If you’re filing for Supplemental Security Income (SSI) for yourself or on behalf of a child, there’s a possibility that you may receive a presumptive disability finding.
This allows you to almost immediately begin collecting SSI benefits, including entitlement to Medicaid, for up to six months while your disability claim is formally being decided.
Presumptive disability benefits are not awarded often or lightly — there has to be a fairly high certainty, based on what is either readily observable to the claims representative (such as someone who has had a massive spinal trauma and is confined to a wheelchair) or some other evidence that’s presented at the time of filing.
Presumptive disability allowances can also sometimes overlap with other types of expedited claims, like those with a terminal illness. Some situations allow the field office, where the claim is taken, to award presumptive payments, while others require the decision to come from the Disability Determination Services.
There are a couple of things that you should keep in mind if you are awarded presumptive disability payments:
— You are not guaranteed a final approval. Your disability claim can still be medically denied. In fact, slightly more than 10 percent of those claims given a presumptive approval are later medically denied.
— If you are given presumptive disability payments, then later medically denied, you do not have to repay the payments. You only have to repay any part of the payments for which you did not meet the financial eligibility requirements of SSI.
— If you were due presumptive payments and did not receive them prior to the medical denial, it is possible for Social Security to issue them as a one-time payment.
If you do receive a presumptive approval and then a medical denial, it’s important to understand the reason for the denial. Did you not meet the eligibility standards for your particular condition? If so, should Social Security consider other disabling factors that you didn’t mention, including depression or anxiety? Did one of your medical sources simply forget to submit your medical evidence?
Once you determine the reason for the medical denial, you can file your Request for Reconsideration. It may also be time to consider speaking to a disability attorney who handles SSI claims and asking for assistance.
Source: Social Security, “DI 233.001 Presumptive Disability/Presumptive Blindness (PD/PB) Eligibility, Authority, and Payment Issues,” accessed April 11, 2017