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Presumptive Disability and Supplemental Security Income  Disability Benefits

By R. M. Bottger

Sometimes the Social Security Administration temporarily pays Supplemental Security Income (SSI) benefits while it gathers the evidence it needs to make a decision on a disability case. This procedure is called “Presumptive Disability,” and here is a description of how the procedure works.

In most cases, people do not receive any benefits while waiting for the Social Security Administration to make a decision on their disability cases. However, sometimes the Social Security Administration does pay benefits to a person while it gathers the evidence needed to make a decision on his or her case. This is called a “Presumptive Disability.” When the Social Security Administration has evidence in file that strongly suggests that a person will be found disabled but still needs more evidence to make its final decision, it can perform a presumptive disability to temporarily provide benefits to the person until it gathers the evidence it needs to make its final decision. Presumptive disability only applies to SSI cases; this includes children’s cases. People who are applying only for Social Security Disability Insurance cannot receive temporary benefits while waiting for SSA to make its decision. Presumptive disability only applies to initial cases. If your case has been denied at the initial level and is currently being appealed, you are not eligible for a presumptive disability. To be eligible for a presumptive disability, you must meet the non-medical requirements for SSI benefits including the income and resource requirement. (You must have below a certain level of income and resources to be eligible for SSI benefits.) A person can receive benefits under a presumptive disability for up to 6 months. The presumptive disability benefits cease as soon as the Social Security Administration makes its decision as to whether or not the person is disabled. Although the Social Security Administration only performs a presumptive disability when it is pretty sure the case is going to be an allowance, it can still deny the case if the evidence it receives supports the decision of not disabled.

You apply for SSI disability benefits at your local SSA office. If you have one of the following conditions, the claims representative in your local SSA office can start your temporary benefits by performing a presumptive disability:

·        Amputation of the leg at the hip

·        Total deafness

·        Total blindness

·        Confinement to bed due to a longstanding condition

·        Confinement to a wheelchair due to a longstanding condition

·        A stroke at least 3 months in the past resulting in inability to walk requiring the use of a wheelchair/cane/walker or severe inability to use one hand

·        Cerebral palsy, muscular dystrophy, or muscular atrophy resulting in the inability to walk requiring the use of a wheelchair/cane/walker or a severe limitation on the use of one’s hands

·        Down Syndrome

·        Severe mental deficiency in someone older than 7 years old resulting in the need for assistance with daily activities

·        Baby less than 6 months old with a birth weight of less than 1200 grams

·        HIV with allegation of a resulting infection that meets SSA’s requirements

·        Hospice care for cancer

·        Spinal injury greater than 2 weeks old resulting in an inability to walk requiring the use of a cane/wheelchair/walker

·        Severe prematurity- with weight below a certain level for the child’s gestational age based on a chart contained in SSA’s regulations

       Once you have applied for SSI benefits, your local SSA office sends the case to your state’s disability determination services (DDS) to make the medical decision on your case. The DDS can perform a presumptive disability for any medical condition when the evidence in file strongly suggests that the case is going to be an allowance. When I was a disability determination specialist, I didn’t do all that many presumptive disabilities because most of the time I wasn’t all that sure that a case was going to be an allowance until I actually had everything I needed to go ahead and allow the case. Let me give you an example of a case that would be a good candidate for a presumptive disability. Take the case of a 61-year-old woman who has only done physically demanding work. She has medical records in file showing that she has severe chronic obstructive pulmonary disease. The Social Security Administration requires a breathing test performed a particular way on all cases of people with breathing problems. Most of the time, people’s existing medical records do not contain a breathing test performed in this particular way. Consequently, SSA usually schedules a breathing test that SSA pays for to get the evidence it needs. In this case in which the medical evidence in file strongly suggests that the case will be an allowance, the Social Security Administration might well do a presumptive disability so that the woman could receive benefits while waiting for the results of the breathing test needed to make the final decision. If the breathing test results come back better than expected, the case could still be denied.

   

 

  

  

  

 

 


 
 

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