Elements and Performance Criteria
- Receive claim against group life policy
- Review member’s group history and eligibility for cover
- Manage relationships and information collection
- Identify important contact points and intermediaries, and confirm each one’s role and responsibilities
- Identify communication channels most appropriate to each relationship
- Manage information collection and communication strategy
- Refer case to suitably authorised team member where communication problems arise, in accordance with organisational policy and procedures
- Assess claim
- Review claim submission to establish circumstances of member’s claimed condition
- Identify appropriate policy wordings to establish assessment criteria
- Evaluate evidence to determine whether assessment criteria are met
- Assess whether client complied with all additional disclosure requirements where cover was provided by means other than automatic acceptance
- Decide whether a benefit is payable
- Consider opportunity for rehabilitation with disability claims
- Pay group life insurance benefits
- Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required
- Identify parties authorised to receive benefits paid by insurer
- Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements
- Evaluate dependent relationships and beneficiary nominations for death benefits, if necessary
- Set in place ongoing assessment processes for salary continuance claims and ensure benefit is appropriately taxed prior to payment
- Review member’s group history and eligibility for cover