What is Presumptive Disability in SSDI Claims and How Does it Work?

What is a presumptive disability? For those who have few assets, a low income and are disabled or blind, Social Security Income is a benefit paid monthly that can help pay the bills. To qualify as disabled, you must have a medical condition that prevents you from supporting yourself financially. Unfortunately, the process of obtaining disability payments can be long and sometimes complicated. This means that if you become disabled, it may be a long time before you would begin receiving the monthly payments. Yet, for those with certain disabilities, there may be the possibility of obtaining your benefits faster through Presumptive Disability payments, which can be paid up to six months while waiting for a claim to be approved. 

What Is Presumptive Disability?

A Presumptive Disability payment is ultimately a payment that is designed to provide you with the support you need while the Social Security Administration works to process your claim. To qualify for Presumptive Disability, there must be sufficient evidence that a disability claim will most likely be approved once all of the evidence-gathering processes have been completed. You must also fall into the required income limits as well, which will include all household income and assets. 

Conditions That Might Qualify Your for Presumptive Disability Payments

To possibly qualify for Presumptive Disability, you must first be diagnosed with a condition that has such severe impairment that it would be easy for the SSA to make the assumption that the result would be total disability. Some of the conditions that may qualify your for SSI payments under Presumptive Disability include:

  • AIDS or an HIV infection where you are showing symptoms
  • Complete blindness
  • Complete deafness
  • Amputation as long as it involves two limbs or a leg that has been amputated at the hip
  • A spinal cord injury that results in the inability to walk without the assistance of a device such as a walker or a wheelchair
  • A stroke that has occurred three months ago or longer and you are still having difficulties using an arm or hand, or walking
  • Muscular conditions that result in severe muscle atrophy leading to complications walking, speaking, or using hands, such as cerebral palsy or muscular dystrophy
  • End-stage renal failure that requires constant dialysis treatments
  • Amyotrophic Lateral Sclerosis
  • Low birth weight
  • A severe intellectual disability in an individual older than the age of seven
  • Confinement to a bed with the requires use of a wheelchair, crutches, or walker to be able to move
  • Terminal illnesses where you are expected to live less than six months and require hospice care

How to Apply for Presumptive Disability

You apply for Presumptive Disability payments at the same time you file your SSI paperwork with the Social Security Administration. They will review the condition, and for certain conditions, they may be able to make a determination for presumptive disability right at the field office. Most likely, in these cases, they will need to get some preliminary information before making a decision, such as information from a social worker, physician, or school staff who can attest to the condition or diagnosis. 

When cases cannot be made in the field office, they will be forwarded on to the Disability Determination Services. It is this office that will ultimately render all SSI Disability decisions. They also have the ability not only to make determinations on Presumptive Disability for the above-mentioned conditions but also ones that are not listed but may still qualify. 

If you qualify for Presumptive Disability payments after the review is complete, you will begin receiving your SSI payments while you are waiting for your application to be completely processed. There is also the chance that the determination may come back, not allowing you to receive cash payments until your application is completed, but allowing you access to Medicaid during the time. 

If you have a disability claim that has been denied and you have appealed the decision, you will not be able to request Presumptive Disability. All requests for Presumptive Disability must occur at the initial stage of your Social Security Disability claim. If you do start receiving cash benefits, they will come for up to six months or the completion of your application and the rendering of the SSA’s decision, whichever comes first. It is important to note that if the Social Security Administration has not yet made a decision within the six month time frame, the Presumptive Disability payments will stop 

How Much Might You Receive From Presumptive Disability?

How much of a Presumtpvive Disability payment you are entitled to will largely depend on the amounts of both your household assets as well as all the income going into the household. It is important to understand that SSI is based on need. So even if you have a valid claim for disability pending application with the SSA, if your household income does not meet the income requirements, you will not be able to receive any Presumptive Disability payments and will have to wait until your claim is finalized. 

When it comes to how much you will receive with your Presumptive Disability case, most often, it will be equal to the amount of SSI you would receive when the application is approved. The range for SSI benefits in 2020 is between $800 and $1800 per month, with the average being around $1,258.

What to Expect if Your Claim is Denied

Even though you wouldn’t be granted Presumptive Disability unless you had a strong case for disability benefits, there is always the chance that your claim could eventually be denied. Many people are afraid to file for Presumptive Disability because they believe that they will be required to pay the funds back to SSA in the event that their disability claim comes back denied. This is not typically the case. If the case comes back denied for a medical reason, you will not be required to repay the money that you had received in Presumptive Disability payments. Yet, if your claim has been denied because of filing errors or discrepancies that were found in your household assets and income, you may be required to make repayment. Because of this, it is critically important to be completely honest about all income and assets coming into the household. 

Who Is Most Likely to Qualify for Presumptive Disability?

Not everyone who applies for disability will be eligible for Presumptive Disability payments, even if there is a strong medical case. Since Presumptive Disability is need-based, you will need to prove that your income is severely limited. Even if you are not eligible for Presumptive Disability, you may still qualify for regular disability after the application process is complete. 

Other Expedited Social Security Disability Programs Are Available

If you do not qualify for Presumptive Disability and are still in need of expedited Social Security Disability programs, there are others available. The SSA may provide Compassionate Allowances, which would help to quickly identify diseases and medical conditions that would meet Social Security’s standards, such as cancer and brain disorders. Once identified, a Compassionate Allowance may push forward the application more quickly. There are also ways to file for emergency advance payments, immediate payments, and immediate reinstatement. 

What Is an Emergency Advance Payment?

An emergency advance payment is a one-time payment as an advance on SSI payments in the event a new applicant is facing a financial emergency, and the benefits have been delayed. The most you can receive in the emergency advance payment is:

  • The SSI Federal benefit rate
  • The total amount of benefits that would have been due
  • The amount requested to cover the financial emergency.

Once regular SSI payments are being made to you, the emergency advance payment amount will be subtracted from the amount before the funds are dispersed to you. If there are no payments to you that are past due, the amount will be broken up into six monthly installments and subtracted from the monthly benefit amount. 

What Is an Immediate Payment?

Another option for an expedited payment is an immediate payment that new applicants may qualify for if their benefits are delayed, and they are facing financial issues. The payment cannot exceed $999.00 and is only available to those who have applied and are due benefits for SSI but have not yet received their payments. The money will be deducted from the first check when benefits start.

What Is Expedited Reinstatement?

If you had been receiving benefits and they ended due to earnings, you may be able to have your benefits restart without reapplying if your financial situation changes. To qualify, you will have to prove that you cannot engage in gainful activity due to the impairments that previously qualified you for benefits. You must also make the request within five years of when the original benefit ended. To facilitate your reinstatement, you will need to provide updated medical information. If the request for an expedited reinstatement is approved, you could begin receiving your SSI benefits as soon as a month after your initial request. These provisional benefits can be granted for up to six months while the case is reviewed, and if it is determined that you are not able to receive benefits again, you will not likely have to repay the benefits. 

The process of obtaining SSDI can be long and difficult, meaning you may have to wait months to obtain benefits. But if you are in a financial bind and have a good case for disability, then you can take advantage of the expedited payment options offered by the SSA, such as Presumptive Disability.

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