Voluntary Plan Claim Eligibility and Requirements

Determining Liability

The employer should start their determination by verifying if the employee is covered by a Voluntary Plan (VP) or State Disability Insurance (SDI). Company records should indicate which coverage the employee has selected, either the employer’s VP benefit program or SDI state plan benefit coverage.

VP coverage may begin on the date that the employee chooses to be covered by the VP, rather than SDI. The VP may require the employee to work for the company for a specific period of time, before VP disability coverage becomes effective. In these situations, SDI will cover the employee for that unpaid benefit period.

When the VP chooses to cover all employees, a signed rejection slip must be on file for any employee who chooses to be covered by SDI instead. If automatic coverage is not in effect, an enrollment sheet or other documentation, must confirm each employee’s coverage choice.

Eligibility for VP Disability Insurance

An employee may submit a claim for Voluntary Plan Disability Insurance (VPDI) if they are unable to work due to a non-work-related illness, injury, or pregnancy.

Determination of VPDI liability must be based on the date that the:

  • Disability began.
  • Condition reached a point where the employee was unable to perform their regular or customary work.

This date may be different from the stated claim date, or the first day that the employee is entitled to receive benefits. While accidents tend to establish a clear beginning of the disability, chronic health conditions may require investigation. Personnel records, attendance information, and discussion with the employee’s supervisor may be necessary to determine when the condition became disabling. A medical condition may exist for some time without preventing an employee from doing their regular or customary work. That same condition may then worsen to a degree that constitutes “disability” under the law and entitles the employee to disability benefits.

Eligibility for VP Paid Family Leave

Employees covered by a VP are also covered for Voluntary Plan Family Leave (VPFL). If a VP insurer provides VPDI coverage, then it must also provide Paid Family Leave coverage.

An employee may submit a claim for VPFL benefits for the following reasons:

  • To care for a seriously ill child, parent, parent-in-law, grandparent, grandchild, sibling, spouse, or registered domestic partner.
  • To bond with a minor child entering the family through birth, adoption, or foster care placement.
  • To participate in a qualifying event because of an eligible family member’s (spouse, registered domestic partner, parent, or child) military deployment to a foreign country.

For more information about the VP program, such as types of security deposits, reporting requirements, and disputed coverage claims, or the VPDI and/or VPFL program, visit the Disability Insurance Employer’s Guide to Voluntary Plan Procedures (DE 2040).