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Presumptive disability and SSI disability benefits?

Recently on our legal forum a user asked, “I have very limited income and have never really worked or paid taxes. I have also been diagnosed with end stage renal disease. I have heard that getting disability benefits from the Social Security Disability Administration (SSA) can be a nightmare, with some applicants waiting up to two years to have a judge hear their case. I am wondering if the SSA ever awards benefits upfront while they make the final disability decision? I think I heard about a program called presumptive disability benefits. What is this?”


Overview of disability benefits offered by the SSA

The Social Security Administration administers two disability benefits programs. Given the information you have provided it sounds like the only one you might qualify for is Supplemental Security Income (SSI). Supplemental Security Income is a wage replacement program offered to the blind, disabled, or aged who have limited income and resources and who are unable to work for at least 12 continuous months.

Now, as you mentioned, filing for disability benefits can be a long, arduous, and difficult process. In fact, there are claimants who have applied and been denied benefits multiple times. The good news for you, however, is that the SSA does have a program- referred to as presumptive disability benefits- which allows claimants to receive temporary SSI disability payments while the SSA reviews their disability case.

What is the goal of the presumptive disability program?

The SSA has created the presumptive disability program specifically for SSI claimants. In fact, this program is not offered to claimants who are applying for Social Security Disability Insurance (SSDI). The assumption is that claimants who meet the income and resource limitations of the SSI program do not have discretionary income to support themselves while the SSA attempts to validate their claim.

Who will qualify for presumptive disability benefits?

It’s important to note that not all SSI claimants will qualify for presumptive disability benefits or immediately receive benefits. In fact, only the most serious conditions will qualify including the following: 

-Symptomatic HIV infection or AIDS
-Total blindness
-Total deafness
-Cerebral palsy
-Amputation or two limbs or one leg at the hip
-Spinal cord injury with the inability to walk without a walker
-Stroke which occurred more than 3 months ago and does not allow the claimant to use her hands or arms
-Muscular dystrophy
-End stage renal disease
-Severe mental retardation
-Lou Gehrig’s disease
-Low birth weight
-Terminal illness, in hospice, with six months or less to live

How long will I receive my presumptive disability benefits?

Presumptive disability benefits by their very nature are temporary. You will receive them for a total of six months. If after six months the SSA still has not made a disability decision, you will not receive payment. The good news, however, is that if they have made a decision and you are denied benefits, you will not have to repay any of the SSI disability payments you have received.

Bottom Line:

You may qualify for presumptive disability benefits under some conditions. Talk to the SSA and find out what steps you need to take to get SSI benefits as soon as possible.

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