What is Presumptive Disability and How Does it Affect SSA Benefits?

Oftentimes people who apply for Social Security Disability benefits are in a serious financial crisis. Unable to work, you may be faced with mounting bills and overwhelming financial obligations. To make matters worse, it can take months, or even years, for your Social Security Disability claim to be approved. You may be wondering how you are going to feed your family and pay your rent in the meantime. Fortunately, there is an option that may allow you to receive Social Security Disability benefits while waiting for your disability claim to go through.

Presumptive Disability Benefits

In certain situations, the Social Security Administration is willing to pay benefits while gathering the evidence needed to make a decision on your Social Security Disability claim. This is called Presumptive Disability. In order to qualify for Presumptive Disability you must have sufficient evidence showing that your Social Security Disability claim is likely to be approved and you must meet the income limit requirements of the Supplemental Security Income program.

The Presumptive Disability program is only available to those who qualify for Supplemental Security Income, meaning your household income and assets will need to be below the limits set forth by the Social Security Administration and you will need to have a condition that is likely to result in the approval of your Social Security Disability claim.

Examples of disabling conditions that may qualify you for Presumptive Disability include total deafness, total blindness, amputation of the leg at the hip, confinement to bed or a wheelchair, a stroke resulting in the inability to walk or use one hand, cerebral palsy, muscular dystrophy, certain cancers and other severely debilitating physical or mental conditions.

Once you apply for Social Security Disability and SSI benefits, the person handling your claim will send your case to your state's Disability Determination Services department. At this point, the Social Security Administration can decide whether or not you qualify for Presumptive Disability. If you do qualify and are approved, you will receive payments while you wait for your Social Security Disability claim to be processed. In some cases you may not qualify for cash benefits under Social Security's Presumptive Disability program, but you may qualify for access to Medicaid to help cover medical expenses while you wait for a Social Security Disability determination.

It is important to understand that you will not qualify for Presumptive Disability under the SSI program if your Social Security Disability claim has been denied and is in the appeal process. You must be in the initial stage of your Social Security Disability claim. If you do qualify for Presumptive Disability, you will only be entitled to receive these benefits for a total of up to six months. The benefits will be discontinued after six months or as soon as the Social Security Administration makes a decision regarding your Social Security Disability claim.

How Much Will You Receive Under Presumptive Disability?

The amount of your Presumptive Disability payments will be affected by the amount of your total household income and assets. Presumptive Disability is only available to SSI applicants and SSI is a needs-based program. If you do not meet the income requirements, you will not receive any Presumptive Disability payments, even if the Social Security Administration is positive that it will be approving your case for Social Security Disability benefits.

In most cases your Presumptive Disability payment would be equal to the amount you would receive in SSI benefits. The maximum SSI benefit amount is $674 per month for an individual and $1,011 for an eligible couple.

What Happens if Your Claim is Denied?

Many people worry that they will have to pay Presumptive Disability payments back to the Social Security Administration if their claim for Social Security Disability benefits is later denied. This is not necessarily the case. You will not have to pay back the Presumptive Disability benefits that you have received if your disability claim is denied for medical reasons. If, however, your claim for SSI is denied due to clerical errors or discrepancies in household income, then you may be responsible for paying back the Presumptive Disability payments you received while waiting for a decision on your Social Security Disability claim.

Do You Qualify for Presumptive Disability?

Not many people who apply for Social Security Disability benefits will qualify for Presumptive Disability payments. If, however, your income and assets are very limited and you have a severe medical condition that is likely to qualify you for Social Security Disability and SSI, you should contact the Social Security Administration to inquire about applying for Presumptive Disability payments.