Unit of competency Outline

Date retreived
22/07/2026 6:24 PM AWST

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Evaluate life insurance claims

Evaluate life insurance claims

Unit of competency
National Code
FNSILF405
State Code
AUR70
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
40
Description
This unit describes the skills and knowledge required to handle the receipt, initial assessment and processing of claims made under risk-based life insurance policies.It applies to those engaged in claims management functions of life insurance organisations.No licensing, legislative or certification requirements apply to this unit at the time of publication.
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 claimant is authorised to deal with policy
  • 1.4 Check that documentation is correct and complete
  • 1.5 Determine authority level required to evaluate 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 and confirm whether terms and conditions of policy have been 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
No information
No information
Replaces
State Code National Code Title Type
WC238 FNSILF405A Evaluate life insurance claims Unit of competency
Replaced By
State Code National Code Title Type
ODR89 FNSILF415 Evaluate life insurance claims Unit of competency
State Code National Code Title Type
AVX2 FNS41515 Certificate IV in Life Insurance Qualification