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The Department of Labor recently published an information letter responding to a question from a plan about whether it must disclose an audio recording of a telephone conversation between a claimant and the plan’s insurer relating to an adverse benefit determination. The plan justified denying the request for the audio recording because the plan did not rely on the recording itself to document and administer the claim, instead relying on contemporaneous notes taken about the call. The plan further explained that the audio recording was made solely for “quality assurance purposes.”
Under ERISA regulations, a plan must provide a claimant copies of “all documents, records, and other information relevant to the claimant’s claim for benefits” upon request. Information is “relevant” to a claim if it (1) was relied upon in making the benefit determination; (2) was submitted, considered, or generated in the course of making the benefit determination (regardless of whether it was actually relied on to make the decision); or (3) demonstrates compliance with the administrative processes.
The DOL clarified that “documents, records, or other information” does not solely refer to paper or written materials, but also includes video, audio, or other electronic media. Further, the agency explained that information can be considered relevant even if it was not created, maintained, or relied on for claims administration reasons; under the second factor described above, it is enough that it is created in the course of making the benefit determination. Lastly, the DOL observed that this recording was also relevant under the third factor, since a recording made for “quality assurances” is necessarily made to demonstrate compliance with the administrative process.
While informational letters are not binding on the DOL regarding any particular factual situation, this letter offers beneficiaries a useful suggestion for disputing adverse benefit determinations and offers plans guidance on how to comply with requests.
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