Unit of Competency Mapping – Information for Teachers/Assessors – Information for Learners

FNSILF506A Mapping and Delivery Guide
Manage group life insurance claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSILF506A - Manage group life insurance claims
Description This unit describes the procedural functions required to effectively handle claims made against group life insurance policies.
Employability Skills This unit contains employability skills.
Learning Outcomes and Application The unit applies to those engaged in case management and claims management functions associated with group life insurance policies.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.
Prerequisites/co-requisites Not applicable.
Competency Field
Development and validation strategy and guide for assessors and learners Student Learning Resources Handouts
Activities 		Slides
PPT 		Assessment 1 Assessment 2 Assessment 3 Assessment 4
Elements of Competency Performance Criteria              
Element: Receive a claim against a group life policy
  • Ensure that correct channels of lodgement have been followed
  • Identify the relevant policy and the type of cover
  • Evaluate evidence of the member’s identity
       
Element: Review the member’s group history and eligibility for cover
  • Identify whether cover was granted within the policy’s automatic acceptance provisions or if it was individually underwritten
  • Establish whether the member was at work on the commencement date of the present insurance
  • Verify that premium contributions are current and correct
       
Element: Manage relationships and information collection
  • Identify important contact points and intermediaries, understanding each one’s role and responsibilities
  • Identify communication channels most appropriate to each relationship
  • Manage an information collection and communication strategy
  • Where communication problems arise, refer the case to a suitably authorised team member
       
Element: Assess the claim
  • Review claim submission to establish the circumstances of the member’s claimed condition
  • Identify the appropriate policy wordings to establish assessment criteria
  • Evaluate evidence to determine whether the assessment criteria are met
  • Where cover was provided by means other than automatic acceptance, assess whether the client complied with all additional disclosure requirements
  • Decide whether a benefit is payable
  • For disability claims, consider the opportunity for rehabilitation
       
Element: Pay group life insurance benefits
  • Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required
  • Identify the parties authorised to receive the benefits paid by the insurer
  • Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements
  • In the case of death benefits, evaluate dependent relationships and beneficiary nominations if necessary
  • In the case of salary continuance claims, set in place ongoing assessment processes and ensure benefit is appropriately taxed prior to payment
       


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 to group life insurance claims assessment

maintain and apply a thorough understanding of all aspects of claims procedures 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 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, assignment, 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:

liaise and share information with others

gather and check information

communicate appropriately with people from diverse backgrounds

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 payments

organisational skills to efficiently plan and sequence work

research and analysis skills to:

maintain currency of products and services knowledge

effectively analyse information and data

identify and interpret relevant information

critically evaluate evidence

reading skills to:

read and understand relevant procedures

read and understand group life insurance policies

read and interpret group life insurance claims and supporting documentation

writing skills to:

accurately record information

prepare professional letters and emails

appropriately reference source documents including policy definitions and submitted evidentiary documents.

Required knowledge

with reference to claims against group life insurance policies, it is necessary to be able to apply and explain:

dispute resolution procedures

life insurance administrative requirements

life insurance policy terms and conditions

management of group life schemes

organisational guidelines relating to automatic acceptance under group life insurance policies

organisational procedures

practice and ethics in group life insurance management

practice in prudential risk associated with disability claims in insurance

principles of procedural fairness

procedure and practice in insurance claims investigation

product information

relevant regulatory requirements

role and function of stakeholders and information sources.

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.

Type of cover may include:

death

total & permanent disablement (TPD)

salary continuance (income protection)

trauma

consumer credit.

At work definitions need to consider:

policy wording

relevant Financial Services Council guidance notes and standards.

Commencement date of the present insurancemay be:

for individuals whose group membership pre-existed the present insurance contract, the date that the policy commenced with the present insurer (i.e. the takeover date)

for individuals who joined the group since the policy has been held with the present insurer, the date that the member took out cover or was granted automatic cover (i.e. the risk commencement date).

Contact points and intermediaries may include:

the member

policy beneficiaries

the member’s employer

superannuation fund trustees

superannuation fund administrators

medical professionals

solicitors

donee of power of attorney

financial adviser

insurance broker

internal divisions of the insurer.

Claimed condition may be:

death

disability.

Assessment criteria may include:

death or survivorship

existence of medical condition

severity of medical condition

financial assessments

medical disclosure assessments.

Evidence may include:

legal certification (e.g. birth certificates, death certificates)

statements from:

the member

the member’s employer

potential beneficiaries

medical attendant

medical records

functional capacity tests

employment records

accounting/taxation records.

Relevant policy conditions may include:

benefit offsets

definitions of partial disability

ancillary benefits, such as

rehabilitation expenses

trauma benefits.

Procedures may include:

organisational complaints handling processes

organisational customer service charter

organisational guidelines

organisational policy

organisational privacy and confidentiality guidelines

organisational procedures.

Regulatory requirements may include:

corporations legislation

life insurance legislation

privacy legislation

superannuation legislation

Australian Securities and Investments Commission (ASIC) regulatory guides

Financial Services Council guidance notes and standards.

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
Ensure that correct channels of lodgement have been followed 
Identify the relevant policy and the type of cover 
Evaluate evidence of the member’s identity 
Identify whether cover was granted within the policy’s automatic acceptance provisions or if it was individually underwritten 
Establish whether the member was at work on the commencement date of the present insurance 
Verify that premium contributions are current and correct 
Identify important contact points and intermediaries, understanding each one’s role and responsibilities 
Identify communication channels most appropriate to each relationship 
Manage an information collection and communication strategy 
Where communication problems arise, refer the case to a suitably authorised team member 
Review claim submission to establish the circumstances of the member’s claimed condition 
Identify the appropriate policy wordings to establish assessment criteria 
Evaluate evidence to determine whether the assessment criteria are met 
Where cover was provided by means other than automatic acceptance, assess whether the client complied with all additional disclosure requirements 
Decide whether a benefit is payable 
For disability claims, consider the opportunity for rehabilitation 
Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required 
Identify the parties authorised to receive the benefits paid by the insurer 
Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements 
In the case of death benefits, evaluate dependent relationships and beneficiary nominations if necessary 
In the case of salary continuance claims, set in place ongoing assessment processes and ensure benefit is appropriately taxed prior to payment 

Forms

Assessment Cover Sheet

FNSILF506A - Manage group 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:

Signature:

Date:

Assessment Record Sheet

FNSILF506A - Manage group 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: