What Are Presumptive Benefits?
If you are applying for Supplemental Security Income benefits on the basis of disability or blindness, the Social Security Administration may pay you benefits before making a formal finding of whether or not you are disabled or blind
In order to receive presumptive benefits, Social Security must find that you are presumptively disabled or presumptively blind. You must also meet all other eligibility requirements for Supplemental Security Income (SSI) benefits. Payments my be made to you for a period no longer than 6 months. These payments will not be considered overpayments if we later find you are not disabled or blind.
Presumptive disability or blindness payments are computed like other SSI benefits, based on financial need. Presumptive payments may be made for up to six months while you wait for the formal disability or blindness decision. They normally begin with the month after the month a disability/blindness finding is made (by the local Social Security office or State disability determination agency based on specific criteria). Payments end after six months even if a formal decision has not been made. Even if Social Security makes a formal decision that you are not disabled or blind, you would not be responsible for repaying any money that you received. Any overpayment would have to be based on a non-medical factor of eligibility such as income (i.e. failure to disclose any income in the household).
Social Security can make a presumptive disability or presumptive blindness payment to you if:
- You are applying for the first time for SSI based on disability or blindness;
- Your medical condition is such that it presents a strong likelihood that you will be found disabled or blind under our rules; and
- You meet all non-medical factors of eligibility.
Examples of conditions that may entitle you to presumptive benefits include:
• Amputation of a leg at the hip;
• Allegation of total deafness; that is, no sound perception in either ear;
• Allegation of total blindness; that is, no light perception in either eye;
• Allegation of bed confinement and immobility without a wheelchair, walker, or crutches, due to a longstanding condition excluding recent accident and recent surgery;
• Allegation of stroke (cerebral vascular accident) more than three months in the past and continued marked difficulty in walking or using a hand or arm;
• Allegation of 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;
• Allegation of Down syndrome;
• Allegation of severe mental deficiency made by another individual filing on behalf of a claimant who is at least 7 years of age;
• Symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS); Form SSA-4814 or SSA-4815 are needed;
• 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 appropriate medical professional;
• 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;
• Allegation of amyotrophic lateral sclerosis (ALS) known as Lou Gehrig's disease.
• A child has not reached 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: less than 2000 grams (4 pounds, 6 ounces);
- 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)
If the local Social Security office is not able to make a determination for Presumptive benefits, it is possible that Disability Determination Services will make a determination based on one of the medical conditions listed above, or on the basis of another severe condition.