If you or your child has one of several medical conditions, your local Social Security office or the Disability Determining Services will determine that you are eligible for SSI payments to begin either immediately or very quickly because it is presumed that you are or your child is disabled.
Presumptive disability does not apply to Social Security Disability benefits. See our article “After I File a Disability Claim, How Long Does It Take the Social Security Office to Make a Determination?” for information about criteria for expedited Social Security benefits.
Presumptive SSI disability benefits will be paid for a maximum of six months while a full medical review of your claim is being conducted. The amount paid will depend on the amount of countable income you have in each month of presumptive disability payments. For information about countable income, see our articles “When I Complete My SSI Application Form, It Asks Me to Declare My Income. Does All My Income Affect My SSI?” and “Why Do I Have to Give Information about My Family’s Income and Assets When I Apply for SSI Benefits?”
If you or your child is denied benefits because it is determined that you or your child is not disabled, you will not be asked to repay the funds paid to you. If you were overpaid for another reason such as unreported income, you would be responsible for repaying that overpayment.
The following conditions allow payment of SSI presumptive disability or blindness payments:
- 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 walking or using a hand or arm.
- Allegation of cerebral palsy, muscular dystrophy, or muscular atrophy and marked difficulty walking (such as requiring an assistive device), speaking, or coordinating use 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.
- A birth certificate or other medical evidence showing that a child who has not reached his or her first birthday had a birth weight below 2 pounds, 10 ounces at birth, regardless of gestational age at birth.
- Available medical evidence of a child who has not attained his or her first birthday shows a low birth weight at the corresponding a gestational age at birth.
33 weeks; weight at birth: at least,, but no more than 2 pounds, 15 ounces;
34 weeks; weight at birth: 3 pounds, 5 ounces or less;
35 weeks; weight at birth: 3 pounds, 12 ounces or less;;
36 weeks; weight at birth; 4 pounds, 2 ounces or less;
37-40 weeks; weight at birth: less than 4 pounds, 6 ounces.
- Symptomatic human immunodeficiency virus infection, known as HIV, or acquired immunodeficiency syndrome, known as AIDS. For presumptive disability, you will need to have your physician complete Form SSA-4814 if you are an adult or SSA-4815 if you are filing for a child.
- 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 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 requiring chronic dialysis. You will need to submit a completed CMS–2728 form “End Stage Renal Disease Medical Evidence Report–Medicare Entitlement and/or Patient Registration;”
- Allegation of amyotrophic lateral sclerosis, often called ALS or Lou Gehrig’s Disease.
If you or your child has any of these conditions, disability and SSI will be approved presumptively and payment will be started.