The disability process takes a long time, causing a huge financial and emotional strain on families. With mounting medical and household bills it is no wonder people often come to me who have continued to work in some capacity while waiting for a decision. The first question the Administration will ask when looking at a file is whether or not the individual is engaged in “substantial gainful activity.” If the claimant is engaged in “substantial gainful activity,” the Administration cannot pay benefits. However, the exceptions and definition of “substantial gainful activity” is not as easy as it sounds. For this reason, it is important that this work activity is clearly investigated.
The Social Security Administration’s Understanding of SGA
The Social Security Administration uses the term “substantial gainful activity” to describe work like activity that is done for pay or profit that they consider to be significant, or substantial. Work like activity is really any activity that involves any physical and mental functions. The Administration decides whether or not it is substantial using a dollar amount that is adjusted every year. For the year 2022 this amount is $1,350. If an individual is making more than this amount the agency presumes, they are engaged in substantial gainful activity. In this regard, they are focused on dollars earned, not hours work. So, the fact that one is working only a few hours a week at a high hourly wage can still create a problem.
It is important to have paystubs or other details to document the full extent of the work activity because the dollar amount earned may not actually reflect substantial gainful activity that would otherwise disqualify someone from benefits. For example, an individual who tried to work part-time for a few months earning more than the $1,350 threshold may not have engaged in “substantial gainful activity.” This is because periods that last less than six months can be considered unsuccessful attempts to work if the work ends due to medical conditions or the removal of particular conditions. As such, questions should be asked about the circumstances surrounding the length of work activity, reasons the work ended, and the environment in which the activity was performed. Documentation, such paystubs, personnel documents, or even a letter from the former employer or medical provider may be helpful.
Sheltered or Subsidized Work – Potential Problems w/ SSA & SGA
Similarly, if an individual is working under special conditions, the Administration may consider this as sheltered or subsidized and therefore may not meet the definition of “substantial gainful activity.” Examples of this include working for family or close friend, or program for individuals with disabilities, in an environment that allows for flexible hours, limited job duties, or other special accommodations that are not typical for the role. These conditions can indicate that a subsidy is involved or that the individual is receiving more pay than their work would be worth outside of these circumstances. Documentation surrounding the accommodations or special programs should be sought from the employer or service provider.
Importantly, work activity can also come into play at a different stage of the Administration’s consideration of a claim. In doing their analysis, the Administration must decide what is the most the individual can do on a regular sustained basis. This is called a “residual functional capacity.” This includes examining the activities the individual engages in- such as work activity. For example, if one is performing a job that requires standing on their feet for hours at a time or complex mental activity, even though they can only do it for a limited number of hours, it may indicate they can do less demanding activity for a greater number of hours. For this reason, it is again important to have documentation regarding the work environment that includes any accommodations, flexibility, or other such circumstances to provide an accurate picture of the activity.
The Sooner Work Activity is Fully Analyzed the Easier it is to Discuss How to Address the Issue Head On
People’s situations often change so it is important to consistently seek and share updates on work activity. Questions surrounding the length of the work, the type of work, work schedule, pay rate, any performance issues or accommodations, and the general environment.