Elements and Performance Criteria
- Determine validation criteria
- Compile necessary documentation
- Requests are classified according to established payment criteria and required evidence is obtained from appropriate parties to confirm that the request complies with the terms and conditions of the policy
- Required forms and documents are completed and distributed in accordance with legislation, organisation policies and procedures
- Advise customer/client of the consequences of processing the settlement
- Assign validity of request
- Review evidence available in support of payment request
- Payment criteria is established to enable compliance to be determined within the terms and conditions of the policy, legislation and regulations
- Available information on the payment request is reviewed against criteria to ensure compliance
- Request is assessed to determine whether terms and conditions of the policy have been met
- Additional opinion on the validity of the request is sought from relevant parties
- Establish liability for payment under the policy
- Liability is identified in accordance with the terms and conditions of the policy
- Evidence is reviewed against the policy to determine the benefits payable
- Benefits payable are accurately calculated and cross-checked according to organisation procedures
- Register is updated to record payment liability and if appropriate, reinsurance recovery is made
- Authorise payment where required and communicate decision
- Decision on liability is promptly advised to all relevant parties
- Level of payment authority is identified from organisation standards and procedures
- Payment details are checked for compliance with legislative and organisation requirements within delegated authority
- Authorisation is confirmed and discharge obtained as appropriate