits are given by the Social Security Administration (SSA) and may also be approved by your local Disability Determination Services (DDS) office. Both the SSA and DDS evaluate your SSI application before it can be approved.

To qualify for presumptive disability benefits, you must have a severe disability that limits your ability to work any job, not just your previous occupation (if applicable). The SSA has a list of qualifying disabilities they will use to determine whether an individual can receive presumptive disability benefits. If your disability is not on this list, the SSA will likely send your application to your local DDS office for further evaluation.

If you are selected to receive presumptive disability benefits, you can start getting payments within a few weeks or even a few days. You can receive payments for up to six months or until your SSI application is processed. Just like SSI benefits, you must submit medical evidence proving the severity of your condition to qualify for presumptive disability benefits.

Your eligibility for presumptive medical benefits is not based on your financial need but rather on your medical condition and the medical evidence you provide. However, the amount you receive will likely be based on your income and the financial resources available to you. Your eligibility will also depend on the likelihood of you getting approved for SSI benefits.

Presumptive disability benefits can be life-saving for individuals who have no other way to support themselves. If you would like to apply for SSI benefits but are worried about how you will support yourself as your application processes, presumptive disability benefits may be right for you. Working with an experienced legal team can help you gather and submit the necessary medical evidence to prove to the SSA that you deserve these benefits payments. Our team can walk you through the application process for a higher chance of success. For more information, contact our office today at 480-999-4740.

How Do You Apply for Presumptive Disability Benefits?

When you submit an SSI application, you are automatically applying for presumptive disability benefits. You do not have to do anything special or extra with your information to apply for presumptive disability. The SSA and DDS will examine your SSI application and medical evidence to see if you qualify for presumptive disability benefits. If your condition is so severe that you cannot work to support yourself while your application is being processed, it is very likely that you will receive presumptive disability benefits.

Presumptive disability benefits are only available to individuals applying for SSI. They are not available for applicants waiting to receive Social Security Disability Insurance (SSDI). If you have submitted an SSI application previously and it was denied, you are no longer eligible for presumptive disability benefits.

How Are Presumptive Disability Benefits Approved?

While presumptive disability benefits can seem like a mysterious process, the approval method is actually quite simple. When you submit your SSI application, the SSA will review it, plus all the medical evidence you have submitted alongside it. If you have a qualifying disability that renders you unable to work to support yourself, the SSA will begin checking your application more thoroughly to determine if you should receive presumptive disability benefits.

The SSA will likely call a trusted reference of yours for confirmation of your disability. In most cases, this is a doctor, social worker, or school staff member. This reference, plus your medical evidence, will often be enough to determine whether you can receive presumptive disability benefits or not.

If the SSA is unable to make a decision about your presumptive disability, they will forward the application to your local DDS office. Your local DDS office can then review your application and medical evidence again, plus talk to any references you have provided. DDS agencies are often more lenient and will provide presumptive disability benefits even if your disability is not technically on the qualifying list.

You can improve your chances of qualifying for presumptive disability benefits by providing large amounts of medical evidence surrounding your disability. Doctor statements, test results, and diagnoses are all helpful when the SSA and DDS make their decision about benefits payments. Medical evidence also increases your chances of being approved for SSI benefits, so in general, the more you can provide, the better.

If you are approved for presumptive disability benefits, you will start receiving payments as soon as your approval has been processed. For most people, payments start a few days or a few weeks after submission. Your income level and your financial resources will determine the amount you receive in each payment.

Which Disabilities Qualify for Presumptive Disability Benefits?

There are many disabilities that may qualify you for presumptive disability benefits. The SSA has a list of disabilities they will almost always approve. Reviewing this list can be helpful as you fill out your SSI application for submission. Always submit the necessary documentation as medical evidence of your disability.

Below are the disabilities that qualify for presumptive disability benefits:

• HIV or AIDS
• Total deafness
• Total blindness
• ALS
• Down syndrome
• Bed confinement
• Amputation of the leg at the hip
• Stroke that causes difficulty walking or using your arms and legs
• Terminal illness with a life expectancy of six months or less
• End-stage renal disease requiring chronic dialysis

Muscular dystrophy

Muscular atrophy

Cerebral palsy

Immobility without a mobility aid (including a wheelchair, walker, and cane) due to a long-standing medical condition

Extremely low birth weight for children under the age of one

Intellectual disability

Neurological impairments

Even if your disability is not listed above, your condition may qualify you for presumptive disability payments. DDS offices are often able to grant benefits payments to individuals with disabilities that are not on this list. However, your condition must be comparable to at least one of the conditions above to be considered eligible. You must also be unable to work any job, not just your previous occupation.

How Long Do Presumptive Disability Payments Last?

Presumptive disability payments last for six months or until your SSI application is processed. If you are approved for SSI benefits, you will stop receiving presumptive disability payments and start getting regular SSI benefits. If your SSI application is denied, you will stop receiving presumptive disability payments. You are not required to pay back your presumptive disability benefits payments even if your SSI application is denied.

For individuals in a financial crisis, the SSA has a program called “emergency advance payment.” If you qualify, you can get a one-time payment from Social Security. However, this payment is a loan and must be repaid by presumptive disability benefits if you get them. Emergency advance payments will be considered with your SSI application and are always up to the discretion of the SSA. You cannot appeal a decision if the SSA denies you an emergency advance payment.

Who Does Not Qualify for Presumptive Disability Benefits?

Along with understanding the approval process, it is essential to learn which disabilities and conditions will not be eligible for presumptive disability. These conditions, while they may qualify for SSI benefits, will not allow you to receive presumptive disability payments.

Below are some common conditions that will likely not qualify you for presumptive disability benefits:

• Fibromyalgia
• Celiac disease
• Carpal tunnel syndrome
• Migraine headaches
• Degenerative disc disease

To qualify for presumptive disability benefits, your condition must be so debilitating that you cannot work any job to support yourself. If your medical condition is not that severe, it is likely that you will not receive presumptive disability benefits.

Similarly, if you list multiple medical conditions on your SSI application, but none of them are severe enough to qualify for disability on their own, it is unlikely that you will qualify for presumptive disability payments. Unfortunately, you cannot appeal a decision not to get presumptive disability payments, as these benefits are up to the discretion of the SSA and DDS.

Submitting your SSI application with the right medical evidence is the best way to prove that you qualify for presumptive disability benefits. If you would like assistance with your application, our team can help. Contact our office today for more information.

Are There Other Resources Available for SSI Applicants?

The approval process for presumptive disability benefits happens quickly, and you will know within a few days or weeks whether you have been approved or not. Although there are no ways to appeal a denial of presumptive disability benefits, there are other programs you can qualify for to expedite the SSI application process.

One of these programs is called Compassionate Allowance Condition (CAL). If your medical condition is on the SSA’s Listing of Impairments, you may be able to receive a CAL. This is not a payment made to you; instead, it allows the SSA to expedite your application and approve your SSI benefits much faster. Typically, conditions that qualify for CAL are severe and require minimal medical information to confirm. Certain types of cancers and other life-threatening diseases often qualify for CAL.

The Terminal Illness Program (TERI) is another way to get your SSI application fast-tracked. If you have a terminal illness listed on your SSI application, the SSA will automatically flag it for TERI, allowing your application to move to the front of the line. TERI cases often include stage IV inoperable cancers, AIDS, and liver, pancreas, or lung cancer. Applicants who have been in a coma for more than one month or are on life support may also be eligible for TERI.

The Quick Disability Determination program (QDD) also helps applicants receive SSI benefits much faster. QDD is a computer software program that scans applications for specific keywords, like words related to qualifying medical conditions. If the computer flags an application, it will then check for the necessary medical evidence to prove this condition. If the software finds the application qualifies, it will be sent to QDD claims examiners for a final determination. Using QDD, the SSA can process and approve claims in as little as one month.

Can an Experienced Legal Team Help Me Get Presumptive Disability Benefits?

If you are considering submitting an SSI application but are concerned about the waiting period before your benefits are approved, you’re not alone. Many disabled individuals find it disheartening to think about how they will support themselves as their application is processed. The presumptive disability benefits program provides enough income to buy necessities and keep a roof over your head while you wait for your final determination. The best way to qualify for presumptive disability benefits is to submit a solid SSI application with all the necessary medical evidence.

Our team at Roeschke Law can help you gather medical documentation and talk to your healthcare team to ensure they are on your side. We will walk you through the application process to give you a higher chance of receiving presumptive disability benefits. The disability application process can be overwhelming, but with our team on your side, you can submit your application with little stress. We are confident that our services can help you. For more information about us and to talk to an experienced attorney on our team, call today at 480-999-4740.