What Does Social Security Consider a Presumptive Disability?

What does Social Security consider a presumptive disability? Applying for Supplemental Security Income (SSI) benefits through Social Security can be frustrating, complex, and time-consuming. When you’re living with a disability that renders you unable to work and you need that money, it’s a level of stress you frankly don’t need.

While for many, having the best disability attorney in your corner is essential to getting you the benefits you need, it also helps to understand as much as you can about the process. There is a means by which you can gain immediate payments to get you through while waiting on the final decision for benefits.

The SSA issues these immediate payments on the presumption that your disability is genuine and that your case will eventually see benefits awarded. The technical term for this is “presumptive disability.” This presumption allows you to make ends meet while you continue the fight for permanent benefits. What exactly does Social Security consider a presumptive disability, and how do you apply for these benefits? Let’s look at an overview of all you need to know about these vitally important payments.

What Social Security Considers a Presumptive Disability

As with many Social Security requirements, the Social Security Agency (SSA) maintains a very specific list of the kinds of illnesses, injuries, and conditions that comprise a presumptive disability.

These include:

  • Limb amputation, either two limbs or one leg at the hip
  • Total blindness or deafness
  • Confinement to bed or long-term immobility requiring a walker, wheelchair, or crutches to get around, including as the result of spinal injuries
  • Mobility issues related to a stroke over three months prior
  • Muscular atrophy, cerebral palsy, or muscular dystrophy creating difficulty moving or speaking
  • Down syndrome
  • Severe intellectual disorders in those aged seven or higher
  • HIV or AIDS with symptoms
  • Terminal illness resulting in less than six months to live or in hospice
  • End-stage renal kidney disease resulting in chronic dialysis
  • Lou Gehrig’s disease
  • Low birth weight in infants

Low Birth Weight

Determining whether a child has low birth weight gets even more specific. The maximum weight that qualifies an infant depends on how premature (if at all) the baby was upon delivery. The baby must be a maximum of six months old to be eligible for low birth weight payments. If the child meets the weight requirements at birth, not only are you able to receive presumptive disability benefits but the baby is also entitled to free medical care from Medicaid, which can be life-saving for all involved.

Specific birth weights are as follows:

  • 37 weeks: 4 pounds, 6 ounces
  • 36 weeks: 4 pounds, 2 ounces
  • 35 weeks: 3 pounds, 12 ounces
  • 34 weeks: 3 pounds, 5 ounces
  • 33 weeks: 2 pounds, 15 ounces
  • Any gestational stage: 2 pounds, 10 ounces.

 Making the Presumptive Disability Decision

The local SSA field office where you apply for SSI benefits can usually make a quick decision regarding presumptive disability. In some cases, they may need to contact a qualified third party like a doctor, social worker, school employee, or the like. In general, however, the condition resulting in presumptive disability is obvious enough to be evident.

Exceptions to Presumptive Benefits

Those under reconsideration for disability benefits or undergoing administrative appeals are not eligible for presumptive benefits. In addition, those who are prerelease cases, or cases where the individual has proven they can still engage in sustained work, but have terminated that work for reasons not clearly related to their impairment, may be denied presumptive benefits.

When SSA Denies Your Presumptive Disability Claim

If SSA denies your initial claim, you may still be able to get presumptive disability if you are still within the six months, and they move your file to Disability Determination Services. The DDS has a great deal of leeway in granting these benefits. They can even award benefits to those with conditions and illnesses that aren’t on the standardized list.

Length of Presumptive Disability Payments

Presumptive Disability payments are only a temporary stopgap while you pursue permanent or long-term SSI benefits. They can last for up to six months, and as soon as the SSA reaches a final decision in your case, they end. Even if the SSA hasn’t decided within six months, these payments still end. You cannot continue to get presumptive benefits if SSA has denied your case, even if it is in appeal.

Overpayments and Repayments

On the upside, however, if SSA denies your claim, you do not have to repay the presumptive benefits. They are not an advance paid against permanent benefits. The only exception is if you received an overpayment. In this case, you may have to repay the overpayment. That’s why it’s important to report any potential overpayment right away; while it can seem like a boon at first, it can create financial hardships down the road when you have to pay it back.

Overpayments can occur for several reasons. If SSA rejects your final disability claim for reasons unrelated to your medical condition or if the SSA determines your benefit amount was incorrect, you may have to repay a portion of the presumptive disability benefits you received.

 When Approved Payments Fail to Arrive

Sometimes issues occur with the mail or something else interferes with approved presumptive benefit payments. Suppose SSA approves a claim for these payments, and they do not arrive by the time the claimant’s case is settled (including in cases of denials). In that case, the SSA might re-issue the benefits via a one-time payment encompassing the entire value. If this has happened to you, it’s a good idea to talk to your Social Security benefits attorney for help.

 How to Apply for Presumptive Disability Payments

Like most Social Security, the initial application process to apply for presumptive benefits is fairly simple. If you think you have a disability that falls under the list, all you have to do is contact the SSA and inquire about presumptive benefits when you begin your SSI application. The presumptive benefits will form part of your overall application, and SSA should award the benefits quickly.

Summary Presumptive Disability Benefits

Presumptive disability benefits are a protective measure that the SSA has put in place to help protect people who are pursuing SSI benefits. They are a stopgap that only lasts for six months and require a disability on a particular list. If SSA Denies your presumptive application, your case moves to the DDS, who has more authority to grant benefits for disabilities not on the list.

If SSA denies your complete SSI application, you can no longer receive presumptive benefits. You would not have to pay these benefits back unless you received an overpayment. In the case of an overpayment, you may have to repay a portion of the benefits you received.

The process of seeking SSI benefits can be stressful, complex, and confusing, and presumptive disability benefits can take some of the stress off while you pursue long-term benefits. To make sure you are completely covered, you should always have the help of a qualified and experienced Social Security disability attorney.

An attorney can help to guide you through the frustrating and complicated waters of Social Security law, ensure you don’t make any critical mistakes that can cost you benefits, and can help you to gather all the information you need to prove your case so you can get the benefits to which the law entitles you.

The right lawyer can also help you to challenge a denial and get the benefits you need. More importantly, at the beginning of the whole process, a good attorney will give you the best chance at getting the presumptive benefits you need to make ends meet.

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