Unit of competency Outline
Date retreived
22/07/2026 11:29 AM AWST
22/07/2026 11:29 AM 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.
Manage group life insurance claims
Manage group life insurance claims
Unit of competency
National Code
FNSILF506A
FNSILF506A
State Code
WC246
WC246
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
45
Description
This unit describes the procedural functions required to effectively handle claims made against group life insurance policies.
Notes
Elements and Performance Criteria
1. Receive a claim against a group life policy
- 1.1 Ensure that correct channels of lodgement have been followed
- 1.2 Identify the relevant policy and the type of cover
- 1.3 Evaluate evidence of the member’s identity
2. Review the member’s group history and eligibility for cover
- 2.1 Identify whether cover was granted within the policy’s automatic acceptance provisions or if it was individually underwritten
- 2.2 Establish whether the member was at work on the commencement date of the 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, understanding each one’s role and responsibilities
- 3.2 Identify communication channels most appropriate to each relationship
- 3.3 Manage an information collection and communication strategy
- 3.4 Where communication problems arise, refer the case to a suitably authorised team member
4. Assess the claim
- 4.1 Review claim submission to establish the circumstances of the member’s claimed condition
- 4.2 Identify the appropriate policy wordings to establish assessment criteria
- 4.3 Evaluate evidence to determine whether the assessment criteria are met
- 4.4 Where cover was provided by means other than automatic acceptance, assess whether the client complied with all additional disclosure requirements
- 4.5 Decide whether a benefit is payable
- 4.6 For disability claims, consider the opportunity for rehabilitation
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 the parties authorised to receive the benefits paid by the insurer
- 5.3 Communicate decisions to relevant parties, in accordance with procedures and regulatory requirements
- 5.4 In the case of death benefits, evaluate dependent relationships and beneficiary nominations if necessary
- 5.5 In the case of salary continuance claims, set in place ongoing assessment processes and ensure benefit is appropriately taxed prior to payment
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.
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.
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
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
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUR90 | FNSILF506 | Manage group life insurance claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| D776 | FNS51312 | Diploma of Life Insurance | Qualification |