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Presumptive Disability (Best Overview: All You Need To Know)

What is presumptive disability?

How do you define presumptive disability?

How does the process work?

We will look at what is presumptive disability, its definition, how the process works through the Social Security Administration, presumptive disability insurance, filing for presumptive disability benefits, examples and more!

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What is presumptive disability 

The presumptive disability concept is used in disability insurance and by the Social Security Administration (SSA) when dealing with disability payments.

Social security presumptive disability 

The Social Security Administration uses the concept of presumptive disability to provide monthly cash benefits (Supplemental Security Income or SSI) to low-income and low-asset individuals with a disability who have applied for SSI payments but the SSA has not yet made a disability determination.

Applying for Supplemental Security Income or SSI can take many months to complete and eventually lead to disability payments.

In some cases, due to the severity of the disability and the applicant’s limited means, the SSA will provide temporary disability payments to cover the SSI application review period.

In essence, a presumptive disability is when a condition is so severe rendering a disabled person immediately eligible to receive disability payments until the SSA reviews the file.

The nature of the disability leads the SSA to presume that the applications SSI application may be approved and as a result, they’ll start making temporary payments to the applicant.

The Social Security presumptive disability payments can be made for up to a period of six months from the moment the applicant files his or her presumptive disability forms.

Insurance presumptive disability 

Now, let’s look at what is a presumptive disability in disability insurance.

A presumptive disability provision is a contractual provision in a disability insurance policy where the insurance company will pay out full disability insurance benefits for disabilities so severe that they can presume total disability.

Under a disability insurance policy, the presumptive disability provision will define what a disability means such as loss of speech, sight in both eyes, and loss of two limbs or hearing.

Depending on the disability, disability insurance benefits could be potentially paid out for life.

Presumptive disability definition

We can define presumptive disability as follows:

A presumptive disability is a type of disability, severe in nature, qualifying a disabled person to receive temporary monthly presumptive disability payments while the Social Security Administration thoroughly reviews the disability application.
Author

In essence, a person will be eligible for SSI payments due to the nature of their impairment where the SSA can “presume” the person to be disabled until the person is confirmed as such.

SSA presumptive disability 

Benefits eligibility 

According to the Social Security Administration, the following medical conditions may result in presumptive disability findings and lead to Supplemental Security Income (SSI):

  • Amputation of a leg at the hip
  • Total deafness; that is, no sound perception in either ear
  • Total blindness; that is, no light perception in either eye
  • Bed confinement or immobility without a wheelchair, walker, or crutches, due to a longstanding condition excluding recent accident and recent surgery
  • Stroke (cerebral vascular accident) more than three months in the past and continued marked difficulty in walking or using a hand or arm
  • 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
  • Down syndrome
  • Intellectual disability or another neurodevelopmental impairment (for example, autism spectrum disorder) with complete inability to independently perform basic self-care activities (such as toileting, eating, dressing, or bathing) made by another person filing on behalf of a claimant who is at least 4 years of age;
  • A child has not attained 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:
  • Symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS);
  • 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
  • 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 acceptable medical source
  • End-stage renal disease (ESRD) requiring chronic dialysis
  • Amyotrophic lateral sclerosis (ALS) known as Lou Gehrig’s disease
#Label

In addition to the above, 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:

  • 37-40 weeks; weight at birth: 2000 grams (4 pounds, 6 ounces) or less
  • 36 weeks; weight at birth: 1875 grams (4 pounds, 2 ounces) or less
  • 35 weeks; weight at birth: 1700 grams (3 pounds, 12 ounces) or less
  • 34 weeks; weight at birth: 1500 grams (3 pounds, 5 ounces) or less
  • 33 weeks; weight at birth: at least 1200 grams, but no more than 1325 grams (2 pounds, 15 ounces) or less
  • 32 weeks; weight at birth; at least 1,200 grams (2 pounds, 10 ounces), but less than 1,325 grams (2 pounds, 15 ounces)

In addition to the above medical conditions, a person must also be of low income and financial means to qualify for presumptive benefit payments.

Presumptive benefits are not available to Social Security Disability Insurance (SSDI) applicants.

Presumptive disability filing

To get presumptive disability benefits, you’ll need to file an application with the SSA for review.

Typically, your SSI presumptive disability application will be filed along with your SSI payment application.

In some cases, the SSA office can make the disability determination by reviewing your application.

In other cases, they’ll need to consult medical records and documents issued from credible sources.

Once you apply for disability benefits, you will start receiving SSI monthly payments until a disability determination is made.

If you are eventually denied, the good news is that you will not have to reimburse the money that was paid.

Presumptive disability determination 

At the time of your initial disability claim filing, the SSA will evaluate your application and make a presumptive disability determination.

Once your presumptive disability application is submitted, the SSA will submit your application to the disability determination services (DDS) to obtain a medical decision on your file. 

Based on the information available in the file, a medical examiner will make a presumptive disability determination.

Benefit amounts

The presumptive disability benefit amounts are determined based on the applicant’s income.

If the applicant earns an income above the eligibility threshold, he or she may be disqualified.

The applicant’s income considered can include:

  • Earned income
  • Unearned income such as unemployment benefits
  • In-kind earnings 
  • Deemed earnings 

Once an applicant is eligible to receive presumptive disability payments, the payments will be made until the SSA finds the applicant eligible for SSI or not.

Eligibility period 

The SSI payments are generally made for a period of up to six months.

The SSA has implemented the expedited payment process as the review of an SSI application may take several months.

A disabled person with low income and assets may not have any other means to live during this period.

As a result, the SSI presumptive benefits can last up to six months giving the SSA enough time to review and process the disability while not causing further harm to the disabled person.

VA presumptive disability 

The U.S. Department of Veterans Affairs or VA also uses the notion of presumptive disability for individuals affected by a disability due to military service.

According to the Veterans Benefits Administration, a presumptive service connection is explained as follows:

VA presumes that certain disabilities were caused by military service. This is because of the unique circumstances of a specific Veteran’s military service. If a presumed condition is diagnosed in a Veteran in a certain group, they can be awarded disability compensation. 
Author

A veteran who is diagnosed with a disability or disease within one year from active duty release may be eligible for presumptive disability compensation.

Presumptive disability insurance

What is presumptive disability insurance?

How do you get presumptive-disability insurance?

Presumptive disability insurance is a type of insurance policy providing coverage to the insured in the event they become disabled.

Coverage 

A total disability coverage pays a premium for a qualifying injury or disease when the person is totally disabled.

In most disability insurance policies, you’ll have some form of presumptive disability provision and associated benefits.

Presumptive disability coverage is when the disability is such that the insurance company can “presume” the disability due to the nature, gravity and severity of the disability. 

If your policy does not have such a provision, you may need to speak with your insurance carrier to see how it can be added to your policy.

Typically, your insurer will need to include a rider to your policy to provide you with this coverage.

Benefits eligibility 

Are you eligible to receive presumptive disability benefits under your policy?

Some insurance policies have a wait-period (also known as an elimination period) where you must wait before you become eligible to receive the benefits in case of disability.

If you become disabled after the elimination period, you will be eligible to receive your policy benefits.

For most disabilities, the wait-period will be for a period of approximately 90 days.

However, when dealing with presumptive disability (considered a permanent one), your policy will most likely not have a wait-period.

As a result, you will be eligible to receive presumptive benefits the moment you file for your disability.

Eligibility period

What’s notable when your presumptive disability clause is triggered in your policy is that you may get the presumptive benefits for the rest of your life.

In other words, this type of benefit may extend even beyond your age of retirement.

Unlike short-term disability benefits lasting a few months or long-term disability benefits potentially lasting until the age of retirement, presumptive disability payouts can be made for so long as you are alive.

Takeaways

Needless to say that anyone who has applied for Social Security Disability (SSD) or Supplemental Security Income (SSI) can expect long application processing delays.

For some people, this waiting period may be financially detrimental.

Fortunately, the Social Security Administration may immediately issue temporary SSI payments to applications with disabilities so severe rendering them eligible to “presumptive disability” benefits. 

Presumptive disabilities are types of disabilities that are very severe where the SSA office, on the basis of the information and file records immediately available, can issue SSI payments until the application is thoroughly reviewed.

We’ve outlined the presumptive disabilities in this article and you can consult the SSA website for more information. 

Editorial Staffhttps://lawyer.zone
Hello Nation! I'm a lawyer and passionate about law. I've practiced law in a boutique law firm, worked in a multi-national organization and as in-house counsel. I've been around the block! On this blog, I provide you with golden nuggets of information about lawyers, attorneys, the law and legal theories. Enjoy!

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