Voluntary Plan (VP) Claim Eligibility and Requirements
The first step is to verify whether the employee is covered by a VP or State Disability Insurance (SDI). Company records should indicate which coverage the employee has selected.
VP coverage may begin on the date that the employee chooses to be covered by the VP, rather than SDI. The employee may be required, by the VP may require the employee to work for the company for a specific period of time, before coverage becomes effective. In these situations, SDI will cover the employee for that 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.
Determination of 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 Disability Insurance 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 as defined by the California Unemployment Insurance Code.
- To bond with a minor child within one year of the birth, adoption, or placement in connection with foster care.
Note: Beginning January 1, 2021, VPFL will expand by adding a new claim type called Military Assist. VPFL Military Assist benefits will be available to eligible Californians who need time off work to participate in a qualifying event because of the military deployment of their spouse, registered domestic partner, parent, or child to a foreign country.
This applies to VPFL claims with a start date of January 1, 2021, or after.
For more information about the VP program, such as types of security deposits, reporting requirements, and disputed coverage claims, or the VPFL program, visit the Disability Insurance Employer’s Guide to Voluntary Plan Procedures (DE 2040).