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Evidence Guide: FNSILF505A - Manage ongoing disability claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSILF505A - Manage ongoing disability claims

What evidence can you provide to prove your understanding of each of the following citeria?

Manage claim review procedures and determine ongoing assessment criteria

  1. 1.1 Recognise the need to undertake a review of the insurer's continuing liability against an ongoing disability claim
  2. Identify appropriate periodical claimant submissions
  3. Maintain contact with the claimant and other relevant parties
  4. Review claim file and apply policy terms, conditions and definitions to establish ongoing assessment criteria
1.1 Recognise the need to undertake a review of the insurer's continuing liability against an ongoing disability claim

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify appropriate periodical claimant submissions

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Maintain contact with the claimant and other relevant parties

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review claim file and apply policy terms, conditions and definitions to establish ongoing assessment criteria

Completed
Date:

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Review the claim

  1. Receive appropriate periodical claimant submissions for comparison with ongoing assessment criteria
  2. Review submissions and identify the need for additional information, where appropriate
  3. Where necessary, plan information collection in accordance with ethical and regulatory requirement
Receive appropriate periodical claimant submissions for comparison with ongoing assessment criteria

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review submissions and identify the need for additional information, where appropriate

Completed
Date:

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Where necessary, plan information collection in accordance with ethical and regulatory requirement

Completed
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Appoint specialists to assist in additional information collection, as required

  1. Identify the need to appoint specialists to undertake claims investigations
  2. Engage and brief appointed specialists as required
  3. Monitor specialists’ activities to ensure adherence to timelines, procedures and ethical and regulatory requirements, as appropriate
  4. 3.4 Interpret and utilise specialists' reports
Identify the need to appoint specialists to undertake claims investigations

Completed
Date:

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Engage and brief appointed specialists as required

Completed
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Monitor specialists’ activities to ensure adherence to timelines, procedures and ethical and regulatory requirements, as appropriate

Completed
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3.4 Interpret and utilise specialists' reports

Completed
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Conduct assessment of the ongoing claim

  1. Review claimant submissions and specialist reports against ongoing assessment criteria
  2. Evaluate whether the ongoing assessment criteria have been satisfied
  3. Communicate the results of assessments to relevant parties
Review claimant submissions and specialist reports against ongoing assessment criteria

Completed
Date:

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Evaluate whether the ongoing assessment criteria have been satisfied

Completed
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Communicate the results of assessments to relevant parties

Completed
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Adjust benefits as required

  1. Calculate benefit entitlements in accordance with policy terms and conditions and procedures
  2. Where necessary, apply and calculate partial disability benefits in accordance with policy terms and conditions and procedures
  3. Where necessary, apply offsets and/or indexation to benefits in accordance with policy terms and conditions
  4. 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
Calculate benefit entitlements in accordance with policy terms and conditions and procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Where necessary, apply and calculate partial disability benefits in accordance with policy terms and conditions and procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Where necessary, apply offsets and/or indexation to benefits in accordance with policy terms and conditions

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

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

Required Skills and Knowledge

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.

Range Statement

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.