Assessor Resource

FNSILF405
Evaluate life insurance claims

Assessment tool

Version 1.0
Issue Date: May 2024


This unit describes the skills and knowledge required to handle the receipt, initial assessment and processing of claims made under risk-based life insurance policies.

It applies to those engaged in claims management functions of life insurance organisations.

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 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.

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 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.

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
Receive claim form and compile necessary documentation 
Review policy details to ensure valid cover is in force 
Establish that claimant is authorised to deal with policy 
Check that documentation is correct and complete 
Determine authority level required to evaluate claim and refer application to appropriate authority as necessary 
Identify and review evidence against payment criteria 
Check and confirm whether terms and conditions of policy have been met 
Identify whether policy exclusions apply 
Seek additional specialist advice as appropriate 
Recognise where information suggests unresolved complexity and seek further information as appropriate 
Determine whether claim can be admitted in accordance with procedures and within authority limits 
Make payment recommendation in accordance with procedures 
Communicate outcomes to all relevant parties in accordance with procedures 
Update records and file documentation in accordance with procedures and regulatory requirements 

Forms

Assessment Cover Sheet

FNSILF405 - Evaluate 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:

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Date:

Assessment Record Sheet

FNSILF405 - Evaluate 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: