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Evidence Guide: FNSILF405 - Evaluate life insurance claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSILF405 - Evaluate life insurance claims

What evidence can you provide to prove your understanding of each of the following citeria?

Receive claim form

  1. Receive claim form and compile necessary documentation
  2. Review policy details to ensure valid cover is in force
  3. Establish that claimant is authorised to deal with policy
  4. Check that documentation is correct and complete
  5. Determine authority level required to evaluate claim and refer application to appropriate authority as necessary
Receive claim form and compile necessary documentation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review policy details to ensure valid cover is in force

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Establish that claimant is authorised to deal with policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check that documentation is correct and complete

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine authority level required to evaluate claim and refer application to appropriate authority as necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Evaluate claim information

  1. Identify and review evidence against payment criteria
  2. Check and confirm whether terms and conditions of policy have been met
  3. Identify whether policy exclusions apply
  4. Seek additional specialist advice as appropriate
  5. Recognise where information suggests unresolved complexity and seek further information as appropriate
Identify and review evidence against payment criteria

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check and confirm whether terms and conditions of policy have been met

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify whether policy exclusions apply

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Seek additional specialist advice as appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Recognise where information suggests unresolved complexity and seek further information as appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Establish liability for payment

  1. Determine whether claim can be admitted in accordance with procedures and within authority limits
  2. Make payment recommendation in accordance with procedures
  3. Communicate outcomes to all relevant parties in accordance with procedures
  4. Update records and file documentation in accordance with procedures and regulatory requirements
Determine whether claim can be admitted in accordance with procedures and within authority limits

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Make payment recommendation in accordance with procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate outcomes to all relevant parties in accordance with procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Update records and file documentation in accordance with procedures and regulatory requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

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

1. Receive claim form

1.1 Receive claim form and compile necessary documentation

1.2 Review policy details to ensure valid cover is in force

1.3 Establish that claimant is authorised to deal with policy

1.4 Check that documentation is correct and complete

1.5 Determine authority level required to evaluate claim and refer application to appropriate authority as necessary

2. Evaluate claim information

2.1 Identify and review evidence against payment criteria

2.2 Check and confirm whether terms and conditions of policy have been met

2.3 Identify whether policy exclusions apply

2.4 Seek additional specialist advice as appropriate

2.5 Recognise where information suggests unresolved complexity and seek further information as appropriate

3. Establish liability for payment

3.1 Determine whether claim can be admitted in accordance with procedures and within authority limits

3.2 Make payment recommendation in accordance with procedures

3.3 Communicate outcomes to all relevant parties in accordance with procedures

3.4 Update records and file documentation in accordance with procedures and regulatory requirements

Required Skills and Knowledge

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

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

1. Receive claim form

1.1 Receive claim form and compile necessary documentation

1.2 Review policy details to ensure valid cover is in force

1.3 Establish that claimant is authorised to deal with policy

1.4 Check that documentation is correct and complete

1.5 Determine authority level required to evaluate claim and refer application to appropriate authority as necessary

2. Evaluate claim information

2.1 Identify and review evidence against payment criteria

2.2 Check and confirm whether terms and conditions of policy have been met

2.3 Identify whether policy exclusions apply

2.4 Seek additional specialist advice as appropriate

2.5 Recognise where information suggests unresolved complexity and seek further information as appropriate

3. Establish liability for payment

3.1 Determine whether claim can be admitted in accordance with procedures and within authority limits

3.2 Make payment recommendation in accordance with procedures

3.3 Communicate outcomes to all relevant parties in accordance with procedures

3.4 Update records and file documentation in accordance with procedures and regulatory requirements

Evidence of the ability to:

check and evaluate claims to identify exclusions and possible unresolved complexities

make payment recommendations in accordance with relevant procedures and regulatory requirements

effectively communicate outcomes to relevant parties and update records accurately.

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:

outline life insurance administrative requirements and organisational procedures relating to life insurance claims evaluation and processing

explain life insurance policy payment criteria

outline life insurance policy terms and conditions

explain organisational systems for data entry and filing

describe product information

outline relevant regulatory requirements relating to life insurance claims evaluation.