Does the regulation require that a group health plan provide a claimant with copies of the claimant s medical records relating to his or her benefit claim?
Yes. The regulation requires a plan to provide claimants, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to a claimant s claim for benefits. Under the regulation, relevant documents include, among other things, documents or records relied upon in making a benefit determination and documents and records submitted in the course of making the benefit determination. Inasmuch as a claimant s medical records relating to the benefit claim would be relevant documents, access to, and copies of, the claimant s medical records would have to be provided upon the claimant s request. The Department notes, however, that if a plan has reason to believe that a claimant s medical records contain information that should be explained or disclosed by the physician (or other health professional) who developed the information, it would not be inconsistent with the regulation to refer the claimant to the physician (or other health p
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