What to Do When Your California Voluntary Plan Disability Benefits are Denied

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Most California workers pay into State Disability Insurance (SDI). However, some workers have Voluntary Plan (VP) instead of SDI. Voluntary Plan is an alternative form of SDI. It is used by large employers like Google and Apple. If you become disabled while you work at an employer with a Voluntary Plan, you may get short term disability benefits through the Voluntary Plan, sometimes called Voluntary Disability Insurance (VDI).

Under California law, a VP must give the same or better rights to workers than SDI. In other words, the rules and terms of the VP cannot be less favorable than those of SDI. For example, SDI can last up to 52 weeks. Therefore, the VP must also provide up to 52 weeks (or more) of benefits. In practice, however, the VP administrators often give the claimants less rights than SDI.

In one of my recent VP cases, the claimant became disabled on Sept 1, 2024, but did not see his doctor until the first available appointment on Sept 24, 2024. The claimant had been treated by that doctor for many years. The VP administrator denied the claim because the claimant did not have a “doctor’s visit” within the first eight days of disability. This was a misinterpretation of the SDI rule at section 2706-1(a), Title 22 of California Code of Regulations, of which the relevant part of the code states:

Any person or his or her authorized representative may file a first claim for disability benefits who has been continuously unemployed and disabled for a period of eight consecutive days, provided that a claimant has been examined by or under the care of a physician or practitioner during some portion of such period.

(Emphasis mine)

The SDI rule does not require the claimant to have a “doctor’s visit” within the first eight days of disability. The SDI rule requires the claimant to be either examined or under the care of a physician during those 8 days. Since the VP rule is stricter than the corresponding SDI rule, the VP rule is invalid under California law. We wrote a letter to the VP administrator pointing out their mistaken interpretation of the California code, and the administrator reversed the denial and paid the disability benefits to my client.

In another VP case, the VP administrator denied a claim because it was not filed within 30 days of the onset of disability. Since SDI allows claimants to file within 49 days of the onset, the administrator was wrong to deny the claim. They eventually reversed the denial.

Steps To Take When Your Voluntary Plan Disability Benefits are Denied

First, read the denial notice carefully and figure out why the claim is denied. People often misunderstand the reasons for the denials. For example, sometimes people believe they are denied because their illnesses were not severe, but actually, they were denied because of something like their doctor’s failure to record the correct information on the disability form. Some examples of this might be the doctor reporting the wrong onset date of disability, or the incorrect first date of treatment, or the employee’s expected return to work date, etc.)

Second, once you know the reason for the denial, find out the corresponding rule for SDI. Is the VP administrator applying a stricter rule than the corresponding SDI rule? If yes, the denial is probably wrong. 

Third, speak to the VP administrator about their misapplication of the California rules. They may reverse their own decision, but always be ready to appeal your case. The VP administrator may not reverse the decision, and you don’t want to miss the appeal deadline. You can file your appeal with the Employment Development Department (EDD), the same agency that runs SDI.

Even if the VP administrator did not misinterpret the California rules, they may still be wrong and you may still have a valid appeal. Speak to a disability benefit attorney about it, and when in doubt, appeal.