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PRESUMPTIVE DISABILITY BENEFITS

Because applying for disability benefits can be a long process, the SSA has made temporary or presumptive disability benefits available for SSI applicants who have some disabilities. These benefits are available for six months while the SSA processes your disability claim. Presumptive disability payments are only available to SSI recipients. Therefore, presumptive disability payments are not available to Social Security Disability (SSD) applicants.

Temporary Payments

Presumptive disability SSI payments can last for up to six months. As soon as the SSA reaches a final decision about your disability claim, the presumptive disability benefits will stop. Even if the SSA has not made a decision within six months, the presumptive disability payments will end. If the SSA denies your disability claim, you are not responsible for paying the presumptive disability benefits back. The following are examples of SSI claims that immediately qualify for presumptive disability benefits.

PRESUMPTIVE DISABILITY EXAMPLES – SSI ONLY

  • amputation of a leg at the hip;
  • deafness; that is, no sound perception in either ear;
  • total blindness; that is, no light perception in either eye;
  • allegation of bed confinement or immobility without a wheelchair, walker, or crutches, due to a longstanding conditionexcluding recent accident and recent surgery;
  • 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;
  • a physician confirms by telephone or in a signed statement that an individual has a terminal illness with a life expectancy of six months or less; or a physician or knowledgeable hospice official (for example, hospice coordinator, staff nurse, social worker or medical records custodian) 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 and the file contains a completed CMS-2728-U3 (End Stage Renal Disease Medical Evidence Report-Medicare Entitlement and/or Patient Registration).

CHILDHOOD PRESUMPTIVE DISABILITY EXAMPLES – SSI ONLY

  • Down syndrome;
  • 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;
  • child has not attained his or her first birthday and the birth certificate or other medical evidence shows a weight below 1,200 grams (2 pounds, 10 ounces) at birth:
  • 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: 2000 grams (4 pounds, 6 ounces) or less;
    – GA: 36 weeks; weight at birth: 1875 grams (4 pounds, 2 ounces) or less;
    – GA: 35 weeks; weight at birth: 1700 grams (3 pounds, 12 ounces) or less;
    – GA: 34 weeks; weight at birth: 1500 grams (3 pounds, 5 ounces) or less; or
    – GA: 33 weeks; weight at birth: at least 1200 grams, but no more than 1325 grams (2 pounds, 15 ounces) or less;
    – GA: 32 weeks; weight at birth; at least 1,200 grams (2 pounds, 10 ounces), but less than 1,325 grams (2 pounds, 15 ounces).

How to Apply for Presumptive Disability

You apply for presumptive disability benefits when you file your application for SSI at the local SSA office. For some conditions, the local SSA office is able to make a presumptive disability determination. In other cases, the Disability Determination Services (DDS), which is the agency responsible for making all SSI disability decisions, must look at your case. The DDS can make presumptive disability determinations as well, even for impairments that aren’t listed above.

If you think your SSI claim qualifies for you for a presumptive disability payment, contact us now. We can often tell you over the phone if we can help.  It is very important to apply for benefits immediately at ssa.gov if you have one of the above conditions. Because every day you wait to apply, is a day you lose benefits. You aren’t eligible for benefits until you apply. If you need help with your application or any other Social Security Disability matter, call us for free, today.

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