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DisabilityWhat Conditions Qualify For Presumptive Disability?

August 31, 2022

The Social Security Administration awards presumptive disability to those expected to qualify for Supplemental Security Income (SSI). This means that those who are eligible for presumptive disability will start receiving disability benefits while they are awaiting a decision on their disability claim. In this blog post, the disability team at Watson & Carroll discusses presumptive disability — and how to become eligible for it. 

Watson & Carroll, P.C., L.L.O.’s Social Security Disability team can help you secure benefits needed  to support yourself. Chellsie Weber, our wildly successful and experienced disability attorney, and Abby Reid, our wonderful and thorough disability paralegal, can offer support and advice as it pertains to your disability and the benefits approval process. Remember, you’re more likely to have a successful disability claim with an attorney by your side. Call us today at 402-991-2100. You also can share your story here.

What Conditions Qualify For Presumptive Disability?

Conditions that are severe enough to be expected in an approved disability claim are eligible for presumptive disability payments. Some of those conditions include:

  • 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 or 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 in walking or using a hand or arm;
  • allegation of 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;
  • allegation of Down syndrome;
  • allegation of 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:
  • 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:
    • GA: 37-40 weeks; weight at birth: 2000 grams (4 pounds, 6 ounces) or less;
    • GA: 36 weeks; weight at birth: 1875 grams (4 pounds, 2 ounces) or less;
    • GA: 35 weeks; weight at birth: 1700 grams (3 pounds, 12 ounces) or less;
    • GA: 34 weeks; weight at birth: 1500 grams (3 pounds, 5 ounces) or less; 
    • GA: 33 weeks; weight at birth: at least 1200 grams, but no more than 1325 grams (2 pounds, 15 ounces) or less; or
    • GA: 32 weeks; weight at birth; at least 1,200 grams (2 pounds, 10 ounces), but less than 1,325 grams (2 pounds, 15 ounces);
  • symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS); Form SSA-4814-F5 or SSA-4815-F6 is needed;
  • 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;
  • 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 acceptable medical source;
  • allegation of end-stage renal disease (ESRD) requiring chronic dialysis and the file contains a completed CMS-2728-U3 (End Stage Renal Disease Medical Evidence Report-Medicare Entitlement and/or Patient Registration); or
  • allegation of amyotrophic lateral sclerosis (ALS) known as Lou Gehrig’s disease

What Is Presumptive Disability?

Just because you are approved for presumptive disability benefits it does not mean that you qualify for disability. Presumptive disability is receiving financial assistance using the assumption that your claim will be approved. 

What Happens If I Am Denied Disability Benefits, But Received Presumptive Disability?

If your disability claim is denied after you received presumptive disability benefits, you will not be asked to repay those benefits. But, if you received an overpayment because your income exceeded SGA limits or because of excess resources, you may have been overpaid. If that is the case, you may be required to repay any overpayment. 

Get Help From A Disability Attorney

If you need to get your disability claim underway, enlist the help of the experienced disability attorneys at Watson and Carroll. Chellsie and Abby have helped thousands of disabled workers secure a successful disability claim.  

About Watson & Carroll 

Watson & Carroll, P.C., L.L.O., is not a high-volume law firm that only speaks with clients when it is absolutely necessary. For us, it’s personal. Our team works closely with our clients and their loved ones – not only so that we understand their challenges and concerns, but so we can tailor our approach to address those factors, aggressively pursue results, and secure peace of mind. Whether it is a medical malpractice case or advocating for disability benefits, we work to protect our clients and make sure their rights are upheld. 

Our firm can help. Call 402-991-2100 or email contact@watsoncarroll.com. You also can fill out our confidential contact form.

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