Unit of competency Outline

Date retreived
22/07/2026 7:10 AM AWST

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Manage ongoing disability claims

Manage ongoing disability claims

Unit of competency
National Code
FNSILF515
State Code
ODR82
TGA Status
Current
DTWD Status
Approved
Current Release Number
1.00
Current Release Date
27/01/2022
View on TGA
State Implementation and Classification
Approved Date
08/04/2022
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
08/04/2022
Nominal Hours
55
Description
This unit describes the skills and knowledge required to manage the assessment of ongoing life insurance disability claims.The unit applies to individuals in the life insurance industry involved in disability claims management that is prolonged and requires ongoing supervision.No licensing, legislative or certification requirements apply to this unit at the time of publication.
Notes
Elements and Performance Criteria
1. Manage disability claim review procedures
  • 1.1 Identify required claim information and timeframes for update
  • 1.2 Review continuing liability of insurer against ongoing disability claim
  • 1.3 Identify required periodical claimant submissions and review ongoing disability claims
  • 1.4 Maintain contact with claimant and required stakeholders
  • 1.5 Review claim file, apply policy terms, conditions and definitions and establish ongoing assessment criteria
2. Review claim and source additional information
  • 2.1 Evaluate whether information satisfies ongoing assessment criteria
  • 2.2 Determine expected timeframe for client recovery from disability according to required disability guidelines
  • 2.3 Discuss expected timeframe with medical expert, and confirm timeframes with client and treating doctor
  • 2.4 Identify and document potential delays to client recovery with client and treating doctor
  • 2.5 Review information and identify need for additional evidence
  • 2.6 Collect additional information according to organisational policies and procedures, code of ethics, and legislative and regulatory requirements
3. Consult and monitor specialists regarding complex claims as required
  • 3.1 Identify need to appoint specialists to assist in ongoing review of claim
  • 3.2 Engage and instruct appointed specialists as required
  • 3.3 Monitor specialist activities as required
  • 3.4 Interpret and review specialist reports and information
4. Assess ongoing claim
  • 4.1 Analyse and review claimant submissions, information and specialist reports against ongoing assessment criteria
  • 4.2 Determine if claim has been fulfilled according to ongoing assessment criteria
  • 4.3 Communicate results of assessments to required stakeholders
5. Adjust benefits as required
  • 5.1 Calculate benefit entitlements according to policy terms and conditions, and organisational policies and procedures
  • 5.2 Apply offsets and indexation to benefits according to policy terms and conditions, and organisational policies and procedures
  • 5.3 Interpret and apply criteria for ceasing income-stream benefit payments according to policy terms and conditions, code of ethics, organisational policies and procedures, and legislative and regulatory requirements
6. Identify requirements for ongoing assessment
  • 6.1 Identify periodical claimant submissions required to support the review of the ongoing disability claim
  • 6.2 Determine date of last benefit according to organisational policies and procedures
  • 6.3 Communicate result with required stakeholders
7. Finalise and close claim
  • 7.1 File required documentation on claim according to organisational policies and procedures
  • 7.2 Complete medical, financial and closure fields according to organisational policies and procedures
  • 7.3 Update policy records in required systems according to organisational policies and procedures
  • 7.4 Close claim in required systems and communicate closure to policy owner or authorised parties
No information
No information
Replaces
State Code National Code Title Type
AUR78 FNSILF505 Manage ongoing disability claims Unit of competency
State Code National Code Title Type
BHU8 FNS51822 Diploma of Financial Services Qualification
BFE8 FNS51820 Diploma of Financial Services Qualification