NOTE: Disability determination services (DDS) legacy systems may only identify one type of priority case when multiple priority flags are present (e.g., Suicide Risk, Terminal Illness (TERI), and PD). The disability examiner must review the certified electronic folder (CEF) or the paper modular disability folder (MDF) to ensure the case is developed and processed appropriately.
PD/PB provisions do not apply in the following situations:
Reconsideration or other administrative appeals; Prerelease cases; orCases where the individual has a history of sustained work while severely impaired (but not at listing level severity), which terminated for reasons that were not obviously impairment related.
NOTE: Prior technical denials for excess income that have been reversed on appeal are eligible for PD/PB, as there was not a previous determination based upon the medical evidence and are initial claims for the DDS.
SSA field offices (FOs) are authorized to make a PD/PB finding for only those categories listed in DI 11055.231.
The DDS is authorized to make a PD/PB finding in any case in which there is a high degree of probability that the case will be allowed on formal determination (see DI 23535.010A.1.).
Sufficient evidence of a worsening in his or her physical or mental condition; orNew impairment(s) not previously assessed, which demonstrate(s) a strong likelihood that the subsequent claim will be allowed.
Prior to the final determination of disability or blindness, an individual may receive up to six months of payments based on a PD/PB finding, if he or she meets all other eligibility requirements.
The claim is disallowed due to ineligibility based on factors other than disability or blindness; orIt is subsequently determined that the claimant had excess resources or that the amount of payment was computed in error. In such cases, only the incorrect payment amount is considered an overpayment.
If a claimant eligible for PD/PB benefits does not receive the payment(s), or it/they were returned, and the claimant subsequently receives a denial decision from the DDS, SSA may re-issue the PD/PB benefit(s) via one-time payment (OTP).
DI 23535.001 - Presumptive Disability/Presumptive Blindness (PD/PB) Eligibility, Authority, and Payment Issues - 11/08/2012
Batch run: 01/15/2019
Rev: 11/08/2012
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