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Evidence Guide: FNSILF506A - Manage group life insurance 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

 

FNSILF506A - Manage group life insurance claims

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

Receive a claim against a group life policy

  1. Ensure that correct channels of lodgement have been followed
  2. Identify the relevant policy and the type of cover
  3. Evaluate evidence of the member’s identity
Ensure that correct channels of lodgement have been followed

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify the relevant policy and the type of cover

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Evaluate evidence of the member’s identity

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Review the member’s group history and eligibility for cover

  1. Identify whether cover was granted within the policy’s automatic acceptance provisions or if it was individually underwritten
  2. Establish whether the member was at work on the commencement date of the present insurance
  3. Verify that premium contributions are current and correct
Identify whether cover was granted within the policy’s automatic acceptance provisions or if it was individually underwritten

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Establish whether the member was at work on the commencement date of the present insurance

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Verify that premium contributions are current and correct

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Manage relationships and information collection

  1. Identify important contact points and intermediaries, understanding each one’s role and responsibilities
  2. Identify communication channels most appropriate to each relationship
  3. Manage an information collection and communication strategy
  4. Where communication problems arise, refer the case to a suitably authorised team member
Identify important contact points and intermediaries, understanding each one’s role and responsibilities

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify communication channels most appropriate to each relationship

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Manage an information collection and communication strategy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Where communication problems arise, refer the case to a suitably authorised team member

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assess the claim

  1. Review claim submission to establish the circumstances of the member’s claimed condition
  2. Identify the appropriate policy wordings to establish assessment criteria
  3. Evaluate evidence to determine whether the assessment criteria are met
  4. Where cover was provided by means other than automatic acceptance, assess whether the client complied with all additional disclosure requirements
  5. Decide whether a benefit is payable
  6. For disability claims, consider the opportunity for rehabilitation
Review claim submission to establish the circumstances of the member’s claimed condition

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify the appropriate policy wordings to establish assessment criteria

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Evaluate evidence to determine whether the assessment criteria are met

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Where cover was provided by means other than automatic acceptance, assess whether the client complied with all additional disclosure requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Decide whether a benefit is payable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

For disability claims, consider the opportunity for rehabilitation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Pay group life insurance benefits

  1. Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required
  2. Identify the parties authorised to receive the benefits paid by the insurer
  3. Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements
  4. In the case of death benefits, evaluate dependent relationships and beneficiary nominations if necessary
  5. In the case of salary continuance claims, set in place ongoing assessment processes and ensure benefit is appropriately taxed prior to payment
Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify the parties authorised to receive the benefits paid by the insurer

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

In the case of death benefits, evaluate dependent relationships and beneficiary nominations if necessary

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

In the case of salary continuance claims, set in place ongoing assessment processes and ensure benefit is appropriately taxed prior to payment

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 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

Required Skills and Knowledge

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.

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.

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.