Yesterday, Eric Berger, Acting Chief, Division of Coverage, Reporting and Disclosure, in the Office of Regulations and Interpretations of the Employee Benefits Security Administration (EBSA) issued an informational letter concerning an ERISA fiduciary’s responsibility to provide information following an adverse benefit determination. EBSA received the following inquiry: “whether ERISA section 503 and the Department of Labor’s implementing claims procedure regulation at 29 CFR 2560.503-1 require the responsible plan fiduciary to provide, upon a claimant’s request, a copy of an audio recording and transcript of a telephone conversation between the claimant and a representative of the plan’s insurer relating to an adverse benefit determination.” The inquiry was made by an attorney who represents claimants in ERISA benefit disputes. An insurance company refused to provide its audio recordings made in the course of deciding one claimant’s long-term disability claim.
EBSA explained that “a recording or transcript of a conversation with a claimant would not be excluded from the requirements under 29 CFR 2560.503-1 to disclose relevant ‘documents, records, and other information’ merely because the plan or claims administrator does not include the recording or transcript in its administrative record; does not treat the recording or transcript as part of the claim activity history through which the insurer develops, tracks and administers the claim; or because the recording or transcript was generated for quality assurance purposes.”
The full letter can be read here.
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