This unit applies to those involved in disability claims management that is prolonged and requiring ongoing supervision within the life insurance sector.
This unit describes the performance outcomes, skills and knowledge required to manage the periodical assessment of ongoing life insurance disability claims.
You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)
Prerequisites
Not applicable.
Employability Skills
This unit contains employability skills.
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.
The evidence guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit
Evidence of the ability to:
apply highly developed analytical and administrative skills
maintain and apply a thorough understanding of claims procedures, policy guidelines and administrative requirements
perform tasks in accordance with relevant procedures and regulatory requirements.
Context of and specific resources for assessment
Assessment must ensure:
competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment
access to and the use of a range of common office equipment, technology, software and consumables
access to records
access to organisational policies and procedures.
Method of assessment
A range of assessment methods should be used to assess practical skills and knowledge. The following examples are appropriate for this unit:
evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency
observing processes and procedures in workplaces
verbal or written questioning on underpinning knowledge and skills
evaluating samples of work
accessing and validating third party reports
setting and reviewing workplace projects and business simulations or scenarios.
Guidance information for assessment
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.
Required skills
communication skills to:
gather and check information
liaise and share information with others
communicate appropriately with people from diverse backgrounds
conduct structured interviews with case management
IT skills to:
use computer applications (word processing, spreadsheet, database, specific purpose computer systems)
access and update records electronically
access web-based information services
numeracy skills to interpret numeric data and relevant statistics and calculate benefit entitlements
organisational skills to efficiently plan and sequence work
problem solving skills to address errors in life insurance documentation
reading skills to:
read and understand relevant procedures
read and understand life insurance policies
read and interpret life insurance claims and supporting documentation
research and analysis skills to:
identify and interpret relevant information
analyse information and data
maintain currency of products and services knowledge
writing skills to:
accurately record information
prepare professional letters and emails.
Required knowledge
the ability to apply and explain as relevant to the management of disability claims:
industry practice and ethical standards in disability claims management
life insurance administrative requirements
life insurance policy payment criteria
life insurance policy terms and conditions
organisational procedures
practice in prudential risk associated with disability claims in insurance
procedure and practice in insurance claims investigation
product information
relevant regulatory requirements.
The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.
Need to undertake a review may include:
a change in the claimant's situation
anomalies detected during the initial claim assessment
indexation scheduling
medical updates
new and relevant information
recovery benchmarks
standard scheduling as per processes and procedures
suspicions of fraud.
Periodical claimant submissions may include:
activities questionnaires
other medical, financial and occupational information
progress claim forms
progress medical reports
rehabilitation reports.
Relevant parties may include:
accounting and finance professionals
advisers
carers
claimant
consultants
legal or other practitioners
medical professionals
reinsurer
trustees
workers compensation.
Additional information may include:
additional claimant forms
functional capacity evaluation
information related to moral risks
interview records
medical reports
meeting notes
official, general and other correspondence
psychological assessment
records of telephone conversations
reports from others such as assessors, insurers, medical providers and others
surveillance
tax documentation
vocational assessment.
Ethical and regulatory requirements may include:
Australian Securities and Investments Commission (ASIC) regulatory guides
corporations legislation
life insurance legislation
privacy legislation
professional Codes of Practice.
Specialists may include:
advisers
Chief Medical Officer
consultants
forensic accountants
investigators
medical professionals
solicitors
surveillance professionals.
Procedures may include:
organisational complaints handling processes
organisational customer service charter
organisational guidelines
organisational policy
organisational privacy and confidentiality guidelines
organisational procedures.
Results of assessments may include:
decision to alter benefit payments
decision to cease benefit payments
decision to continue benefit payments unaltered.
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
1.1 Recognise the need to undertake a review of the insurer's continuing liability against an ongoing disability claim
Maintain contact with the claimant and other relevant parties
Review claim file and apply policy terms, conditions and definitions to establish ongoing assessment criteria
Receive appropriate periodical claimant submissions for comparison with ongoing assessment criteria
Review submissions and identify the need for additional information, where appropriate
Where necessary, plan information collection in accordance with ethical and regulatory requirement
Identify the need to appoint specialists to undertake claims investigations
Engage and brief appointed specialists as required
Monitor specialists’ activities to ensure adherence to timelines, procedures and ethical and regulatory requirements, as appropriate
3.4 Interpret and utilise specialists' reports
Review claimant submissions and specialist reports against ongoing assessment criteria
Evaluate whether the ongoing assessment criteria have been satisfied
Communicate the results of assessments to relevant parties
Calculate benefit entitlements in accordance with policy terms and conditions and procedures
Where necessary, apply and calculate partial disability benefits in accordance with policy terms and conditions and procedures
Where necessary, apply offsets and/or indexation to benefits in accordance with policy terms and conditions
Where necessary, interpret and apply criteria for ceasing income-stream benefit payments, in accordance with policy terms and conditions, procedures and ethical and regulatory requirements
Forms
Assessment Cover Sheet
FNSILF505A - Manage ongoing disability 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
FNSILF505A - Manage ongoing disability 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