Presumptive Disability: Eligibility and Filing
Ailments that make it difficult to walk or serious, chronic illnesses like AIDS can qualify you for immediate payments while you await an SSI decision.
Applying for Social Security disability benefits can be a long and frustrating process. Fortunately, the Social Security Administration (SSA), recognizing that waiting months for a decision can cause extreme financial hardship, has set up a process to make immediate payments to those applicants who are likely to qualify for SSI (Supplemental Security Income). This is called “presumptive disability” since the applicants are presumed to be disabled.
This presumption, and the payment of disability payments, lasts six months. If the SSA hasn’t made an initial disability determination on your case at the end of six months, the payments will stop until the SSA makes a disability determination. If the SSA denies you benefits because it finds you aren’t disabled, you won’t have to pay back any presumptive disability payments (unless the SSA finds that you were never financially eligible for SSI).
Disabilities That Qualify for Presumptive Disability Benefits
The following conditions may qualify for presumptive disability:
- amputation of two limbs
- amputation of a leg at the hip
- total blindness
- total deafness
- bed confinement and immobility without a wheelchair, walker, or crutches due to longstanding condition
- stroke more than three months ago, with difficulty walking or using a hand or arm
- cerebral palsy, muscular dystrophy, or muscular atrophy, with difficulty walking, speaking, or using hands or arms
- Down syndrome
- severe mental retardation (must be at least seven years old)
- symptomatic HIV infection or AIDS
- terminal illness with hospice services or six months or less to live
- spinal cord injury with inability to walk without walker or similar device
- end stage renal (kidney) disease (ESRD) requiring chronic dialysis
- amyotrophic lateral sclerosis (ALS), a.k.a. Lou Gehrig’s disease, and
- low birth weight (see below).
Low-Birth Weight Babies
Babies who were born at a significantly low birth weight are eligible for presumptive disability (whether or not the baby was premature). To qualify for presumptive disability for low-birth weight, your baby must be six months or younger and have a birth weight below:
- 4 pounds, 6 ounces (2,000 grams) if born at 37 weeks or later
- 4 pounds, 2 ounces (1,875 grams) if born at 36 weeks
- 3 pounds, 12 ounces (1,700 grams) if born at 35 weeks
- 3 pounds, 5 ounces (1,500 grams) if born at 34 weeks
- 2 pounds, 15 ounces (1,325 grams) if born at 33 weeks, or
- 2 pounds, 10 ounces (1,200 grams) if born at any gestational age.
If your baby meets the above weight requirements, you will receive SSI payments for up to six months while your case is decided. Your baby will also be able to receive free medical care through Medicaid. Your SSA representative will have to confirm your child’s birth weight by contacting the hospital or doctor before granting you presumptive disability.
Who Decides Whether You Qualify for Presumptive Disability
Your local SSA field office is able to make presumptive disability determinations in many cases. For some conditions, the field office must get confirmation from a reliable source of information, such as a doctor, a social worker, or school personnel.
If the SSA declines to grant you disability benefits, you may still qualify when your file moves to Disability Determination Services (DDS), the agency that determines whether you qualify for regular disability benefits. The DDS has more leeway in granting presumptive disability, and can grant benefits to applicants with illnesses and conditions that aren’t included on the above list.
Applying for Presumptive Disability Benefits
You apply for presumptive disability benefits when you apply for SSI. Call the SSA at 800-772-1213.