Unit of competency Outline
Date retreived
22/07/2026 1:32 PM AWST
22/07/2026 1:32 PM AWST
Whilst all efforts are made to provide accurate and timely information from the relevant source/documentation, please be aware that the information supplied may not be the most current version. The accuracy of the detail has not been confirmed by the Department and therefore should not be relied upon without first confirming the contents.
Evaluate life insurance claims
Evaluate life insurance claims
Unit of competency
National Code
FNSILF405A
FNSILF405A
State Code
WC238
WC238
TGA Status
Replaced
Replaced
DTWD Status
Replaced
Replaced
State Implementation and Classification
Approved Date
29/07/2014
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
29/07/2014
Nominal Hours
40
Description
This unit describes the performance outcomes, skills and knowledge required to handle the receipt, initial assessment and processing of claims made under risk-based life insurance policies.
Notes
Elements and Performance Criteria
1. Receive claim form
- 1.1 Receive claim form and compile necessary documentation
- 1.2 Review policy details to ensure valid cover is in force
- 1.3 Establish that the claimant is authorised to deal with the policy
- 1.4 Check that documentation is correct and complete
- 1.5 Determine authority level required to evaluate the claim and refer application to appropriate authority as necessary
2. Evaluate claim information
- 2.1 Identify and review evidence against payment criteria
- 2.2 Check whether the terms and conditions of the policy have been verifiably met
- 2.3 Identify whether policy exclusions apply
- 2.4 Seek additional specialist advice as appropriate
- 2.5 Recognise where information suggests unresolved complexity and seek further information as appropriate
3. Establish liability for payment
- 3.1 Determine whether claim can be admitted in accordance with procedures and within authority limits
- 3.2 Make payment recommendation in accordance with procedures
- 3.3 Communicate outcomes to all relevant parties in accordance with procedures
- 3.4 Update records and file documentation in accordance with procedures and regulatory requirements
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.
Documentation may include:
financial records
other medical records
records of birth
records of death
records of disablement
statutory declarations and other such records.
Valid cover may include:
policy is current
premiums are up to date.
Appropriate authority may include:
supervisor
manager
other levels of management.
Payment criteria may include evidence of:
death (including terminal illness)
invalidity (permanent or temporary disability)
trauma.
Policy exclusions may include:
geographical location
high risk activities
medical conditions
pre-existing illnesses.
Specialist advice may include:
accountants
administrators
investigation agencies
Chief Medical Officers
trustees
underwriters
government regulators
Australian Securities and Investments Commission (ASIC)
Australian Tax Office (ATO).
Unresolved complexity may include indicators of possible:
fraud
misrepresentation
non-disclosure.
Further information may include:
additional questionnaires
employment details
financial evidence
interviews
medical evidence
surveillance.
Procedures may include:
organisational complaints handling processes
organisational customer service charter
organisational guidelines
organisational policy
organisational privacy and confidentiality guidelines
organisational procedures.
Outcomes may include:
admit claim
amend claim
investigate claim
deny claim.
Relevant parties may include:
claimant
adviser
other relevant business teams.
Regulatory requirements may include:
Australian Securities and Investments Commission (ASIC) regulatory guides
corporations legislation
insurance contracts legislation
life insurance legislation
privacy legislation.
Documentation may include:
financial records
other medical records
records of birth
records of death
records of disablement
statutory declarations and other such records.
Valid cover may include:
policy is current
premiums are up to date.
Appropriate authority may include:
supervisor
manager
other levels of management.
Payment criteria may include evidence of:
death (including terminal illness)
invalidity (permanent or temporary disability)
trauma.
Policy exclusions may include:
geographical location
high risk activities
medical conditions
pre-existing illnesses.
Specialist advice may include:
accountants
administrators
investigation agencies
Chief Medical Officers
trustees
underwriters
government regulators
Australian Securities and Investments Commission (ASIC)
Australian Tax Office (ATO).
Unresolved complexity may include indicators of possible:
fraud
misrepresentation
non-disclosure.
Further information may include:
additional questionnaires
employment details
financial evidence
interviews
medical evidence
surveillance.
Procedures may include:
organisational complaints handling processes
organisational customer service charter
organisational guidelines
organisational policy
organisational privacy and confidentiality guidelines
organisational procedures.
Outcomes may include:
admit claim
amend claim
investigate claim
deny claim.
Relevant parties may include:
claimant
adviser
other relevant business teams.
Regulatory requirements may include:
Australian Securities and Investments Commission (ASIC) regulatory guides
corporations legislation
insurance contracts legislation
life insurance legislation
privacy legislation.
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 analytical and administrative skills in the evaluation of claims
maintain and apply a thorough and up-to-date understanding of life insurance terms and conditions and claims processing
maintain and apply a thorough and up-to-date understanding of life insurance 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
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit
Evidence of the ability to:
apply analytical and administrative skills in the evaluation of claims
maintain and apply a thorough and up-to-date understanding of life insurance terms and conditions and claims processing
maintain and apply a thorough and up-to-date understanding of life insurance 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
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUR70 | FNSILF405 | Evaluate life insurance claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| D775 | FNS41512 | Certificate IV in Life Insurance | Qualification |