SAQA All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.
SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD THAT HAS PASSED THE END DATE: 

Administer a long term insurance claim 
SAQA US ID UNIT STANDARD TITLE
117104  Administer a long term insurance claim 
ORIGINATOR
SGB Financial Services 
PRIMARY OR DELEGATED QUALITY ASSURANCE FUNCTIONARY
-  
FIELD SUBFIELD
Field 03 - Business, Commerce and Management Studies Finance, Economics and Accounting 
ABET BAND UNIT STANDARD TYPE PRE-2009 NQF LEVEL NQF LEVEL CREDITS
Undefined  Regular  Level 3  NQF Level 03 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Passed the End Date -
Status was "Registered" 
2004-12-02  2005-10-12  SAQA 0557/04 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2006-10-12   2009-10-12  

In all of the tables in this document, both the pre-2009 NQF Level and the NQF Level is shown. In the text (purpose statements, qualification rules, etc), any references to NQF Levels are to the pre-2009 levels unless specifically stated otherwise.  

This unit standard replaces: 
US ID Unit Standard Title Pre-2009 NQF Level NQF Level Credits Replacement Status
14431  Assess a long term insurance claim  Level 4  NQF Level 04  Complete 

This unit standard is replaced by: 
US ID Unit Standard Title Pre-2009 NQF Level NQF Level Credits Replacement Status
119263  Assess a Long-term insurance claim  Level 4  NQF Level 04  Complete 

PURPOSE OF THE UNIT STANDARD 
This unit standard is intended for people who work in the long term environment and who are required to understand how claims are processed. Learners are required to administer claims within a limited level of authority.

The qualifying learner is capable of:
  • Collating the documents required to administer a long term claim.
  • Interpreting a claim in order to confirm the payment amount.
  • Interpreting evidence and making a decision to accept or reject a claim.
  • Implementing and communicating the decision. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    There is open access to this unit standard. Learners should be competent in Communication and Mathematical Literacy at Level 2. 

    UNIT STANDARD RANGE 
    The typical scope of this unit standard is:
  • Claims include benefits for death, funeral, retirement, maturity, disability, health and additional illness/disease related benefits.
  • Checking for validity includes checking that the policy or fund is current and that membership of a retirement fund is active.
  • The documents required once a decision is accepted by the claimant include claim statements and Income Tax Certificates. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Collate the documents required to administer a long term claim. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    A claim is received, recorded and checked for validity. 

    ASSESSMENT CRITERION 2 
    The relevant documents required by the circumstances of an event are identified and supporting documentation is collected and collated for five case studies. 

    ASSESSMENT CRITERION 3 
    The claim benefit amounts are determined from records relating to the policies and rules for five case studies. 

    ASSESSMENT CRITERION 4 
    The need for records to be updated and the procedures applied in updating records are explained with reference to a selected system. 

    ASSESSMENT CRITERION 5 
    The implications if records are not updated regularly and accurately are explained with reference to the consequences for the member and the organisation at claims stage. 

    SPECIFIC OUTCOME 2 
    Interpret a claim in order to confirm the payment amount. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Policy conditions, fund rules and medical information applicable to the claims are interpreted and applied to five case studies. 

    ASSESSMENT CRITERION 2 
    Legal applications, industry agreements and practices associated with the possible limitation of the payment of the claim amount are explained with examples. 

    SPECIFIC OUTCOME 3 
    Interpret evidence and make a decision to accept or reject the claim. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Evidence is interpreted and a decision or recommendation is made for five case studies. 

    ASSESSMENT CRITERION 2 
    The basic checks for fraud are applied to five case studies and an indication is given of the action that can be taken in the event of fraud. 

    ASSESSMENT CRITERION 3 
    A decision is made and supported as to whether to accept, refer or reject the claim for five case studies. 

    SPECIFIC OUTCOME 4 
    Implement and communicate the decision. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Reasons why a claim will or will not be paid out are explained for five case studies and the decision is communicated to the claimant. 

    ASSESSMENT CRITERION 2 
    The documents required once a decision to pay a claim has been made are identified and the decision is communicated in writing with the required documentation. 

    ASSESSMENT CRITERION 3 
    The payment options available under specific products are explained for five case studies. 

    ASSESSMENT CRITERION 4 
    Records required when claims are paid are updated and an indication is given of the time limits required for the records. 

    ASSESSMENT CRITERION 5 
    The process to be followed on finalisation of a claim is explained with reference to an organisation's policies. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
    This Unit Standard will be internally assessed by the provider and moderated by a moderator registered by a relevant accredited ETQA or an ETQA that has a Memorandum of Understanding with the relevant accredited ETQA. 

    UNIT STANDARD ESSENTIAL EMBEDDED KNOWLEDGE 
    N/A 

    UNIT STANDARD DEVELOPMENTAL OUTCOME 
    N/A 

    UNIT STANDARD LINKAGES 
    N/A 


    Critical Cross-field Outcomes (CCFO): 

    UNIT STANDARD CCFO IDENTIFYING 
    Learners are able to identify and solve problems in which responses show that responsible decisions using critical and creative thinking have been made in making a recommendation and a final decision to accept or refer a claim within own levels of authority. 

    UNIT STANDARD CCFO ORGANISING 
    Learners are able to organise and manage themselves and their activities responsibly and effectively in administering claims. 

    UNIT STANDARD CCFO COLLECTING 
    Learners are able to collect, organise and critically evaluate information needed to validate and administer a claim. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are able to communicate effectively in calculating the payment amount, and informing the claimant of the decision. 

    UNIT STANDARD CCFO SCIENCE 
    Learners are able to use science and technology effectively in accessing information to administer a claim and updating the claim records. 

    UNIT STANDARD CCFO DEMONSTRATING 
    Learners are able to demonstrate an understanding of the world as a set of related systems by understanding the implications if records are not kept accurately and if fraud is suspected. 

    UNIT STANDARD CCFO CONTRIBUTING 
    Learners are able to be culturally sensitive in conveying a decision to a claimant. 

    UNIT STANDARD ASSESSOR CRITERIA 
    N/A 

    UNIT STANDARD NOTES 
    This unit standard has been replaced by unit standard, 119263 which is "Assess a Long-term insurance claim", Level 4, 5 credits.

    This unit standard has replaced 14431 which was "Assess a long term insurance claim", Level 4 with 2 credits 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Elective  49089   National Certificate: Financial Services  Level 3  NQF Level 03  Reregistered  2023-06-30  INSETA 
    Elective  49649   Further Education and Training Certificate: Long-term Insurance  Level 4  NQF Level 04  Reregistered  2023-06-30  INSETA 
    Elective  49529   Further Education and Training Certificate: Long-Term Risk Assessment  Level 4  NQF Level 04  Reregistered  2023-06-30  INSETA 


    PROVIDERS CURRENTLY ACCREDITED TO OFFER THIS UNIT STANDARD: 
    This information shows the current accreditations (i.e. those not past their accreditation end dates), and is the most complete record available to SAQA as of today. Some Primary or Delegated Quality Assurance Functionaries have a lag in their recording systems for provider accreditation, in turn leading to a lag in notifying SAQA of all the providers that they have accredited to offer qualifications and unit standards, as well as any extensions to accreditation end dates. The relevant Primary or Delegated Quality Assurance Functionary should be notified if a record appears to be missing from here.
     
    1. CKP Development Agency (Pty) Ltd. 
    2. Intec College 
    3. Invuya Institute of Learning (Pty) Ltd 
    4. Masifunde Training Centre (Pty) Ltd 
    5. Sanlam Life Insurance Ltd 
    6. Sanlam Life Insurance Ltd. 
    7. The Institute of Health Risk Managers (Pty) Ltd 



    All qualifications and part qualifications registered on the National Qualifications Framework are public property. Thus the only payment that can be made for them is for service and reproduction. It is illegal to sell this material for profit. If the material is reproduced or quoted, the South African Qualifications Authority (SAQA) should be acknowledged as the source.