How to Survive a DOL Health & Welfare Plan Investigation
Here are the best practices for plans chosen for investigation:
1. Consider getting employee benefits counsel involved early
The DOL investigation process generally includes requests for a long list of documents ranging from plan documents to financial documents. Working with your employee benefits counsel from the beginning may help with the overwhelming process that awaits you with the large quantity of documents and broad, and sometimes vague, requests. Having knowledgeable counsel at hand may help correct or intercept any mistakes as well as be helpful in crafting appropriate responses to the DOL.
2. Confirm the scope of the document request
The DOL may request a year’s worth of claims data, but you may want to ask if the DOL
would be satisfied with a smaller, random sampling of claims data instead. This is
important if the requested information includes protected health information (PHI)
under HIPAA. A plan administrator must limit the disclosure of PHI to the “minimum
necessary,” so in doing so, you may reasonably rely on a representation from the DOL
that the requested information was the minimum necessary for its purpose.
3. Stay organized and document your disclosures
This process could take months or even years, so while you find yourself free of any
requests while the investigator is processing the information, take that time to prepare
a log that records the documents requests, the documents produced and any notes
or comments you may have.
4. Prepare your employees for interviews
You may find it helpful to prepare your employees in case the DOL has to interview
them regarding the investigation. So to lessen the fear and anxiety, prep your
employees on what to expect and general best practices, such as answering questions
truthfully and if they do not know the answers to the DOL’s questions do not guess.
5. Carefully review findings and closing letters
The DOL will issue a “findings letter” toward the end of the investigation that explains
any violations they may have found. If you disagree, it is important to respond. Once
the terms in the letter are agreed upon, the DOL may refer your case to other
agencies for further investigation or to assess penalties. If no violations are found or
if all violations have been corrected, the DOL will then issue you a “closing letter.”
For more information contact firstname.lastname@example.org. The information contained in this post, and any attachments, is not intended and should not be misconstrued as legal advice. You should contact your employment, benefits or ERISA attorney for legal direction.