Unit of competency Outline

Date retreived
23/07/2026 12:11 AM AWST

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Manage ongoing disability claims

Manage ongoing disability claims

Unit of competency
National Code
FNSILF505
State Code
AUR78
TGA Status
Replaced
DTWD Status
Replaced
Current Release Number
1.00
Current Release Date
25/03/2015
View on TGA
State Implementation and Classification
Approved Date
16/09/2015
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
16/09/2015
Nominal Hours
45
Description
This unit describes the skills and knowledge required to manage the periodical assessment of ongoing life insurance disability claims.It applies to those involved in disability claims management that is prolonged and requiring ongoing supervision within the life insurance sector.No licensing, legislative or certification requirements apply to this unit at the time of publication.
Notes
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
  • 1.2 Identify appropriate periodical claimant submissions
  • 1.3 Maintain contact with claimant and other relevant parties
  • 1.4 Review claim file and apply policy terms, conditions and definitions to establish ongoing assessment criteria
2. Review claim
  • 2.1 Receive appropriate periodical claimant submissions for comparison with ongoing assessment criteria
  • 2.2 Review submissions and identify need for additional information, where appropriate
  • 2.3 Plan information collection in accordance with ethical and regulatory requirements, where necessary
3. Appoint specialists to assist in additional information collection, as required
  • 3.1 Identify need to appoint specialists to undertake claims investigations
  • 3.2 Engage and brief appointed specialists as required
  • 3.3 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
  • 4.1 Review claimant submissions and specialist reports against ongoing assessment criteria
  • 4.2 Evaluate whether ongoing assessment criteria have been satisfied
  • 4.3 Communicate results of assessments to relevant parties
5. Adjust benefits as required
  • 5.1 Calculate benefit entitlements in accordance with policy terms and conditions, and procedures
  • 5.2 Apply and calculate partial disability benefits in accordance with policy terms and conditions, and procedures
  • 5.3 Apply offsets and/or indexation to benefits in accordance with policy terms and conditions, where necessary
  • 5.4 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
No information
No information
Replaces
State Code National Code Title Type
WC245 FNSILF505A Manage ongoing disability claims Unit of competency
Replaced By
State Code National Code Title Type
ODR82 FNSILF515 Manage ongoing disability claims Unit of competency
State Code National Code Title Type
AWB9 FNS51315 Diploma of Life Insurance Qualification