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Follow the links below to find material targeted to the unit's elements, performance criteria, required skills and knowledge

Elements and Performance Criteria

1. Establish validation criteria
   • Identify product type to determine payment criteria and facilitate processing of payment or termination
   • Establish payment criteria to ensure compliance with terms and conditions of contract
2. Compile necessary documentation
   • Classify requests according to established payment criteria and obtain required evidence from appropriate parties to confirm that request complies with terms and conditions of policy
   • Complete and distribute forms and documents in accordance with legislation, and organisational policy and procedures
3. Advise client of the consequences of processing settlement
   • Identify consequences relevant to policy type
   • Communicate information clearly and concisely to ensure client understands consequences
   • Record and file result of communication according to organisational procedures to ensure record is complete
4. Assign validity of request
   • Validate request within limits of delegated authority
   • Communicate decision to proceed with payment or termination of contract to relevant parties
5. Review evidence available in support of payment request
   • Establish payment criteria to enable compliance to be determined within terms and conditions of policy, legislation and regulations
   • Review available information on payment request against criteria to ensure compliance
   • Assess request to determine whether terms and conditions of policy have been met
   • Seek additional opinion from relevant parties on validity of request
6. Establish liability for payment under policy
   • Identify liability in accordance with terms and conditions of policy
   • Review evidence against policy to determine benefits payable
   • Accurately calculate and cross-check benefits payable according to organisational procedures
   • Update register and record payment liability and, if appropriate, initiate reinsurance recovery
7. Facilitate payment where required and communicate decision
   • Promptly advise all relevant parties of decision on liability
   • Identify level of payment authority from organisational standards and procedures
   • Check that payment details are within delegated authority and compliant with legislative and organisational requirements
   • Confirm authorisation and obtain discharge as appropriate

Performance Evidence

Evidence of the ability to:

distinguish between different life insurance product types to classify requests and determine payment types

review entitlements and conditions to be met and complied with, to approve payments within level of authority

calculate benefits payable in accordance with life insurance policy guidelines

review life insurance policies to determine payments or terminations.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

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Knowledge Evidence

To complete the unit requirements safely and effectively, the individual must:

explain key features of organisation policy, procedures, guidelines and authorities relevant to policy payments and terminations

outline the industry sector compliance requirements including the Australian Securities and Investments Commission (ASIC), Australian Prudential Regulation Authority (APRA) and Life Insurance Act

outline the industry sector product terms and conditions

outline relevant medical terminology to assess claims

describe a range of situations that can impact on benefits payable

explain key underwriting principles relevant to life insurance policies.

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