Unit of competency Outline

Date retreived
22/07/2026 11:35 AM AWST

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Manage complex life insurance claims

Manage complex life insurance claims

Unit of competency
National Code
FNSILF504
State Code
AUR80
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 manage people, information systems and other resources needed to assess life insurance claims of a complex nature.It applies to those involved in complex non-standard claims management within the life insurance sector.No licensing, legislative or certification requirements apply to this unit at the time of publication.
Notes
Elements and Performance Criteria
1. Confirm validity of claim
  • 1.1 Receive and acknowledge claim notification
  • 1.2 Review details of life insurance policy to ensure valid cover is in force
  • 1.3 Establish that claimant is authorised to deal with policy
  • 1.4 Compile necessary documentation
  • 1.5 Check that documentation is correct and complete, and address any gaps in accordance with procedures
  • 1.6 Assess organisational authority level required to process claim and refer it to an appropriately authorised individual as necessary
2. Conduct complex claim assessment
  • 2.1 Review and apply policy terms, conditions and definitions to identify payment criteria in accordance with procedures
  • 2.2 Identify and review evidence against payment criteria in accordance with procedures
  • 2.3 Review all information relevant to circumstances of loss, damage or injury to establish chain of events
  • 2.4 Identify potential fraud indicators
  • 2.5 Identify whether policy exclusions apply
  • 2.6 Recognise need for further information and collect as appropriate
3. Appoint specialists to assist in complex claims assessment as required
  • 3.1 Identify need to appoint specialists to undertake claims assessment
  • 3.2 Engage and brief appointed specialists as required
  • 3.3 Monitor specialists’ activities to ensure adherence to timelines, procedures and ethical and regulatory requirements
  • 3.4 Interpret and utilise specialists' reports
4. Assess and report on liability
  • 4.1 Identify whether terms and conditions of policy have been verifiably met
  • 4.2 Assess liability in accordance with terms and conditions of policy
  • 4.3 Where claim is not admitted, communicate decision to appropriate stakeholders
  • 4.4 Where claim is admitted, calculate payments due
5. Finalise claim payments
  • 5.1 Advise client of consequences of proceeding with payment
  • 5.2 Obtain policy discharge, as appropriate
  • 5.3 Process payment in accordance with organisational authority levels, procedures and ethical and regulatory requirements
  • 5.4 Update all appropriate records in accordance with procedures
  • 5.5 Communicate settlement details to appropriate stakeholders in accordance with procedures and regulatory requirements
  • 5.6 Initiate reinsurance recovery, if appropriate
No information
No information
Replaces
State Code National Code Title Type
WC244 FNSILF504A Manage complex life insurance claims Unit of competency
Replaced By
State Code National Code Title Type
ODR88 FNSILF514 Manage complex life insurance claims Unit of competency
State Code National Code Title Type
AWB9 FNS51315 Diploma of Life Insurance Qualification