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What is presumptive disability?

 

The Social Security Administration (SSA) takes several months to process a disability-based application for Supplemental Security Income (SSI), a monthly benefit for disabled and older people with very low incomes. Applicants with certain medical conditions, however, may be able to collect advance payments while awaiting a decision on their claim.

These presumptive disability (PD) benefits are designed to provide financial support for people whom the SSA deems highly likely to be approved for SSI, based on the information in their application. The payments can last up to six months and typically do not have to be repaid, even if the agency ultimately decides the applicant is not medically qualified for disability benefits.

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A finding of presumptive disability is based on the severity of your impairment and the medical evidence available when you applied. In most cases your SSI claim or a claim you make on behalf of another person must involve one or more of these conditions to warrant early payments:

  • AIDS or a symptomatic human immunodeficiency virus (HIV) infection
  • Amputation of a leg at the hip
  • Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease
  • Cerebral palsy, muscular dystrophy or muscle atrophy resulting in marked difficulty in speaking, using hands or arms, or walking
  • Confinement to bed — or immobility without crutches, a walker or a wheelchair — because of a long-standing condition and not an accident or recent surgery
  • Down syndrome
  • End-stage renal disease, also known as chronic kidney failure
  • An intellectual disability or neurodevelopmental disorder, such as autism, accompanied by the inability to perform basic self-care activities like eating or dressing
  • Low birth weight in a child not yet 1 year old
  • A spinal-cord injury resulting in the inability to move without a walker or similar apparatus
  • A stroke that occurred at least three months prior and causes continued difficulty in walking or using hands or arms
  • Terminal illness with a life expectancy of less than six months
  • Total blindness
  • Total deafness

You do not need to apply separately for presumptive disability payments. You are considered to be doing so when you file for SSI. The Social Security field offices that initially review applications usually make the decision to award the payments, but Disability Determination Services (DDS), the state-level agencies responsible for approving or denying disability claims, also can do it.

Field offices are limited to considering the conditions listed above, but the DDS has leeway to award presumptive disability for other impairments. The advance payments stop when Social Security makes a decision on your SSI claim or in six months (whichever comes first).

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Keep in mind

  • Presumptive disability payments are available only during the time the SSA is considering your initial application for SSI. You can't receive them while your case is on appeal.
  • You may have to repay some or all of the money if the SSA rejects your claim for reasons other than your medical condition or determines that your presumptive benefit amount was incorrect.
  • Presumptively disabled applicants who are facing an immediate financial need, such as a medical crisis or imminent homelessness, may be able to get a onetime “emergency advance payment” from Social Security. It can happen as early as the month in which they filed for SSI. This money must be repaid, either in a lump sum or as deductions from future benefits.

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