Breaking Down the Eligibility Process: How to Secure Presumptive Disability Benefits

What is Presumptive Disability?

A presumptive disability is a medical condition so severe that by having it, you likely qualify for Supplemental Security Income (SSI). Because Supplemental Security Income applications can take so long to process, the Social Security Administration (SSA) will start your payments early if you have a presumptive disability. You can get up to six months of SSI payments as you wait for Disability Determination Services (DDS) to evaluate your application and make a decision about your benefits payments.

If you apply for SSI without a presumptive disability, it typically takes three to four months for your application to be reviewed and for the SSA to decide. While your application is under review, you will still have to support yourself without any disability benefits payments. The SSA created the presumptive disability program to help individuals through this time period so they can receive payments before their application is officially processed.

When the SSA determines that you have a presumptive disability or presumptive blindness, you start receiving payments right away. You can receive payments for up to six months or until your application is decided upon. If your application for SSI is ultimately denied, you do not have to pay any of the presumptive disability payments back. However, you will not receive any further disability payments unless your application or appeal is approved.

Your eligibility for presumptive disability is not based on your financial need but on the medical evidence you provide and the severity of your medical condition. It will also be based on the likelihood of your claim being approved.

If you are interested in applying for SSI but are worried about supporting yourself in the months between applying and getting accepted, presumptive disability benefits may be right for you. Our legal team has years of experience helping clients secure disability benefits so they can continue to support themselves and their family members. If you have questions about presumptive disability or would like assistance from an experienced legal team, contact our office today by calling 480-999-4740.

Who Qualifies for Presumptive Disability?

Many medical conditions qualify for presumptive disability. You must provide necessary medical evidence to the SSA to prove that you have a presumptive disability and require benefits payments to support yourself.

Below is a partial list of the disabling conditions that qualify you for presumptive disability benefits:

• Total deafness
• Total blindness
• Amputation at the hip
• Stroke that occurred more than three months ago and still causes difficulty walking or using a limb
• Down syndrome
• Bed confinement
• Immobility without a mobility aid if it occurs due to a long-standing condition (rather than a recent accident or surgery)
• Very low birth weight for children under one
• Cerebral palsy
• Muscular dystrophy
• Muscular atrophy that causes difficulty speaking, walking, or coordinating limb movements
• Intellectual disability or neurological impairments
• ALS
• HIV or AIDS
• Terminal illness with a life expectancy of six months or less
• End-stage renal disease that requires chronic dialysis

If you have a medical condition that is not listed above, you may still qualify for presumptive disability benefits. Conditions that are so severe they limit your ability to work and support yourself will often warrant immediate disability payments. Our team can help you provide the proper medical evidence and information to secure presumptive disability while waiting for your SSI application to process.

Who Decides if You Can Recieve Presumptive Disability Benefits?

When you submit an application to the Social Security Administration for SSI payments, your local SSA field office will process your initial application. For most conditions, this field office is the one that will determine whether you can receive presumptive disability benefits or not. In most cases, the field office will contact your doctor, social worker, or school personnel for confirmation of your debilitating medical condition. The SSA will also have its own medical examiner review your case to determine if you qualify for presumptive disability or not.

If the SSA field office cannot make a decision about your presumptive disability benefits, you may still qualify for them when your application is sent to Disability Determination Services (DDS). DDS is a secondary agency that can also determine whether you qualify for SSI benefits. This agency has more leeway and grants presumptive disability more regularly. DDS can also give presumptive disability payments to applicants with medical conditions that are not on the list above.

To receive presumptive disability benefits, be sure to submit a substantial amount of medical evidence along with your SSI application. Diagnoses, medical test results, and treatment plans will prove to your local SSA office and DDS agency the severity of your condition. Before you submit your application, talk to your healthcare team or social worker and let them know you are applying for SSI benefits. Because the SSA will likely contact them to confirm your condition, it is critical that they are prepared to advocate for you with specific examples of how your condition limits your ability to work.

How Do You Apply for Presumptive Disability?

There is nothing special or extra you must do to apply for presumptive benefits. You are eligible for presumptive benefits when you submit your SSI application. If you have one of the conditions listed above or you have a medical condition so severe that you cannot work until your application is approved, it is very likely that you will begin receiving presumptive benefits payments automatically. Typically, these payments will start within a few days or weeks of submitting your SSI application.

You are not eligible for presumptive disability payments if you are applying for Social Security Disability Insurance (SSDI) or if your SSI application has been denied previously. You can receive presumptive disability payments for up to six months or as soon as a final decision has been made about your SSI application.

If you have an immediate financial crisis, like a lack of food or shelter, you may be eligible for an “emergency advance payment” from Social Security. This is a one-time payment that can be used to buy food, clothing, and other basic necessities. However, this payment is a loan and must be repaid with your presumptive disability benefits.

How Long Do Presumptive Disability Payments Last?

Presumptive disability payments last for six months or until your SSI application is processed. If your SSI application is approved, your presumptive disability payments will cease, and your normal SSI benefits will begin. If your SSI application is denied, your presumptive disability payments will stop. You are not responsible for repaying presumptive disability payments if your SSI application is denied. However, you may be asked to repay some or all of your payments if you were paid more than you should have been based on your resources or income level. To avoid being asked to repay these benefits, providing accurate financial information in your SSI application is crucial. If you have concerns about your application or would like more information, contact our office today.

Which Conditions Do Not Qualify for Presumptive Disability?

To receive presumptive disability payments, you must have a medical condition that meets the requirements of the SSA’s listed impairments. Your condition must prevent you from working even the least demanding of jobs, and you must present medical evidence proving the severity of your condition. If your medical condition is not severe enough, it is unlikely that you will qualify for presumptive disability payments.

Common conditions that may qualify you for SSI disability benefits but will not qualify you for presumptive disability include the following:

• Celiac disease
• Carpal tunnel syndrome
• Fibromyalgia
• Degenerative disc disease
• Migraines

While these medical conditions may limit your ability to work, they are not so severe that they prevent you from working all jobs. If you apply for SSI and list multiple impairments, but none of those impairments are severe enough to qualify you for disability on its own, you are still unlikely to receive presumptive disability payments.

You must also meet all the requirements for SSI disability to receive presumptive disability payments. These requirements include having a limited income and having few financial resources. Unfortunately, you cannot receive presumptive disability payments while appealing a denied SSI claim.

What is a Compassionate Allowance Condition?

Compassionate Allowance Condition (CAL) is a way to expedite the SSI application process. If you have a medical condition on the SSA’s Listing of Impairments, you may be able to receive a Compassionate Allowance Condition. CALs are not payments like presumptive disability payments; instead, they allow the SSA to review your SSI application quickly to approve your benefits on a much faster timeline.

You can check the SSA’s Listing of Impairments on their website to see if you qualify for a CAL. These severe conditions typically require minimal medical information to confirm. They include various types of cancer, acute leukemia, and other serious diseases that are often life-threatening. CAL Conditions are available for SSDI and SSI, unlike presumptive disability payments, which are only available for SSI applicants.

There are other expedited Social Security disability programs you may qualify for if your medical condition is severe enough. The Terminal Illness Program (TERI) allows individuals with terminal illnesses or who are on hospice to get their applications processed quickly. The SSA will automatically flag TERI cases, like stage IV inoperable cancers that have metastasized, cancers of the liver, pancreas, or lung, acute leukemia, and AIDS. Applicants may also be flagged as TERI cases if they are on life-support, if they have been in a coma for more than 30 days, if they are receiving end-of-life care, or if they are waiting for a lung, liver, or heart transplant.

The Quick Disability Determination program (QDD) uses software to make quick determinations about SSI applicants. The QDD program scans files for certain phrases, like medical conditions that meet the SSA’s medical listings. The program will then check to see if the applicant included the necessary medical documentation. If it does, the application will be sent to QDD claims examiners, who will make a final decision about the case. Using the QDD program, the SSA can approve a claim in under one month.

Can an Attorney Help Me Secure Presumptive Disability Benefits?

Presumptive disability benefits can be life-saving for individuals with severe medical conditions. SSI applications can take months to process, leaving you unable to work and without a way to support yourself and your family while you wait. If you qualify for presumptive disability payments, you can start receiving disability payments after just a few days of submitting your application, keeping you afloat until your SSI benefits are approved.

Presumptive disability benefits have strict requirements that not all disabilities fall under. When submitting your SSI application, it is crucial to submit the necessary documentation and medical evidence to prove that your condition is severe enough to warrant these benefits payments. Similarly, you must also prepare your healthcare team or social workers so they understand how to answer the SSA’s questions about your disability. Because our team has extensive experience with disability benefits applications, we can help you gather the right documentation to prove that you are qualified for presumptive disability benefits.

At Roeschke Law, we understand just how frustrating it can be to wait for your disability benefits to kick in. In many cases, the waiting period before SSI benefits can be dangerous, leading to disabled individuals going without food, shelter, and other basic necessities. Our experienced attorneys can help you submit your SSI application with the necessary documentation to qualify you for these benefits payments. If you have a debilitating disability, we are confident we can help you receive presumptive disability benefits. For more information, contact our office today by calling 480-999-4740.