Application
This unit describes the skills and knowledge required to manage the periodical assessment of ongoing life insurance disability claims.
It applies to those involved in disability claims management that is prolonged and requiring ongoing supervision within the life insurance sector.
No licensing, legislative or certification requirements apply to this unit at the time of publication.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Manage claim review procedures and determine ongoing assessment criteria | 1.1 Identify need to undertake review of insurer's continuing liability against ongoing disability claim 1.2 Identify appropriate periodical claimant submissions 1.3 Maintain contact with claimant and other relevant parties 1.4 Review claim file and apply policy terms, conditions and definitions to establish ongoing assessment criteria |
2. Review claim | 2.1 Receive appropriate periodical claimant submissions for comparison with ongoing assessment criteria 2.2 Review submissions and identify need for additional information, where appropriate 2.3 Plan information collection in accordance with ethical and regulatory requirements, where necessary |
3. Appoint specialists to assist in additional information collection, as required | 3.1 Identify need to appoint specialists to undertake claims investigations 3.2 Engage and brief appointed specialists as required 3.3 Monitor specialists’ activities to ensure adherence to timelines, procedures and ethical and regulatory requirements, as appropriate 3.4 Interpret and use specialists' reports |
4. Conduct assessment of ongoing claim | 4.1 Review claimant submissions and specialist reports against ongoing assessment criteria 4.2 Evaluate whether ongoing assessment criteria have been satisfied 4.3 Communicate results of assessments to relevant parties |
5. Adjust benefits as required | 5.1 Calculate benefit entitlements in accordance with policy terms and conditions, and procedures 5.2 Apply and calculate partial disability benefits in accordance with policy terms and conditions, and procedures 5.3 Apply offsets and/or indexation to benefits in accordance with policy terms and conditions, where necessary 5.4 Interpret and apply criteria for ceasing income-stream benefit payments, in accordance with policy terms and conditions, procedures and ethical and regulatory requirements, where necessary |
Evidence of Performance
Evidence of the ability to:
manage the periodical assessment of ongoing life insurance disability claims by:
identifying and collecting appropriate information required to assess ongoing disability claims
reviewing and analysing ongoing disability claims to identify changes in a claimant’s situation and recommend changes to benefit payments
adjusting and calculating benefits in accordance with relevant procedures and in line with legislative requirements.
Note: If a specific volume or frequency is not stated, then evidence should be provided at least once.
Evidence of Knowledge
To complete the unit requirements safely and effectively, the individual must:
describe the industry practice and ethical standards in the management of disability claims
outline key features of organisational claims procedures, policy guidelines and administrative requirements relating to disability claims
outline different benefit structures based on the nature of the disability claims
outline key features of life insurance policy terms and conditions, and policy payment criteria
describe the current practice in identifying and managing risks associated with ongoing disability insurance claims
explain the procedure and practice in insurance claims investigation
describe key features of relevant regulatory requirements in the management of ongoing disability claims.
Assessment Conditions
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.
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill | Performance Criteria | Description |
Reading | 1.1, 1.2, 1.4, 2.1, 2.2, 3.1, 3.4, 4.1, 4.2, 5.2-5.4 | Gathers, collates, analyses and interprets simple to complex information from a range of sources to identify and consolidate information relevant to requirements |
Writing | 1.3, 3.2, 3.3, 4.3 | Produces texts in a logical sequence using appropriate language and correct spelling, grammar and terminology Accurately records and completes organisational documents |
Oral Communication | 1.3, 3.2, 3.2, 3.3, 4.3 | Uses appropriate language and correct terminology to convey and share information to diverse audiences Uses active listening, questioning and summarising techniques to gather, confirm and validate information |
Numeracy | 3.2, 3.4, 5.1-5.4 | Uses mathematical functions of varying complexity when performing calculations |
Navigate the world of work | 2.3, 3.3, 5.1-5.4 | Takes full responsibility for adherence to legislative and ethical requirements, explicit and implicit protocols, policies and procedures, and meets expectations associated with own role |
Interact with others | 1.3, 3.2, 3.3, 4.3 | Selects and uses appropriate conventions and protocols when conferring with various stakeholders to gather or share information Adjusts personal communication style in response to the values, beliefs and cultural expectations of others |
Get the work done | 1.1, 1.2, 1.4, 2.2, 2.3, 3.1, 3.3, 4.1, 4.2, 5.1-5.4 | Takes responsibility for planning, sequencing and prioritising tasks and own workload for efficiency and effectiveness Makes decisions based on systematic analysis of all information, taking into account organisational requirements and the regulatory environment Uses the main features and functions of digital tools to complete work tasks |
Sectors
Life insurance