Medical Denial Rates for Presumptive Disability Determinations

Date: 
Wednesday, September 23, 2015
Report Number: 
A-07-15-15032
Report Type: 
Audit Report
Office Affiliation: 

A claimant, including a child, applying for Supplemental Security Income (SSI) based on disability or blindness may receive up to 6 months of payments before the final determination of disability or blindness if he/she is found to be presumptively disabled or blind and meets all other eligibility requirements.

A presumptive disability (PD) determination requires that evidence reflect a high degree of probability that the claimant’s impairment or combination of impairments meets the Social Security Administration’s (SSA) definition of disability or blindness.

According to SSA policy, payments based on a PD determination are not considered overpayments if it is later determined the claimant is not disabled or blind.

This report was issued to evaluate medical denial rates for PD determinations by medical impairment and quantify the associated PD payments.