Manage group life insurance claims

Unit of competency Outline

Date retreived
22/07/2026 11:22 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.

Unit of competency

National Code
FNSILF516

State Code
ODR85

TGA Status
Current

DTWD Status
Pending

Current Release Number
1.00

Current Release Date
27/01/2022

View on TGA

State Implementation and Classification

Approved Date

Field of Education

081103 - Insurance And Actuarial Studies

Original Release Date

Nominal Hours

Description

This unit describes the skills and knowledge required to effectively manage claims made against group life insurance policies.The unit applies to individuals who manage cases and claims 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 and evaluate claim against group life insurance policy

1.1 Confirm channels of lodgement have been followed according to organisational policies and procedures
1.2 Identify relevant policy and type of cover
1.3 Evaluate evidence of identity for member
1.4 Communicate details of claim with claimant and group policy owner according to organisational policies and procedures, and legislative and regulatory requirements, as required

2. Review group history and eligibility for cover of claimant

2.1 Identify nature of fund membership and retained cover for claimant
2.2 Determine whether cover is limited to automatic acceptance and if additional cover was made available
2.3 Establish whether claimant was at work on commencement date of present insurance and determine impact on nature and extent of coverage
2.4 Verify currency and accuracy of premium contributions

3. Manage claim and information collection

3.1 Identify communication channels required for each claim and suited to stakeholder
3.2 Identify required contact points and intermediaries, and engage in line with their role and responsibilities, as required and according to organisational policies and procedures
3.3 Manage information collection and communication strategy in line with agreements and obligations and according to organisational policies and procedures, and legislative and regulatory requirements
3.4 Refer claim to authorised team member where problems or disputes arise, as required, according to organisational policies and procedures

4. Assess claim

4.1 Review claim submission and establish circumstances of claimed condition of member
4.2 Identify and interpret policy wordings and request additional information required to progress claims assessment information according to the code of ethics, as required
4.3 Communicate reasoning to the claimant and Group Policy owner where required
4.4 Evaluate evidence to determine whether assessment criteria are satisfied
4.5 Assess claimant compliance to additional disclosure requirements where cover was provided by means other than automatic acceptance
4.6 Determine benefit payable, and communicate decision to required stakeholders and personnel
4.7 Inform member and Group Policy owner of end date of benefit payments, and any changes to the terms of the cover

5. Pay group life insurance benefits

5.1 Determine entitlements according to required policy conditions and within authority levels, and obtain sign-off as required
5.2 Identify parties authorised to receive benefits paid by insurer
5.3 Communicate decisions to required parties, according to organisational policies and procedures, and legislative and regulatory requirements
5.4 Evaluate dependent relationships and beneficiary nominations for death benefits, as required
5.5 Set in place ongoing assessment processes for salary continuance claims and confirm benefit is taxed prior to payment
5.6 Request additional evidence for salary continuance claims as required

6. Finalise and close claim

6.1 File required documentation on claim according to organisational policies and procedures
6.2 Complete medical, financial and closure fields according to organisational policies and procedures
6.3 Update policy records in required systems according to organisational policies and procedures
6.4 Close claim in required systems and communicate closure to policy owner or authorised parties

No information

Replaces

State Code	National Code	Title	Type
AUR90	FNSILF506	Manage group life insurance claims	Unit of competency

State Code	National Code	Title	Type
BHU8	FNS51822	Diploma of Financial Services	Qualification
BFE8	FNS51820	Diploma of Financial Services	Qualification