What are Presumptive Benefits in a Social Security Claim?

In the time that I have had the privilege of serving our clients, I have seen several cases where an individual’s impairments are so severe they are unable to get through even one day. Often times, these impairments do not respond to normal treatment, are incurable or, in some rare cases, fatal.

The problem is that clients often do not have medical coverage and cannot afford to get any help at all with the serious impairments they are facing. In some cases, Social Security has awarded what they call “presumptive benefits” and our client has been able to receive some of the treatment they need even before they are awarded disability benefits.

So, what are presumptive VA benefits? If you are applying for Social Security income benefits because of a disability or blindness, you may be able to obtain presumptive benefits if certain conditions are met while waiting for a formal disability determination. You may qualify if:

You are applying for SSI benefits for the first time;

Your medical condition is such that it presents a strong likelihood that you will be found disabled; and

You meet all non-medical factors of eligibility.

Like SSI, the amount of your presumptive benefits depends on your household income, your assets, etc.

Social Security has a list of impairments that they consider “presumptive disabilities” for which they will award benefits prior to a formal award. The following list is just a few of the types of disabilities that you can obtain presumptive benefits for:

You have suffered an amputation of a leg at the hip;

Allegation of bed confinement and immobility without a wheelchair, walker, or crutches, allegedly 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;

You allege Down syndrome; and
Your 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.

 Again, this list is not exhaustive and Social Security has the ability to award benefits on the basis of other severe impairments if they feel that a favorable decision is likely. In the event that you are not awarded disability benefits, Social Security will not require repayment unless they determine that you have been overpaid based on a non-medical condition, such as your income.

If you have questions about SSI and whether you may qualify for presumptive benefits while your application is pending, or if you have any question about the application process, don’t hesitate to give our office a call: 1-877-526-3457. Let us help you get all the benefits you deserve and the help you need,