A benefits plan audit should check whether coverage meets workforce needs, tax treatment follows the actual arrangement, unusual claim patterns need investigation, and enrollment records match eligibility rules. Use authorized information and a documented review process; an anomaly alone does not prove fraud.
Look further than the numbers
A solid analysis goes beyond simply identifying the claims usage versus premiums on a plan year-over-year. It looks to understand the duties of the employees, how they are paid, and the purpose and role of offering benefits. A benefits audit also seeks to understand how all of these align for overall job satisfaction. This will be the first indicator of whether the coverage options meet with the expectation of the participants.
Make sure taxes are done properly
Review the actual disability plan’s funding and benefit-payment rules before drawing a tax conclusion. An administrative audit can identify questions for the insurer or tax adviser, but it does not itself determine or guarantee the benefit’s tax treatment.
Keep an eye out for anomalies
Permitted aggregate monitoring can identify anomalies for investigation. An unusual claim pattern is not proof of fraud or misconduct; protect personal information and follow a fair, documented review process.
Catch eligibility errors
Review enrollment and dependant records against actual policy terms. Missed enrollment may trigger late-applicant or evidence requirements, depending on the contract. Any coverage or employer-liability consequence depends on the facts and applicable obligations.
Sources checked October 21, 2026: Privacy Commissioner of Canada: privacy in the workplace; CRA: taxable benefits and allowances.
