What Conditions Qualify For Presumptive Disability?

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The Social Security Administration (SSA) awards presumptive disability to those who may qualify for Supplemental Security Income (SSI). Now, you may be wondering, what exactly is presumptive disability? Presumptive disability are benefits designed to offer financial assistance and support for individuals that, based on the information in their SSI application, the SSA sees as having a high likelihood of ultimately being approved for SSI.

Thus, presumptive disability can enable eligible individuals to start receiving disability benefits more quickly, while they are awaiting a final decision on their disability claim.

Here is a closer look at presumptive disability.

What Conditions Qualify For Presumptive Disability?

There are several conditions that can qualify for presumptive disability payments. It is important to note that these conditions are ones that would most likely be expected to result in a claims approval.

Some conditions that can lead to presumptive disability benefits include:

  • amputation of a leg at the hip;
  • allegation of total deafness; that is, no sound perception in either ear;
  • allegation of 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 condition excluding recent accident and recent surgery;
  • allegation of stroke (cerebral vascular accident) more than three months in the past and continued marked difficulty in walking or using a hand or arm;
  • allegation of 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;
  • allegation of Down syndrome;
  • allegation of 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;
  • a 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:
  • a 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);
  • symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS); Form SSA-4814-F5 or SSA-4815-F6 is needed;
  • 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;
  • allegation of a 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;
  • allegation of 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); or
  • allegation of amyotrophic lateral sclerosis (ALS) known as Lou Gehrig's disease

What Is Presumptive Disability?

Presumptive disability is not automatically qualifying for disability benefits. Instead, it is receiving aid under the impression that your claim will be approved.

What Happens If I Receive Presumptive Disability But Then Get Denied for Disability Benefits?

It is crucial to note that, if your disability claim is ultimately denied, and you have been receiving presumptive disability benefits, you will not be expected or asked to pay back those benefits.

However, if you received an overpayment due to (1) excess income, (2) excess resources, or (3) working and earning more than substantial gainful activity (SGA), you might have been overpaid. As such, you may be asked to repay some of these payments if this is the case.

Next Steps – Getting Help from a Disability Lawyer

If you are unable to work because of a medical condition, it is important that you consider enlisting the help of a disability lawyer. Disability attorneys take cases on a contingency basis, meaning that they get paid depending on whether you win your claim. In other words, you only pay a disability attorney if your claim is approved.

Complete the Free Case Evaluation Form on this page to get connected with an independent, participating disability attorney who subscribes to the website.

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