Claims Management

What you'll learn

• describe the role of a claims assessor in receiving a life insurance claim
• determine the role of specialists and when the services of external specialists are required
• describe the multi-disciplinary approach to claims management
• determine service parameters and expectations to enable performance to be reviewed effectively
• describe the strategies to review and monitor ongoing service performance
• identify the information required to assess the eligibility of benefits in a life insurance claim
• describe the tasks required to admit a life insurance claim
• identify the reasons why a life insurance claim may be denied
• describe the importance of accurate record keeping in claims management
• describe the role of a financial adviser in the claims management process
• determine when an insurer can avoid a contract of life insurance
• determine when a life insurer is obliged, by law, to pay interest on a benefit
• calculate an adjusted sum insured where new information is revealed after a policy has been taken out
• describe the evidence required to meet basic proof of death requirements with regard to the policyowner
• for various death claims scenarios, determine proof of entitlement
• identify the documentation required to effect payment of proceeds from death claims
• for a given death claim scenario, identify whether an insurer can avoid a life insurance claim
• list the required considerations when calculating a death benefit for permanent contracts
• describe three elements that need to be established to validate a morbidity claim at the initial point of contact
• list the three standard components that define TPD
• list at least four documents commonly requested as part of the supporting documentation for lump-sum morbidity claims
• for two given scenarios, determine the validity of a TPD claim
• for a given scenario, calculate the amount of death cover for an insured who has received a benefit under a trauma cover rider
• describe at least five sources of information that may assist in the assessment of a lump-sum morbidity claim
• list at least three standard exclusions that commonly apply to IP policies
• list at least three reasons why early advice of an IP claim is preferable
• describe the proof required by an insured to be deemed eligible for a benefit under an IP claim
• list at least four payments that can result in a reduced benefit under an IP claim
• identify three different bases for assessing the impact of a condition on an insured’s ability to work
• describe how a life office assesses proof of title prior to the payment of a maturity benefit
• list at least five alternatives to surrendering a life policy
• determine the conditions for paying surrender values under a life policy
• describe superannuation business and its legislative basis for life insurance business
• outline the two stages that a benefit payment must pass through to get to the insured member
• list at least four points of contact that can apply under a group insurance situation
• identify the different conditions of release which regulate the payment and forwarding of life insurance benefits.
  
   

Competencies

• FNSILF504 Manage complex life insurance claims
• FNSILF505 Manage ongoing disability claims
• FNSILF506 Manage group life insurance claims