Substantially Gainful Activity Explained, and Examples

Substantially Gainful Activity for SSI SSDI

Social Security Disability benefits are predicated on whether or not you can perform Substantially Gainful Activity (SGA), so it makes sense that a disability blog should define that a bit better and provide examples.  

 

Defining Substantially Gainful Activity (SGA) 

Social Security bases their definition of disability on your ability to work (or perform tasks like working) that do or could, earn you more than the current monthly income threshold.  If you make more than that threshold, you are not seen as warranting disability compensation benefits by the Social Security Administration.  You can appeal these determinations.

 

Gainful Activity 

This can be a bit of a tricky calculation, but here are the basics.  If a wage or earnings are not made, the work is not gainful.  However, if you do perform some form of activity for pay, then it is considered gainful as long as the expense of doing so is less than the income you receive.

Social Security Administration Definition of Gainful Activity 

Work performed for pay or profit; or

Work of a nature generally performed for pay or profit; or

Work intended for profit, whether or not a profit is realized

This is important to know because benefits like SSI are tied to SGA.  If you net too much income per month, you may not qualify for SSI benefits, due to your ability to perform SGA.  This is a common reason for Social Security Disability Denials.

 

Substantial but Not Gainful

It is possible you can perform activities that you might do on a regular basis that would require significant physical or mental abilities.  These activities could be the basis for employment, as such the value of the activities could potentially factor into the income calculations of an SSI claim.

 

Example: HR Professional in Spokane

Jane has been an HR professional in Spokane for 20 years.  Over the last 5 years, she’s had to reduce her hours significantly due to complications from diabetes.  She’s now working about 10 hours per week, earning $15 per hour.

Wage Earnings: $150/week ($600/month)

Jane is unable to work more than this due to increasingly impactful complications.  Her employer has made accommodations, including flexible scheduling, work from home, and other allowances.  But due to her disabling condition(s) Jane is unable to increase her gainful activity.

The value of Jane’s gainful activity is $600 / month (minus certain expenses).  Jane would be eligible for disability due to her inability to meet the SGA monthly income threshold, and her inability to perform supplementary and/or alternatives tasks that would otherwise be substantially gainful.

 

Example: Car Sales Professional in Spokane Valley

Alan is a car salesman in Spokane Valley.  He had a heart attack 3 years ago and has only been able to work part-time since then.  He makes about $500 per month working part-time sales.

Wage Earnings: $500/month

When Alan is not working at the car lot, he helps his sister with her home business by answering phones, filing papers, and responding to emails.  He does this about 2 hours a day or so.

Non Earning Activity (2 hrs/day) = 40hrs/month

Although the activity Alan performs for his sister’s business is not paid, it is substantial activity that could potentially fetch a wage in the economy.

The Social Security Administration determined that in addition to the $500/month Alan was earning at the car lot, the value of his work demonstrated substantially gainful activity and thus he was not entitled to the disability benefits he sought.

Alan should discuss this determination with a Social Security Lawyer in Spokane and potential file an appeal.

 

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If Your SSI Was Denied Will Your SSDI be Denied Too?

SSI Vs SSDI if SSI was Denied

SSI and SSDI are both programs for supporting people who have disabilities that stop them from being able to work. 

However, the program that works best for you will be dependent upon a couple of different factors. 

If we break this down a little further, we can fully address the main question: 

If your SSI was denied will your SSDI be denied too?  

SSI Vs SSDI

We broke down the differences between SSI & SSDI in a previous article titled: Is Social Security the Same As Disability?

Here’s an excerpt that will help frame the answer to the question above:

Supplemental Security Income (SSI) is a program through the Social Security Administration (SSA) designed to provide a monetary benefit to Americans who are older than 65, blind, or disabled.  SSI is needs-based, meaning that the beneficiaries must be below a certain asset threshold.  And they must have limited income, and/or income earning potential.

SSI is often paired with Medicaid, administered by individual states.  Recipients of SSI often also qualify for food stamps.

Social Security Disability Insurance (SSDI) is similar to an insurance program you might buy into for the contingency that you might become unable to work due to an injury in the future.  In actual fact, it is essentially just that – an insurance program.  Though, it’s not really opt-in if you’re employed; you pay (or paid) into it through payroll taxes.

The payout for SSDI is typically higher than SSI, but it requires that you have a relatively recent work history, to base the amount of your benefits on.  Beneficiaries become eligible for Medicare after two years of being on SSDI.

Infographic: SSI Vs SSDI

Are You Eligible for SSDI?

The first question to help you understand whether or not your claim for SSDI is likely to be denied (assuming your application for SSI was denied) is, do you meet the eligibility requirements for SSDI?

We’re keeping it simple here, but here are the two basic qualification criteria for SSDI

Have a work history of jobs covered by Social Security (another great article on who is and is not included here as well)

Have a medical condition acknowledged by Social Security as a disability

Notice that none of these requirements are related to your previous income?  Alternatively, to your assets?  Unlike SSI, SSDI is not a means-tested/related benefit.

If you were denied SSI due to an asset issue (too much $ or property), you would not be denied from SSDI for that same reason.  However, you might be denied for other reasons, including not meeting the criteria listed above.

Is There a Reason Why Your SSI Was Denied?

In addition to assessing your basic eligibility criteria for SSDI, you might want to determine why you were denied for SSI in the first place.

If it is a lack of basic eligibility, that is pretty straightforward.  We covered eligibility for SSDI above, and because there are a lot of “if/else” caveats to SSI eligibility, we will link to the full eligibility criteria for SSI, here, so that you can review them in-depth.

If your reason for being denied SSI is not due to eligibility deficiencies, then we should look elsewhere to assess why you were denied.  Moreover, why you would be looking to SSDI as an alternative to SSI.

It is possible, for instance, that you should have filed for SSDI the whole time and only filed for SSI because of a knowledge gap of the differences between the two programs.  This gaffe does happen, and it is easy to see why! SSI & SSDI have a similar name, similar function, and provide support for similar groups of people.

However, bear in mind you may have been completely correct in filing for SSI in the first place, and were denied for other reasons.

Should you Re-File for SSI? 

Having a better understanding of why your SSI was denied will help you to get perspective on whether you should seek SSDI, re-file for SSI, or file an appeal on SSI.

In reality, if continuing to pursue SSI is the right decision for you, you should file an appeal vs. refile.  Unless, of course, you have missed your deadline to file your appeal.

Lastly, while you are assessing your options, you should re-consider all potential benefits you might be able to obtain.

Consulting with a local advocate or attorney is a good step in the right direction.  They will be able to advise you on likely reasons why your original SSI claim was denied, what to do now, and other benefits you may find value in seeking.

How to Choose a Social Security Lawyer

How to Pick a Social Security Lawyer

If you’re in the process of applying for Social Security Disability, or if you’ve already applied and are looking to get a bit more help for an appeal – then the following criteria can help you select the best Social Security lawyer for your case.  

Work With Someone That Makes You Comfortable

The first and maybe most important factor in picking a Social Security Lawyer is overcoming the initial fear factor of reaching out for help.

Let’s be honest, most of the time the first person called is the attorney with the commercial on TV or that website that shows up on the top of Google.  However, as we’ve learned in our firm, a lot of clients gravitate towards representatives that can understand them.  For instance, if you’re seeking to claim PTSD and already apprehensive about reaching out for help, getting someone on the other end of the phone that has an imposing persona very easily could lead to trouble at many points during the claims process.

A Social Security claim or appeal can be complex, it’s very important that you have confidence in your lawyer, but also that you have the impression that you can communicate with them or their office without worrying about how they might view, judge, or aggravate your impairments.

Be careful to choose a lawyer that doesn’t intimidate you in any way.  You’re going through a tough enough process, keep the barriers to your relationship low, and the trust factor high.

How Much Can You Trust Your Disability Attorney?

The things that generate trust vary widely from one person to the next.  However, there are some basic principals that everyone can rely upon when determining if a given Social Security Lawyer is trustworthy.

Ratings & Reviews

Avvo is a great tool for getting straight-forward ratings and reviews of attorneys.  They have a proprietary ratings system and review system that they claim can’t be gamed.  This is very important, and as you can imagine, review and rating stuffing is common and sadly something that erodes confidence in any rating system.  

In addition to Avvo, Google provides a great system for getting reviews of all sorts of lawyers, including disability lawyers.  If you do a search for disability lawyers near you, or for a specific disability lawyer, you will likely see their Google ratings & reviews pop-up next to their listing.  This is a bit more crowd-sourced than Avvo but is a very valuable tool for both selecting a great disability lawyer, and for reviewing them after you’ve worked with them.  Here is an example of ratings and reviews using Google.

Videos

The internet has been around for a while at this point.  As have digital cameras.  The old saying “a picture is worth a thousand words” is just as true today as when it was coined.  In fact, it might even be truer today than ever.  Consider how a picture helps to establish rapport and trust.

You want a disability lawyer that shows you they know what they’re doing.   They are respectable and respected.  And they will be the best champion for your fight, right?  That’s why every attorney, doctor, consultant, author, etc. has a professional picture of themselves somewhere on their website.  But one of the biggest problems is that pictures can (and are) staged.  However, an authentic video is much harder to fake.

Check out the prospective disability attorney’s Facebook and YouTube channels.  First off, do they even have social media at all?  And on those channels, see if they have videos sharing insights, talking to clients, answering questions.  Sometimes these videos will also be on the lawyer’s website or blog as well.

Watching how the lawyer answers questions will give you a lot more than a picture – at least in helping you to build an idea of who they are and how they communicate.

Ask yourself, “is this someone that can communicate my challenges, is this someone I can communicate my challenges to?”

A short video will usually give you an enormous amount of insight into answering those questions.

Blogs

When seeking insight into a disability lawyer’s persona don’t forget to look at the extras on their website.  Blogs, especially, will tell you how committed they are to sharing information with you.

Is their website a bunch of short questions with hooks at the end of each one?  If so, how does that help you, as a potential client, to understand the processes involved in your claim?  Alternatively, do they have a wealth of information about all aspects of your claim, and questions you hadn’t even thought to ask yet in their blog or newsletter?  Six months from now when you’re wondering what your chances are of succeeding, this might be exactly what you need to keep your spirits high.

A blog may not be what you initially thought of when thinking, “how do I pick a Social Security lawyer,” but now that you’re in the search, take a look around and see who’s keeping their clients and future clients informed and who’s just fishing for the next client.

Capacity: Can Your Disability Attorney Make Time For You? 

Would you rather be a big fish in a small pond or a small fish in a big pond?  Think about this for a moment.. this is something that can help you to identify what type of disability lawyer or disability law firm to work with.

One might argue that a huge firm with many thousands of cases is big because they are good.  They certainly have the advertising budget to portray that success. However, the continued existence of many hundreds, or even thousands, of community disability lawyers fly in the face of that sentiment.  At the end of the day, you can deal with one bureaucracy (huge firm) to fight another one (SSA), or you can work with a personalized firm who remembers your name when you call.

It comes back to that question, big fish or small fish?  The small fish sometimes has a hard time being heard.

Is Your Disability Firm Responsive to Your Questions?

In response to the big fish/small fish question, you do, at some, point want to consider how responsive your disability lawyer will be to your unique needs.  Hint, they have to recognize that you indeed do have unique needs in the first place.

Like a Dr. Office, it’s probably not reasonable that the attorney can stop immediately talking to one patient (client) to take a call from another.  That’s why staff and client liaisons exist.  However, it is reasonable and should be necessary, to have an attorney that is available to talk, within a reasonable amount of time.

Can you call the firm and get a response from the attorney in a reasonable amount of time?  Can you schedule a time to actually come into the firm and talk to the lawyer that’s representing you?  Not everyone can…

Being able to communicate, even briefly, is something you’re going to want to do as a disability hearing approaches.

You Should Seek Out Someone That Will Help You During The Challenge of Your Disability Claim

During the course of your claim (or appeal), there will be curveballs thrown your way.  Whether those curveballs originate from within the claim itself or they happen to come from directions yet unseen, you want someone on your side that “knows someone.”

One of the best things about working with an experienced and established disability lawyer is that you’re also working with their network.  A good lawyer doesn’t gain experience by being an island unto themselves.  They often work with partners in similar fiends to increase the effectiveness of their own services.

To you, the client or future client, this means – that when that curveball arrives you can ask for referrals, assistance, resource information, and things like this.  Or rather, you should be able to.  Unfortunately, this also relies on the idea that your disability lawyer is local, which as we know from previous discussions, is just not always the case.