Disability Benefits During the SSDI Application Process

Getting Temporary Benefits While Waiting for Approval

When you apply for Supplemental Security Income (SSI), you may begin receiving payments even before a final determination if your condition is considered a presumptive disability. A presumptive disability is a loss of sight, hearing or limb. These are observable conditions.

Presumptive disability benefits may also be awarded in cases of disabling conditions or diseases that are expected to last at least a year and can be quickly confirmed by a medical provider.

You are only eligible for presumptive disability if you are filing an initial SSI application. Presumptive benefits are not available to those applying for Social Security Disability Insurance or those whose cases have been denied.

Applying for Presumptive Disability

A presumptive disability is generally determined at the same time as the initial filing by the Disability Determination Services (DDS).

Disabilities are considered presumptive where the Social Security Administration has strong enough evidence to determine a person will be found eligible before the case has been finalized. You may be awarded presumptive disability benefits for the following conditions:

• Cerebral palsy
• Down syndrome
• HIV/AIDS
• Total blindness
• Total deafness
• Amputation of a leg at the hip
• Diminished mobility due to a stroke
• Terminal illness with a life expectancy of less than 6 months
• Spinal cord injury that requires the use of a walker or bilateral handheld device
• End-stage renal disease that requires chronic dialysis
• Amyotrophic lateral sclerosis also known as "Lou Gehrig's Disease"

Presumptive benefits may also be made on behalf of a child under a year old with a birth weight corresponding the gestational age at the time of birth:

• 37 to 40 weeks--less than 4 pounds, 6 ounces
• 36 weeks--4 pounds, 2 ounces (or less)
• 35 weeks--3 pounds, 12 ounces (or less)=
• 34 weeks--3 pounds, 5 ounces (or less)
• 33 weeks--at least 2 pounds, 6 ounces, but no more than 2 pounds, 15 ounces

How DDS Determines a Presumptive Disability

Upon your filing of the case, the SSA forwards the application to the DDS, where a medical examiner will make a decision based on the information  in your file as well as the results of a subsequent examination.

SSA guidelines set out criteria to identify presumptive disability (PD) and presumptive blindness (PB) cases. Section DI 23535.010 stipulates that "a PD/PB finding may be made at any point in the development process at which the available evidence, although not sufficient for a formal determination, demonstrates a strong likelihood that:

• Disability or blindness will be established when complete evidence is obtained, or the evidence establishes a reasonable basis for presuming the individual is currently disabled, and

• The disabling impairment has lasted or is likely to last at least 12 months."

A presumptive disability is generally determined by a field office investigator. In this determination the condition must be directly observable to the investigator during the claims interview, or the condition must be able to be quickly confirmed by a treating physician. A condition with a high probability of meeting the SSA's guidelines is one where a diagnosis alone indicates a high inability to work for 12 months or the presence of a terminal illness.

In the case of an observable impairment, such as total blindness or a leg amputation, the SSA will make a finding of disability without medical or other evidence. However, findings on conditions such as HIV can only be made upon confirmation by a medical source. The medical source must also provide evidence that the condition meets the severity level established by the SSA.

Presumptive Disability Payments

Upon application for SSI benefits, you may receive presumptive disability payments for up to 6 months before DDS has reached a final determination. Repayment of these benefits is not required, even if you are later found not to meet the criteria.

Those applicants facing extreme hardship may receive an emergency advance where the SSI payment is delayed or never received for other reasons. The maximum emergency advance payment will be the smaller of the following:

• The SSI Federal benefit rate
• The total of the benefits due
• The amount requested for the emergency

A "financial emergency" is a situation where you need immediate food, clothing, shelter or medical care. This advance will later be subtracted from the benefits due.

The SSA may also be able to make immediate payments to those already receiving SSI if their benefits have been delayed and they are facing a financial emergency. The immediate payment caps at $999 and will be subtracted from the benefits due.

If you have applied for SSI benefits, in some circumstances you may be eligible for presumptive disability benefits before a final determination. This is especially the case where your disability is immediately observable. If you are facing extreme hardship, you may request an emergency advance or immediate payment. Talk with an experienced disability attorney to determine your eligibility for social security disability.

Next Steps

6. Disability Benefits for Children
7. Working and Getting Benefits
8. Social Security and Types of Impairments

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