I Just Called to Say…I Have a Benefit Claim

by Lyn Domenick

ERISA provides that when an individual makes a claim for benefits under an employer’s plan, they are entitled to copies of all documents, records, and other information relevant to the claimant’s claim for benefits. The Department of Labor (DOL) recently issued an information letter that concludes that an audio recording of a telephone conversation (in this case, between the claimant and a representative of the plan’s insurer) must be among the materials provided to a claimant upon request. The DOL letter was provided in response to a request from a representative of a claimant who was denied an audio recording because the plan administrator considered it to be made only for quality assurance purposes, and not “created, maintained or relied upon for claim administration purposes.”

In relevant part, the regulations pertaining to claims state that a document, record or other information is “relevant” to a claim if the document, record or other information 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. The DOL letter asserts that nothing in the regulations requires that “relevant documents, records or other information” consist only of paper or written materials. Phone call recordings are now clearly among the items that the DOL finds to be relevant to a claim for benefits.

Employers should take note of this guidance and review its procedures related to audio recordings of claimant phone calls, including whether to automatically include audio recordings in the claim file, or to provide them only upon request. Additionally, employers should check their service agreements with TPAs or insurers to review how audio recordings will be maintained in plan and claims records going forward.