Unit of competency Outline

Date retreived
23/07/2026 4:54 PM AWST

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Manage group life insurance claims

Manage group life insurance claims

Unit of competency
National Code
FNSILF506
State Code
AUR90
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 effectively handle claims made against group life insurance policies.It applies to those engaged in case management and claims management functions associated with group life insurance policies.No licensing, legislative or certification requirements apply to this unit at the time of publication.
Notes
Elements and Performance Criteria
1. Receive claim against group life policy
  • 1.1 Check that correct channels of lodgement have been followed
  • 1.2 Identify relevant policy and type of cover
  • 1.3 Evaluate evidence of member’s identity
2. Review member’s group history and eligibility for cover
  • 2.1 Identify whether cover was granted within policy’s automatic acceptance provisions or if it was individually underwritten
  • 2.2 Establish whether member was at work on commencement date of present insurance
  • 2.3 Verify that premium contributions are current and correct
3. Manage relationships and information collection
  • 3.1 Identify important contact points and intermediaries, and confirm each one’s role and responsibilities
  • 3.2 Identify communication channels most appropriate to each relationship
  • 3.3 Manage information collection and communication strategy
  • 3.4 Refer case to suitably authorised team member where communication problems arise, in accordance with organisational policy and procedures
4. Assess claim
  • 4.1 Review claim submission to establish circumstances of member’s claimed condition
  • 4.2 Identify appropriate policy wordings to establish assessment criteria
  • 4.3 Evaluate evidence to determine whether assessment criteria are met
  • 4.4 Assess whether client complied with all additional disclosure requirements where cover was provided by means other than automatic acceptance
  • 4.5 Decide whether a benefit is payable
  • 4.6 Consider opportunity for rehabilitation with disability claims
5. Pay group life insurance benefits
  • 5.1 Determine entitlements as per relevant policy conditions, within authority levels and obtain sign-off where required
  • 5.2 Identify parties authorised to receive benefits paid by insurer
  • 5.3 Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements
  • 5.4 Evaluate dependent relationships and beneficiary nominations for death benefits, if necessary
  • 5.5 Set in place ongoing assessment processes for salary continuance claims and ensure benefit is appropriately taxed prior to payment
No information
No information
Replaces
State Code National Code Title Type
WC246 FNSILF506A Manage group life insurance claims Unit of competency
Replaced By
State Code National Code Title Type
ODR85 FNSILF516 Manage group life insurance claims Unit of competency
State Code National Code Title Type
AWB9 FNS51315 Diploma of Life Insurance Qualification