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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. 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
   • Identify appropriate periodical claimant submissions
   • Maintain contact with claimant and other relevant parties
   • Review claim file and apply policy terms, conditions and definitions to establish ongoing assessment criteria
2. Review claim
   • Receive appropriate periodical claimant submissions for comparison with ongoing assessment criteria
   • Review submissions and identify need for additional information, where appropriate
   • Plan information collection in accordance with ethical and regulatory requirements, where necessary
3. Appoint specialists to assist in additional information collection, as required
   • Identify 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 use specialists' reports
4. Conduct assessment of ongoing claim
   • Review claimant submissions and specialist reports against ongoing assessment criteria
   • Evaluate whether ongoing assessment criteria have been satisfied
   • Communicate results of assessments to relevant parties
5. Adjust benefits as required
   • Calculate benefit entitlements in accordance with policy terms and conditions, and procedures
   • Apply and calculate partial disability benefits in accordance with policy terms and conditions, and procedures
   • 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, where necessary

Performance Evidence

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.

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Knowledge Evidence

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.

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