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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5 Reasons Social Security Denied Your Disability Claim When Your Doctor Said You Were Disabled

Your Doctor isn’t Necessarily an expert in your ailments

 

If you’re wondering why Social Security denied your disability when your doctor soundly believed that your ailments were disabled…you’re not alone!  That may offer some relief, but now that you’ve been denied (or were denied some time ago), you need to get ready to take another look at your application for social security disability.  

Whether you’re re-applying for disability or filing an appeal with a disability appeal lawyer, you probably want to know what led to the miscommunication or outright disconnect between your doctor and the Social Security Administration.  

To help you with this, we compiled the most common reasons we have noticed that Social Security denied claims against doctors’ opinions – for our social security disability appeal clients in Spokane, WA.  

 

Your Doctor Didn’t know How to Communicate your Disability to Social Security

 

This reason is so common that we should write a whole article for the purpose of talking to doctors about how to communicate with Social Security (and the VA).  The point here is that in almost every case doctors practice medicine, not law.  And while your disability is a medical condition, the benefit – and process of obtaining it – is a very legal process.

Imagine you’re taking your car into a shop because it is misfiring.

You have someone that’s willing to pay for the repairs, but they need to know how it’s misfiring so they give you a form that says, “please describe what’s wrong with the car.”

You show up to the shop and ask the mechanic to fill out the form, and without context, the mechanic looks at the form and examines the car.  On the form the mechanic accurately describes what’s wrong with the car:

“The car’s tires are 40% worn, they need to be rotated. The car needs an oil change.  Windshield wipers need to be replaced.  Rear window is cracked.  Electrical issues – radio doesn’t work.  Transmission needs service.  Car Idles rough.”  

Technically the mechanic answered the questions.  But when you turn the form back in to get the repair $, your benefactor says, “I looked at the mechanics response, the problems with the car are generally superficial and are what you can expect from a 20 year old car, there’s no mention of a misfire, I’m denying your repair”

“Why,” you wonder?  The reason, without context the mechanic had no idea what to focus their report on.  They didn’t necessarily know that you needed to have that one item assessed.  They didn’t know how their report would play into the overall discussion.  Had they known they might have written something to the effect of:

“vehicle has wear and tear in a number of places, however, there is a critical misfiring causing a rough idle and imminent breakdown.”

Both statements are true – but in one the mechanic didn’t have context, and in the second one the mechanic knew the context.

This happens more often than you can believe!  And it’s not only Social Security disability that this occurs in, VA claim denials are famous for this situation. A doctor will describe a constellation of issues, but not focus on the issue that is material to your disability claim.  As such, it can create predictably poor results.

 

Your Doctor (or you) Didn’t Get Your records to Social Security Fast Enough

 

At every step of the Disability Application and Disability Appeal process you are under a ticking clock.  You have timelines you have to hit, and the system will not wait for you.  From the SSA’s (Social Security Administration) perspective, they have tens of thousands of cases to assess and to keep the process moving forward they have to decide or decline by a standard deadline date.

A side note to this reason is that if you missed timelines as a result of a disability of yours, that would be something you’d want to be documented in your reconsideration/appeal.  You might also want to get help in filing those, as you don’t want to have the same problems at that point.  If your doctor missed timelines, that’s going to be something that needs to be addressed too.  A great advocate or local disability lawyer is great for this.

 

Your Doctor Never Even Met You

 

Be honest.. did you show up to your doctor appointment(s)?  Did you know you had doctor appointments?  Were you aware that the SSA might try to get ahold of medical records for the care you received (or sought to receive) on your conditions?  In some cases, applicants have a pattern of not showing up to doctor appointments, even critical doctors appointments set by SSA for the purpose of evaluating your disability.

This is common enough of a problem that we had to cover it.  It also means that you probably need some additional help when you file your new application or appeal.  If you need someone to remind you, provide you transportation, give you motivation and a helping hand – reach out to them and ask for help.   We don’t mind providing reminders either!

 

You Gave Your Doctor Confusing Information

This is in the same arena as the mechanic story above.  If you’re not clear about why you are seeing your doctor, they may not be clear about what you are needing.

Also, confusing statements that appear to contradict your claims occur very often in medical records.  Consider the simple question, “how are you today?”

Do you even think before answering this question?  Most people don’t – it’s become a salutation like, “hi” and “hey.”  You probably get asked some variation of this question at least 4-5 times a day without giving it a second thought.  Here’s the issue…

If you’re filing a claim for Social Security Disability, there is likely some aspect of your health that is not “fine” – “good” – or “grand.”  And you need to be deliberate, honest, and accurate in answering that question and others like it when speaking to a doctor, or a judge.

 

Your Doctor Isn’t Necessarily an Expert in Your Ailments

We use terms like “doctor” or “lawyer” in generic ways.  However, like lawyers, most doctors have specialties.  For instance, a dermatologist has a different specialty than a neurologist. There’s a lot the two will have in common, including a great understanding of medicine.  However, one is far more prepared to give testimony on skin issues whereas another is better for brain issues.

A general practice physician may not be able to provide enough information to declare the limits of your abilities or disabilities if they’re very specific.  Ideally, a specialist can provide a more thorough diagnosis and prognosis.  If your only medical testimony is from a doctor who doesn’t specialize in your challenges, you may be reliant upon the judgment of an adjudicator at the SSA.

 

On That Note…

You probably want to work with someone who knows disability and disability law if you’re in a situation where you have already been denied benefits.  A social security lawyer is different than a family law lawyer, or a tax lawyer, etc.  In this manner, a social security lawyer in Spokane is different than one halfway across the country!  If you’re going to consult a lawyer, make sure they have experience in Social Security Law, and that they are actually located nearby.

 

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Highlighting our Ultimate Disability Guide

Lilac City Law is a different kind of law firm.  We are focused on great service and support for you if you are disabled.  And more recently we started focusing on making sure your family is taken care of.   Whether your needs are disability advice, family wealth planning, or something else, you need information.

This last point is why we are thrilled to be able to write this blog.  It is our way of highlighting important information about all our services.  We get to share with you what we know, and what we feel you should too.  One of the tools we created to help you in navigating disability services is The Ultimate Disability Guide.  What’s that?  The Ultimate Disability Guide is 10 insider tips, shared with you for free, to help you maximize your Social Security Disability or SSI Application.

Our Ultimate Disability Guide covers 10 very important topics that you might surprise you.  And yet it is designed to be quick to understand.  In five minutes, you can begin putting into place your plan for applying for SSI or SSDI.  And if you need help, you can know when is the best time to start looking for disability lawyer representation.

Whether you want to know about the biggest pitfalls to avoid or the best ways to keep your disability claim moving, The Ultimate Disability Guide is a great first step.

We’d like to highlight other great resources in the Lilac City Law blog.  Please send us any thoughts you have in the comments below.  In the meantime, here’s a great video about The Ultimate Disability Guide.


Preview the Ultimate Disability Guide

 


 

Lilac City Law advocates on behalf of the disabled in their claims for Social Security Disability and SSI

Take advantage of our FREE 30-minute consultation! 

 

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Social Security Myth #4


“DISABILITY CLAIMS ARE SOARING!”


If you were to turn on the nightly news you might come away with the impression that disability claims have soared in recent years.  Perhaps everyone is onto the secret?   Social Security Disability is a way to get compensation from the Federal Government for being unable to work because of an injury or illness.. Or is it?

The Role of Social Security Disability

Social Security Disability is a benefit paid into by most workers. If something happens that stops these workers from being able to work, they can apply to receive compensation.  An excellent way to look at this benefit is to consider it similar to an insurance policy on someone’s ability to work.  But, as some news outlets have noted, is it something else as well?  Are disability claims a path to easy street?

We’ve already covered the history of fraud, waste, abuse, and drugs in Social Security Disability, and how we got to ‘today.’ In fact, a common theme in our series on busting Social Security Disability myths has been demonstrating how the facts don’t seem to match up with the prevailing opinions on this topic.

The Typical Spin

The Washington Post opines, Welfare is the New Work,” and expands on this assertion by stating, “disability rolls are growing even as worker safety has hit an all-time high.”  The Richmond Federal Reserve Bank decries federal disability benefits becoming the new “general safety net.”  What is the truth behind these seemingly authoritative opinions?   And what are some reasons to question the conclusions of these authors?

One of the best responses to these opinions has come from the opinion pages of the New York Times.  Three entire paragraphs at the end of the previously linked article break down in detail why “Disability claims are not skyrocketing.”  We will summarize below.

If you look at the disability claims and awards over a historical timeline you can see why someone might claim a skyrocketing increase in claims.  It’s certainly something that requires a nuanced and objective look though.

A Closer Look at the Data

Since 2000, claims have doubled, however, something interesting has happened..award rates have stayed essentially the same among the entirety of workers, about 5%.  If claims are skyrocketing and award rates are staying the same, is there a problem of fraud, waste, or abuse?  Logic would say in this case, that if there were it wouldn’t be on the part of the claimants.  It is Social Security that has deviated sharply down from their historical awards rate in recent years.


Another point that is important to understand in this discussion is that while the number of claims and claims awarded may have gone up in the last 10-15 years, so too has the pool of workers from which claims can be drawn.

Bringing the Spin & the Data Together

So why has the rate of total claims increased in recent years?  Several factors likely play into this.  The first being a poor economy from 2009-2015 or so.  During the Great Recession, the total labor force far out numbered available jobs.  Everyone had a hard time finding employment, especially those on the cusp of possibly rating a disability benefit.  The reality of being terminally un-employed likely brought a number of claimants to the disability application process that would potentially have continued being the working disabled in a more traditional economy.

Other, demographic, factors also influenced the spike in applications.  The average age of the workforce was/is moving higher as baby-boomers hit retirement age.  The number of workers 55-65 years remained unusually high during the great recession as many near retirement workers chose to continue working.  Workers in this age range are at a higher risk of needing to file for disability at some point because of a confluence of age and a  lifetime of work.

Another demographic shift can be found in the rising rate of women seeking disabilities.

Women have taken more work as a whole, and also more physically demanding work over the last four decades.  In reference to this trend, since1985 the age-adjusted disability rate for women has increased at a much faster clip than age-adjusted disability rate for men.

Looking at the Assumptions Again

So, is it fair to say, “Disability Claims are Soaring!” 

Well, the disability claims rate is up, sure.  But when adjusted for age and demographics, they are only slightly up, and certainly not “soaring.”  Moreover, as we’ve shown many times in this blog, the actual award rates, despite the number of claims, has remained flat, and in respect to the number of claims – it has dropped drastically.

This last point is probably the more surprising story that places like the Washington Post missed.  The headline should read:

“The Award Rate for Disability is Plummeting!”

But that story doesn’t sell…

Lilac City Law advocates on behalf of the disabled in their claims for Social Security Disability and SSI

We provide a Free 30-minute Consultation 

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