Roanoke County

Claims

To receive LODA benefits, you must file a claim with the Virginia Retirement System (VRS) using the Claim for Line of Duty Act (LODA) Benefits. You will work with VRS, employers and others at each step in the process. Claims for LODA benefits must be filed within five years of an eligible employee’s or volunteer’s qualifying death or disability.

Each claim is subject to an initial review by VRS to confirm eligibility and followed by a medical board review. In some cases, the Virginia State Police will investigate LODA claims.

Claims Process

At various stages in the LODA claims process – from the initial filing of a claim to final approval – you, your employer, the Virginia Retirement System (VRS) and the Department of Human Resource Management (DHRM) bear responsibilities for providing key information related to your case.

Work with your employer to file a claim.

The employer will complete a section of the form and has seven days (from receipt) to submit the application to VRS, including additional documentation. VRS will send letters to you and the employer acknowledging receipt of your claim.

Learn more about filing claims in the Participant Guideopens pdf.

Required Forms

Note: VRS-covered members who already have filed an Application for Disability Retirement (VRS-6) do not need to submit the LODA Physician’s Report (LODA-04) and Employer Information (LODA-05) forms.

VRS reviews your claim.

VRS has hired an independent medical board to review information submitted with LODA claims and to recommend whether to approve or deny an application. The VRS Medical Board is comprised of physicians and other health professionals.

The Virginia State Police may assist VRS in its review by investigating LODA claims to gather and verify information about the incident and collect documentation concerning the claim.

Approved claims: If the LODA death benefit claim is approved, VRS will mail the letter of approval to the eligible family members. Virginia Department of Human Resources will provide approved claimants with an application for health plan enrollment.

LODA provides for reimbursement of health coverage premiums from the time of a qualifying death or disability until LODA benefits are processed. When notified of your approval for LODA benefits, VRS also will send you the Application for Retroactive Health Insurance Premium Reimbursement form. To qualify for reimbursement, the cost of the premiums must not have been subsidized by the employer in any amount.

Denied claims: VRS will send you a letter with the reason for denial and include appeal information. VRS also will notify your employer.

Learn more about claim reviews in the Participant Guideopens pdf

Claim denials may be appealed.

Claims may be denied based on ineligibility under LODA, incomplete information provided in the claim, or medical board or Virginia State Police review. The letter you receive from VRS will provide the reason your claim was denied and appeal instructions, including the number of days you have to appeal the decision.

Learn more about appealing claims in the Participant Guideopens pdf.

Carefully review the claim application instructions. Ensure all required information is completed on the form and required supporting information is included with your claim. Insufficient or missing information will delay the processing of the claim and may lead to your claim being denied.

.btn-default.btn-process, .callout .btn-default { color: #000; display: none; } .card.hovercard img { width: 100%; display: none; } .noJava-message { background-color: #fcf8e3; color: #8a6d3b; padding: 10px; border-radius: 3px; border: 1px solid #faebcc; }