1. What Is Presumptive Disability?

Presumptive disability (PD) allows SSI applicants to receive temporary payments for up to six months while the SSA reviews their application. It is based on the assumption that your medical condition is so severe that approval is highly likely, even though a final determination has not yet been made.

2. Who Qualifies for Presumptive Disability?

Presumptive disability payments are available only for SSI applicants, not SSDI-only applicants. SSA authorizes PD for certain medical conditions that clearly meet disability criteria, including but not limited to:

• Total blindness or deafness
• Amputation of a leg at the hip
• Bed confinement without ability to sit, stand, or move without assistance
• Cerebral palsy, muscular dystrophy, or muscular atrophy with severe limitations
• Down syndrome
• End-stage renal disease requiring chronic dialysis
• Amyotrophic lateral sclerosis (ALS)
• Terminal illness with a life expectancy of six months or less
• Severe intellectual disabilities in individuals age seven or older

Your Disability Determination Services (DDS) office or local SSA field office will evaluate whether your condition qualifies for PD based on available medical evidence or obvious severity at the time of application.

3. How to Apply for Presumptive Disability in New York

When you apply for SSI benefits:

1. Inform your SSA claims representative of your severe medical condition.
2. Provide supporting documentation, such as hospital records, doctor’s statements, or emergency medical assessments.
3. The SSA representative or DDS will make a presumptive disability determination if your condition falls under PD guidelines.

You do not need to file a separate application for PD. It is assessed automatically if your condition appears eligible.

4. How Long Do Presumptive Disability Payments Last?

PD payments:

• Begin shortly after the presumptive disability determination
• Continue for up to six months while SSA processes your full disability application
• End once SSA issues a final decision on your claim, whether approved or denied

5. What Happens If Your Claim Is Ultimately Denied?

If SSA denies your SSI claim after you have received PD payments:

• You do not have to repay the PD payments received during the six-month period unless there was fraud or deliberate misrepresentation
• Payments will stop immediately upon denial, and you can pursue an appeal if you disagree with the decision

6. Difference Between Presumptive Disability and Compassionate Allowances

Presumptive disability provides temporary payments based on severe, obvious conditions. In contrast:

• Compassionate Allowances (CAL) fast-track your application for certain serious conditions (e.g., ALS, pancreatic cancer, advanced cancers), resulting in faster approval rather than temporary payments.
• You can receive both a CAL expedited decision and PD payments if your condition qualifies under both programs.

7. Benefits of Presumptive Disability in New York

Presumptive disability payments provide:

• Immediate financial relief to cover rent, food, and medical needs
• Reduced stress while waiting for a final decision
• Assurance that your severe condition is recognized early in the process

8. Limitations of Presumptive Disability

• Only available for SSI applicants, not SSDI-only applicants
• Not all severe conditions qualify unless they meet SSA PD criteria
• Payments are temporary and will cease if your application is ultimately denied