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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Here’s What You Should Do Now That You’ve Filed Your Social Security Disability Claim

Keep Track of Challenges you Have During the Day

You’ve filed for Social Security Disability (or SSI) because you’re unable to work due to an injury or illness.  Great job!  But now what can you do to set yourself up of the best possible chance of success?  

Here are four things to do for anyone who has filed a social security disability claim.


Keep Going to the Doctor

 

It’s incredibly important that you continue to go to all scheduled medical appointments.  If the Social Security Administration determines that you aren’t going to regularly scheduled appointments, while they’re evaluating your disability claim, they may decide against your claim on the basis that IF you did go to the doctor your impairments would be manageable.  And thus, you would be able to seek, obtain, and maintain employment (or other substantially gainful activity).

Going to appointments can be difficult, depending on your conditions.  If you find it difficult to maintain a schedule of medical appointments you should make sure to note this.  Better, even than keeping personal records on this though, is retaining an advocate and making sure they know how difficult it is for you to attend your medical appointments.   They may be able to secure some accommodations and/or they may be able to communicate your challenges effectively to the Social Security Administration.

 

Maintain Good Records of Any and All Hospital Visits

 

In a perfect world, everyone who needs access (and has permission to access) your medical records, would do so prior to making a decision that impacts you.  However, it’s not a perfect world, and one of the most common goofs on disability claim decisions occurs when the adjudicator makes a decision without all the evidence they should have.   Sometimes, a big piece of the pie is tracking down what SSA knew, and what they should have known.

Of course, this isn’t the only reason to keep records of visits.  It’s good practice to do so even if everyone is on the same page because you never know when someone might lose a record, claim to have never received it, or claim that you didn’t go to that medical appointment in the first place.

Keeping good records can be as easy as making sure everything goes into a specific folder or box.  Just don’t throw them away!

 

Keep Track of Challenges you Have During the Day

 

At some point, someone is going to want to know what kind of impact your impairments have on your everyday life.  You can sit there across from a judge, or in front of a doctor and try to recall ALL the ways in which you’re affected, or you can rely on the notes you’ve taken in preparation for that question.

This means, take notes.  Keep a journal.  Take pictures, if that’s easier.  Keep a video diary.  Just document your challenges in some way.

This one action helps eliminate the ambiguous understanding (on the part of the SSA) that Social Security Disability claims denials often spring forth from.

 

Consider Discussing your Claim with an Excellent & Local Social Security Disability Lawyer

 

It’s never really too early to start a discussion with an excellent local Social Security Disability Lawyer.  There are several reasons you’d want to do this.

#1) An experienced Social Security Disability Lawyer can give you advice from having gone through this process >1000 times.  This is probably your first time through the process.  If you can get any direct advice or even support, it’s worth your time to reach out for it!

#2) If your claim is denied (it happens far too often) – you have a short turn-around to file an appeal.  Being able to bring in a disability attorney that has already heard the merits of your claim, provided input on them, and that you have a pre-existing relationship with – will help to reduce your stress at a very difficult point.

#3) It’s free.

 

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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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Is Social Security the Same As Disability? 

Do you Know the Difference Between Social Security & Disability?

 

Social Security, disability, SSI, & SSDI get confused a lot.  Unless you spend your time working with these terms, it is hard to make sense of which program is for which need.  Here’s a short description of Social Security and Disability benefits.  And an infographic to help you in understanding the differences.  


 

Social Security & SSI

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 & SSDI 

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 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.

 

Is Social Security the Same As Disability? 

Side by Side Comparison Between SSI & SSDI

 

The confusing issue here is that the term, “disability,” could refer to both SSI & SSDI.  When in fact the two benefits, SSI & SSDI, are for people with different experiences, backgrounds, &  current challenges.  And, in addition, the two programs have different requirements, awards, goals, and funding streams.

So, from a basic terminology perspective, Social Security is Disability, though it can refer to more than just that.  Likewise, disability can refer to either SSI or SSDI, or even some VA & states’ benefits.

Regardless of how mixed up this conversation has gotten you, feel free to reach out for help in understanding the difference in the programs.  You can also browse the rest of our blog for answers to questions like this and others regarding disability.

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