SSI and Presumptive Disability: Benefits and Conditions

Supplemental Security Income (SSI) is a federal program financed by the United States government’s general treasury funds. The program is administered by the Social Security Administration (SSA), but Social Security funds do not pay for it. 

As such, SSI is a financial assistance program for disabled adults and children with limited income and resources who lack qualifying employment history that might otherwise entitle them to Social Security Disability Insurance (SSDI).

Criteria required for claiming Supplemental Security Income benefits 

One must meet all of the following requirements to be eligible for the SSI benefit program: 

  • Be disabled, blind, or 65 years of age or older
  • Income and resources are limited
  • Be a citizen or national of the United States or a lawfully allowed alien who meets further qualification criteria (fall within specific categories of aliens)
  • Reside in one of the 50 states, the District of Columbia, or the Commonwealth of the Northern Mariana Islands, except for children whose military parent(s) are stationed permanently outside of the United States or are students studying abroad temporarily.

Why do so many disability applicants seek legal assistance?

To be honest, the SSI application process is complicated and time-consuming for many disabled people trying to establish eligibility and receive payments. Many claimants seek assistance from skilled legal counsel. Having a knowledgeable lawyer on their side allows for a much easier process. 

An attorney can complete the appropriate forms, obtain medical documentation of your disabilities, and ensure that all physical and mental health issues are examined and addressed by SSA to provide you with the best opportunity of obtaining entitlement to disability benefits.

What is presumptive disability?

Supplemental Security Income issues a monthly payment for disabled and older adults with limited income. The application and decision process can take many months to be processed by the SSA. Applicants who have certain qualifying medical conditions may also receive payments in advance while their claim is being processed.

These presumptive disability (PD) benefits are intended to offer financial assistance to those that the government has determined are likely to be eligible for SSI based on their application information and supporting documentation. 

Even if the government ultimately concludes that the applicant is not medically qualified for disability benefits, the payments can continue up to six months and may not have to be reimbursed.

Conditions that meet presumptive disability benefit qualifications

To qualify for early payment through Presumptive Disability benefits, one’s SSI claim, or a claim filed on behalf of another individual, must include one or more of the following medical conditions:

  • amputation of a leg at the hip
  • total deafness or no sound perception in either ear;
  • total blindness or no light perception in either eye;
  • bed confinement or immobility without a wheelchair, walker, or crutches, due to a longstanding condition excluding a recent accident and recent surgery;
  • stroke (cerebral vascular accident) more than three months in the past and continued marked difficulty in walking or using a hand or arm;
  • 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;
  • Down syndrome;
  • 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); 
  • 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.

Uncontrolled diabetes that gives rise to another health condition, long-term and severe anxiety, depression, and some other diseases may also qualify in some cases, but the complete medical history should show the condition has an impact on your life. Many people face disabling conditions due to long-term diabetes and anxiety issues. 

They can apply benefits for diabetes, anxiety, emphysema and other medical conditions. Before taking any steps, you should know the eligibility criteria that is outlined in the SSA’s Blue Book. The Blue Book is a listing of disabling medical conditions and the criteria that must be met to be qualified for disability benefits. Knowing the criteria that must be met can help you to avoid being denied benefits.

How is presumptive disability determined?

The American Association of Retired Persons (AARP), an advocacy group for elderly adults, correctly points out that navigating the complicated SSI application process can take a very long time. The organization also adds that processing a disability application for Supplemental Security Income often takes several months.

During such a long period, many applicants understandably have significant and even compelling financial demands. According to AARP, applicants with certain medical conditions may be able to collect advance payments while waiting for a claim decision. If government examiners discover a presumptive disability after analyzing their benefit claims, they can choose to implement the early payments.

When an applicant’s claim is regarded as highly likely to be approved, a presumptive disability finding may be made. Advance payments can last for up to 6 months and in most cases a claimant will not have to repay the advance payments, even if their application is ultimately denied.

The questions that generally arise are what the severity of the applicant’s disability is? Does medical evidence support the claim? Examiners who are weighing a presumptive disability decision often focus on these questions. 

Claimants should be aware that they do not need to file a separate SSI application for presumptive disability compensation payments. When considering a claim, examiners should consider any such condition, with an enumerated list of illnesses and other impairments serving as an introductory guide.

When the SSA considers an original application for SSI, one may be eligible for presumptive disability payments. Contact a knowledgeable Chicago Disability Lawyer for more information about how to file a claim for disability benefits.

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