Unit of competency details

Release 

Comments 

Release 1

This Unit of Competency first released with FNS10 Financial Services Training Package version 3.0.

Element 

Performance Criteria 

Elements describe the essential outcomes of a unit of competency.

Performance criteria describe the performance needed to demonstrate achievement of the element. Where bold italicised text is used, further information is detailed in the required skills and knowledge section and the range statement. Assessment of performance is to be consistent with the evidence guide.

1. Manage claim review procedures and determine ongoing assessment criteria

1.1 Recognise the need to undertake a review  of the insurer's continuing liability against an ongoing disability claim

1.2 Identify appropriate periodical claimant submissions 

1.3 Maintain contact with the claimant and other relevant parties 

1.4 Review claim file and apply policy terms, conditions and definitions to establish ongoing assessment criteria

2. Review the claim

2.1 Receive appropriate periodical claimant submissions for comparison with ongoing assessment criteria

2.2 Review submissions and identify the need for additional information , where appropriate

2.3 Where necessary, plan information collection in accordance with ethical and regulatory requirement 

3. Appoint specialists to assist in additional information collection, as required

3.1 Identify the need to appoint specialists to undertake claims investigations

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, as appropriate

3.4 Interpret and utilise specialists' reports

4. Conduct assessment of the ongoing claim

4.1 Review claimant submissions and specialist reports against ongoing assessment criteria

4.2 Evaluate whether the ongoing assessment criteria have been satisfied

4.3 Communicate the results of assessments  to relevant parties

5. Adjust benefits as required

5.1 Calculate benefit entitlements in accordance with policy terms and conditions and procedures

5.2 Where necessary, apply and calculate partial disability benefits in accordance with policy terms and conditions and procedures

5.3 Where necessary, apply offsets and/or indexation to benefits in accordance with policy terms and conditions

5.4 Where necessary, interpret and apply criteria for ceasing income-stream benefit payments, in accordance with policy terms and conditions, procedures and ethical and regulatory requirements

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
• maintain and apply a thorough understanding of claims procedures, policy guidelines 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 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 

Need to undertake a review  may include:

• a change in the claimant's situation
• anomalies detected during the initial claim assessment
• indexation scheduling
• medical updates
• new and relevant information
• recovery benchmarks
• standard scheduling as per processes and procedures
• suspicions of fraud.

Periodical claimant submissions  may include:

• activities questionnaires
• other medical, financial and occupational information
• progress claim forms
• progress medical reports
• rehabilitation reports.

Relevant parties  may include:

• accounting and finance professionals
• advisers
• carers
• claimant
• consultants
• legal or other practitioners
• medical professionals
• reinsurer
• trustees
• workers compensation.

Additional information  may include:

• additional claimant forms
• functional capacity evaluation
• information related to moral risks
• interview records
• medical reports
• meeting notes
• official, general and other correspondence
• psychological assessment
• records of telephone conversations
• reports from others such as assessors, insurers, medical providers and others
• surveillance
• tax documentation
• vocational assessment.

Ethical and regulatory requirements  may include:

• Australian Securities and Investments Commission (ASIC) regulatory guides
• corporations legislation
• life insurance legislation
• privacy legislation
• professional Codes of Practice.

Specialists  may include:

• advisers
• Chief Medical Officer
• consultants
• forensic accountants
• investigators
• medical professionals
• solicitors
• surveillance professionals.

Procedures  may include:

• organisational complaints handling processes
• organisational customer service charter
• organisational guidelines
• organisational policy
• organisational privacy and confidentiality guidelines
• organisational procedures.

Results of assessments  may include:

• decision to alter benefit payments
• decision to cease benefit payments
• decision to continue benefit payments unaltered.