The DOL recently issued Information Letter 06-14-2021 addressing whether the claims procedure regulations under ERISA require plan fiduciaries to provide, upon request, the audio recording and transcript of a telephone conversation between a claimant and a representative of the plan's insurer relating to an adverse benefit determination. The claims regulations under ERISA provide that a document, record, or other information is relevant to a claim for benefits, and therefore must be provided to a claimant upon request, if it (i) was submitted, considered, or generated in the course of making the benefit determination, without regard to whether such document, record, or other information was relied upon in making the benefit determination? or (ii) demonstrates compliance with the administrative processes and safeguards. The DOL concluded that a recording or transcript of a conversation between a claimant and a plan's insurer would not be excluded from the ERISA disclosure requirements on the basis that the recording or transcript (x) is not included in the plan's administrative record, (y) is not treated as part of the claim activity history through which the insurer develops, tracks, and administers the claim, or (z) was generated for quality assurance purposes. Plan sponsors should review their agreements with third party administrators and insurers to ensure they have the ability to produce these audio recordings and transcripts upon a claimant's request.
Information Letter 06-14-2021 is available here.