Assessor Resource

FNSILF506
Manage group life insurance claims

Assessment tool

Version 1.0
Issue Date: May 2024


This unit describes the skills and knowledge required to effectively handle claims made against group life insurance policies.

It applies to those engaged in case management and claims management functions associated with group life insurance policies.

No licensing, legislative or certification requirements apply to this unit at the time of publication.

You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)


Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive claim against group life policy

1.1 Check that correct channels of lodgement have been followed

1.2 Identify relevant policy and type of cover

1.3 Evaluate evidence of member’s identity

2. Review member’s group history and eligibility for cover

2.1 Identify whether cover was granted within policy’s automatic acceptance provisions or if it was individually underwritten

2.2 Establish whether member was at work on commencement date of present insurance

2.3 Verify that premium contributions are current and correct

3. Manage relationships and information collection

3.1 Identify important contact points and intermediaries, and confirm each one’s role and responsibilities

3.2 Identify communication channels most appropriate to each relationship

3.3 Manage information collection and communication strategy

3.4 Refer case to suitably authorised team member where communication problems arise, in accordance with organisational policy and procedures

4. Assess claim

4.1 Review claim submission to establish circumstances of member’s claimed condition

4.2 Identify appropriate policy wordings to establish assessment criteria

4.3 Evaluate evidence to determine whether assessment criteria are met

4.4 Assess whether client complied with all additional disclosure requirements where cover was provided by means other than automatic acceptance

4.5 Decide whether a benefit is payable

4.6 Consider opportunity for rehabilitation with disability claims

5. Pay group life insurance benefits

5.1 Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required

5.2 Identify parties authorised to receive benefits paid by insurer

5.3 Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements

5.4 Evaluate dependent relationships and beneficiary nominations for death benefits, if necessary

5.5 Set in place ongoing assessment processes for salary continuance claims and ensure benefit is appropriately taxed prior to payment

Evidence of the ability to:

manage group life insurance claims by:

checking information for eligibility and collecting required information

assessing group life insurance claims

determining entitlements and paying benefits in accordance with relevant procedures and in line with regulatory requirements.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

describe the different types of group life insurance products

explain key features of group life insurance policy terms and conditions

explain key processes associated with management of group life schemes

outline key features of group life insurance administrative requirements and organisational procedures including:

dispute resolution procedures

insurance claims investigation

describe organisational guidelines relating to automatic acceptance under group life insurance policies

explain the practices associated with disability claims in group life insurance

explain ethical standards and current practice applicable to group life insurance management

outline the principles of procedural fairness

describe key relevant regulatory and legislative requirements

outline the role and function of stakeholders and information sources.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the life insurance field of work and include access to:

office equipment, technology, software and consumables

organisational records, policy and procedures.

Assessors must satisfy NVR/AQTF assessor requirements.

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive claim against group life policy

1.1 Check that correct channels of lodgement have been followed

1.2 Identify relevant policy and type of cover

1.3 Evaluate evidence of member’s identity

2. Review member’s group history and eligibility for cover

2.1 Identify whether cover was granted within policy’s automatic acceptance provisions or if it was individually underwritten

2.2 Establish whether member was at work on commencement date of present insurance

2.3 Verify that premium contributions are current and correct

3. Manage relationships and information collection

3.1 Identify important contact points and intermediaries, and confirm each one’s role and responsibilities

3.2 Identify communication channels most appropriate to each relationship

3.3 Manage information collection and communication strategy

3.4 Refer case to suitably authorised team member where communication problems arise, in accordance with organisational policy and procedures

4. Assess claim

4.1 Review claim submission to establish circumstances of member’s claimed condition

4.2 Identify appropriate policy wordings to establish assessment criteria

4.3 Evaluate evidence to determine whether assessment criteria are met

4.4 Assess whether client complied with all additional disclosure requirements where cover was provided by means other than automatic acceptance

4.5 Decide whether a benefit is payable

4.6 Consider opportunity for rehabilitation with disability claims

5. Pay group life insurance benefits

5.1 Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required

5.2 Identify parties authorised to receive benefits paid by insurer

5.3 Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements

5.4 Evaluate dependent relationships and beneficiary nominations for death benefits, if necessary

5.5 Set in place ongoing assessment processes for salary continuance claims and ensure benefit is appropriately taxed prior to payment

Evidence of the ability to:

manage group life insurance claims by:

checking information for eligibility and collecting required information

assessing group life insurance claims

determining entitlements and paying benefits in accordance with relevant procedures and in line with regulatory requirements.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

describe the different types of group life insurance products

explain key features of group life insurance policy terms and conditions

explain key processes associated with management of group life schemes

outline key features of group life insurance administrative requirements and organisational procedures including:

dispute resolution procedures

insurance claims investigation

describe organisational guidelines relating to automatic acceptance under group life insurance policies

explain the practices associated with disability claims in group life insurance

explain ethical standards and current practice applicable to group life insurance management

outline the principles of procedural fairness

describe key relevant regulatory and legislative requirements

outline the role and function of stakeholders and information sources.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the life insurance field of work and include access to:

office equipment, technology, software and consumables

organisational records, policy and procedures.

Assessors must satisfy NVR/AQTF assessor requirements.
Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Check that correct channels of lodgement have been followed 
Identify relevant policy and type of cover 
Evaluate evidence of member’s identity 
Identify whether cover was granted within policy’s automatic acceptance provisions or if it was individually underwritten 
Establish whether member was at work on commencement date of present insurance 
Verify that premium contributions are current and correct 
Identify important contact points and intermediaries, and confirm each one’s role and responsibilities 
Identify communication channels most appropriate to each relationship 
Manage information collection and communication strategy 
Refer case to suitably authorised team member where communication problems arise, in accordance with organisational policy and procedures 
Review claim submission to establish circumstances of member’s claimed condition 
Identify appropriate policy wordings to establish assessment criteria 
Evaluate evidence to determine whether assessment criteria are met 
Assess whether client complied with all additional disclosure requirements where cover was provided by means other than automatic acceptance 
Decide whether a benefit is payable 
Consider opportunity for rehabilitation with disability claims 
Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required 
Identify parties authorised to receive benefits paid by insurer 
Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements 
Evaluate dependent relationships and beneficiary nominations for death benefits, if necessary 
Set in place ongoing assessment processes for salary continuance claims and ensure benefit is appropriately taxed prior to payment 
Identify whether cover was granted within policy’s automatic acceptance provisions or if it was individually underwritten 
Establish whether member was at work on commencement date of present insurance 
Verify that premium contributions are current and correct 

Forms

Assessment Cover Sheet

FNSILF506 - Manage group life insurance claims
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

FNSILF506 - Manage group life insurance claims

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: