Unit of competency Outline
Date retreived
22/07/2026 11:31 PM AWST
22/07/2026 11:31 PM 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 ongoing disability claims
Manage ongoing disability claims
Unit of competency
National Code
FNSILF505A
FNSILF505A
State Code
WC245
WC245
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 performance outcomes, skills and knowledge required to manage the periodical assessment of ongoing life insurance disability claims.
Notes
Elements and Performance Criteria
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
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.
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.
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.
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
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
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
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUR78 | FNSILF505 | Manage ongoing disability claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| D776 | FNS51312 | Diploma of Life Insurance | Qualification |