LAW FIRM BLOG
Presumptive Disability Payments
September 16, 2019
If you are an SSI applicant with one of about 15 severe physical or intellectual impairments, in certain situations, the Social Security Administration (SSA) is willing to pay benefits while gathering the evidence needed to make a decision on your Social Security Disability claim. This is called Presumptive Disability (PD). The “presumptive disability program,” doesn't speed the decision making process, but does pay up to six months of benefits while an applicant is waiting for a disability deterination. In order to qualify for PD you must have sufficient evidence showing that your claim is likely to be approved and must meet the income limit requirements of the Supplemental Security Income (SSI) program. The Presumptive Disability program is only available to those who qualify for SSI and your household income and assets will need to be below the limits set forth by the SSA and you will need to have a condition that is likely to result in the approval of your Social Security Disability claim. In addition to Social Security disability payments, individuals with presumptive disabilities may be eligible for Medicaid coverage.
You may be eligible to receive SSI benefits on the basis of a PD determination if you have one or more of the following medical conditions:
•Amputation of a leg at the hip;
•Bed confinement or immobility without a wheelchair, walker, or crutches, due to a longstanding condition excluding recent accident and recent surgery;
•Stroke (cerebral vascular accident) more than three months in the past and continued marked difficulty in walking or using a hand or arm;
•Cerebral palsy, muscular dystrophy, or muscular atrophy and marked difficulty in walking (for example the use of braces), speaking, or coordination of the hands or arms;
•Intellectual disability or another neurodevelopmental impairment (for example, autism spectrum disorder) with complete inability to independently perform basic self-care activities (such as toileting, eating, dressing, or bathing) made by another person filing on behalf of a claimant who is at least 4 years of age;
•A child has not attained his or her first birthday and the birth certificate or other medical evidence shows a weight below 2 pounds, 10 ounces at birth:
•A child has not attained his or her first birthday and available medical evidence shows a gestational age (GA) at birth with these corresponding birth-weights:
- GA: 37-40 weeks; weight at birth: 4 pounds, 6 ounces or less;
- GA: 36 weeks; weight at birth: 4 pounds, 2 ounces or less;
- GA: 35 weeks; weight at birth: 3 pounds, 12 ounces or less;
- GA: 34 weeks; weight at birth: 3 pounds, 5 ounces or less; or
- GA: 33 weeks; weight at birth: at least 2 pounds, 10 ounces, but no more than 2 pounds, 15 ounces or less;
- GA: 32 weeks; weight at birth; at least 2 pounds, 10 ounces, but less than 2 pounds, 15 ounces;
•Symptomatic Human Immunodeficiency Virus (HIV) infection or Acquired Immunodeficiency Syndrome (AIDS);
•A terminal illness with a life expectancy of six months or less; or a physician or knowledgeable hospice official confirms that an individual is receiving hospice services because of a terminal illness;
•Spinal cord injury producing an inability to ambulate without the use of a walker or bilateral hand-held assistive devices for more than two weeks with confirmation of such status from an acceptable medical source;
•End-Stage Renal Disease (ESRD) requiring chronic dialysis or
•Amyotrophic Lateral Sclerosis (ALS), known as Lou Gehrig's disease.
What Happens To PD Payments If Later Denied SSI?
The SSA does not ask you to repay these PD payments, even if you are later found not to be disabled. However, if you received an overpayment for other reasons, (for example, excess income, SGA, or resources), it may ask you to repay some of the PD payments.