On June 14, 2021, the U.S. Department of Labor (DOL) issued an information letter stating that ERISA claims procedures require participants to be given any telephone conversation audio recordings which are deemed relevant to their claim for benefits.
This statement followed the denial of a request from a participant to be given an audio recording copy of a phone conversation held with her plan’s insurer that related to an adverse determination for benefits.
The insurer and plan denied the recording request, stating that recordings are made solely for quality assurance and are not created, relied upon, or maintained for claim administration. Therefore, they could not form part of the administrative record of the plan document.
What does the DOL say?
The DOL’s information letter stated that all employee welfare benefit plans are required by ERISA to give any participant who has had their claim for benefits denied a fair and full review.
Furthermore, the regulations state that the claims procedures of a plan don’t provide for fair and full reviews unless claimants can be supplied with copies of documents and records relevant to their claim upon their request. Information is deemed to be relevant to the claim if the record or document was relied upon when making a benefit determination, was considered, generated, or submitted during the making of the benefit determination, shows compliance with safeguards and administrative processes, or constitutes guidance or statement of policy regarding the benefit or treatment option that was denied.
The DOL also clarified that there was nothing within the regulation to require relevant records, information, or documents to only consist of written or paper materials. Therefore, audio recordings could form part of the claimant’s administrative records.
The DOL’s Summary
The DOL, in summary, concluded that recordings of conversations with participants would not be excluded from any disclosure just because the claims administrator or plan doesn’t include that recording within its own administrative record, doesn’t treat the transcript or recording as a part of the claim’s activity history through which the claim is developed, tracked, and administered or because that transcript or recording was created for quality assurance.
How to Avoid Penalties?
With this latest information from the DOL in mind, it’s important to maintain compliance with ERISA to avoid a costly government penalty. Also, if an employee decides to bring a lawsuit over his or her denied benefits, this can be time-consuming and expensive.
As the law often changes and clarifications are made, it can be difficult to always stay compliant. This is where ERISAPros can help with our Wrap Plan Document. Our document and compliance solutions allow employers to save money through the adoption of a single wrap plan that covers all their benefit plans and allows only a single Form 5500 and Summary Plan Description (SPD) to be filed and distributed. Employers who have a Wrap Plan Document from ERISAPros can rest easy knowing they don’t have to worry about the stiff penalties and administrative headaches associated with inadvertently falling afoul of the regulations. Call us today to find out how ERISAPros can create a Wrap Plan Document for you.