What Are Presumptive SSI Disability Benefits?

Supplemental Security Income (SSI) pays monthly benefits to Americans with disabilities and little or no income.

Unfortunately, the qualifying process for SSI is complicated and takes a long time. In Illinois, once you have submitted your application for SSI disability benefits, we see it take six to nine months or more for an initial decision, and there is no time limit that the program must follow.

From start to finish, applicants in Illinois typically wait about two years and four months from the time they apply until they are approved.

However, a limited number of applicants with very severe medical conditions may be able to collect advance payments while awaiting a decision—before their case is formally decided—if their disability has been categorized as a “presumptive condition” by the Social Security Administration (SSA), which runs SSI.

If the SSA later finds you don’t meet disability standards and denies your SSI claim, you won’t have to repay any presumptive disability payments you received unless they find that you were never financially eligible for SSI.

Financial eligibility is a key component of SSI because the program is based on financial need.

To be eligible for SSI, your assets must be less than $2,000 for an individual and less than $3,000 for a married couple. However, not all assets count towards the resource limits.

The Social Security Administration lists 44 resource exclusions. The major exclusions include:

• Your home
• One automobile
• Household goods (furniture, etc.)
• Personal effects (jewelry, artwork, etc.) as long as the SSI claimant is actually using the items. 
• Up to $100,000 in an ABLE account
• Assets in a special needs trust

In addition to asset limitations, there are non-medical requirements plus earned income and unearned income limits that you may not exceed. If you exceed the asset or income limits, Social Security may reduce or even potentially terminate your benefits.

Presumptive disability only applies to SSI cases, not to Social Security Disability Insurance (SSDI) cases. To qualify for immediate SSI benefits, you must have a medical condition that’s severe enough for Social Security to presume you’ll meet the SSA’s definition of disability.

What Conditions Are Considered Presumptive Disabilities?

There are several disabling conditions that can be considered presumptive disabilities and thus qualify you for the immediate payment of SSI benefits. They include these conditions:

• Leg amputation at the hip
• Total deafness or blindness
• Bed confinement or immobility without a wheelchair, walker, or crutches if this immobility occurs due to a long-standing condition rather than a recent surgery or accident
• Down syndrome
• Intellectual disability or neurological impairments resulting in difficulty performing self-care independently
• Cerebral palsy, muscular dystrophy  or muscular atrophy causing substantial difficulty walking, speaking, or coordinating arm or hand movements
• Very low birth weight for children under age one (for children’s SSI)
• A terminal illness with a confirmed life expectancy of six months or less
• End stage renal disease requiring chronic dialysis
• ALS
• HIV or AIDS

These are the most common presumptive disabilities. There are a few other less common severe conditions which will lead the SSA to presume you have a qualifying disability and initiate payments immediately.

However, it is not enough just to say you have one of these impairments. You must prove that your medical condition (or combination of conditions) prevents you from sustaining a job.

The SSA relies on accurate and complete medical records and statements from doctors, clinics, and hospitals to determine how severe a physical or mental condition is. That means that if you want the very best chance of winning presumptive disability benefits, you will need to have the most up-to-date records detailing your medical treatments and a list of all of your health care providers.

Presumptive SSI Disability Versus Compassionate Allowance Conditions

Presumptive disability allows SSI payments to begin immediately if you qualify, but it is not the only way to get expedited Social Security Disability benefits.

You may also have a disability benefits claim approved more quickly if you have a specific condition called a compassionate allowances (CAL) condition.

The compassionate allowances program is for workers who have medical conditions that are so serious that it’s plainly obvious they would qualify for benefits.

Under this program, called “CAL” for short, Social Security fast-tracks disability determinations to certain qualified applicants. The average processing time for Social Security to process a compassionate allowance case is 19 days, and it is possible to receive a decision awarding benefits in as little as 10 days after filing an application.

This program only applies to a narrow list of severe impairments. For example, a person can qualify for a compassionate allowance if they can document they have inoperable cancer which cannot be completely removed or has spread to other parts of their body.

Other conditions which may be eligible for compassionate allowance consideration include ALS, some types of muscular dystrophy and muscular atrophy, early-onset Alzheimer’s disease, certain adult brain disorders, and a number of rare disorders that affect children.

You can find a complete list of Compassionate Allowances Conditions  online.

While compassionate allowances can mean a faster disability determination, beneficiaries for the most part still must wait five months after their disability onset date to begin receiving benefits and 24 months after their onset date before Medicare benefits kick in.

CAL conditions are the same for both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI), while presumptive disability benefits only help SSI applicants receive payments sooner.

You can also improve your chances of winning disability benefits by getting an experienced disability lawyer to help fill out the forms, order medical records, and be an advocate for you.

When you work with a disability attorney to help you with your claim, you have someone who is familiar with disability law. And get a local attorney who is familiar with the procedures at the local Social Security offices and the doctors in your community.

Better yet, get in touch with Nash Disability Law in Chicago. We will help you throughout the entire process. We will help you fill out the forms they send you, identify the best evidence to win your case, represent you at your hearing if you have one, and fight to help you get the benefits you have rightfully earned.

It’s easy to get started: just contact us for a free evaluation of you