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SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD: 

Demonstrate knowledge and insight into fraudulent activities that impact on the insurance industry 
SAQA US ID UNIT STANDARD TITLE
243161  Demonstrate knowledge and insight into fraudulent activities that impact on the insurance industry 
ORIGINATOR
SGB Insurance and Investment 
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 5  Level TBA: Pre-2009 was L5 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Reregistered  2018-07-01  2023-06-30  SAQA 06120/18 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2024-06-30   2027-06-30  

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 does not replace any other unit standard and is not replaced by any other unit standard. 

PURPOSE OF THE UNIT STANDARD 
This Unit Standard is intended for learners in short term insurance and risk management. It will be useful for financial managers, Middle and Upper Managers, Internal Brokers, Branch Managers, people responsible for the movement of money, Reinsurers, Underwriters, Claims Brokers, Claims Managers and people who work within the policies of insurance and other organisations and need to be aware of 'red flags' that identify potential fraud. It will also be useful as a stand alone Unit Standard for training potential business insurance clients.

The qualifying learner is capable of:
  • Analysing types of Fraud.
  • Investigating indicators of fraudulent practices.
  • Explaining issues of governance to control fraud that impacts on insurance.
  • Presenting evidence of suspicious fraudulent activity. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    It is assumed that learners are competent in Communication and Mathematical Literacy at Level 4. 

    UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is:
  • Service providers include, but are not limited to, contractors, suppliers, loss adjusters, auditors, legal practitioners and salvage contractors.
  • Unethical practices include, but are not limited to, inflated charges, false documentation, unethical collusion between supplier and insurance employee and fee for work not done.
  • Intermediaries include brokers, underwriting managers and agents.
  • Fraudulent practices of intermediaries include, but are not limited to, cover arrangements, fictitious policies, inaccurate or falsified reporting and documentation.
  • Unethical behaviour of employees includes, but is not limited to, ghost employees, cheque fraud, embezzlement and falsified expenses.
  • Indicators of internal fraud include, but are not limited to, lifestyle indicators, reluctance to take leave, payment patterns, supplier collusion, favoritism, unexplained expenses, lack of documentation, adverse credit record, missing claim files, criminal records, asset misappropriation and whistle blowing.
  • Indicators of external fraud include, but are not limited to, duplicate invoices, copy invoices, collusion, deviation from budget, customer complaints, chance reports and management reporting.
  • Legislation includes, but is not limited to, Short Term Insurance Act, Prevention of Organised Crime Act (POCA), Protection of Constitutional Democracy Against Terrorism and Organised Crime Act (POCDATARA), Financial Intelligence Centre Act (FICA), Financial Advisory and Intermediary Services Act (FAIS), Criminal Procedures Act and the Prevention of Corruption Act.
  • Internal clients include, but are not limited to, employees and contractors. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Analyse types of fraud. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The elements of fraud are analysed and an indication is given of the difference between theft, fraud and corruption. 

    ASSESSMENT CRITERION 2 
    Unethical practices of external service providers that could result in fraud are analysed for different scenarios. 

    ASSESSMENT CRITERION 3 
    Activities of clients and other external customers that could constitute fraud are investigated with reference to deliberate non-disclosure, misrepresentation, exaggerating claims, arson, fictitious claims, self destruction, organised crime and other criminal activities. 

    ASSESSMENT CRITERION 4 
    Activities of intermediaries that could constitute fraud are investigated for different case studies. 

    ASSESSMENT CRITERION 5 
    Unethical behaviour of employees and contractors that could constitute fraud as defined by the Criminal Procedures Act are analysed with examples. 

    SPECIFIC OUTCOME 2 
    Investigate indicators of fraudulent practice. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Potential indicators of fraud on the part of internal clients are explained with examples. 

    ASSESSMENT CRITERION 2 
    Potential indicators of external fraud are explained with examples. 

    SPECIFIC OUTCOME 3 
    Explain issues of governance to control fraud that impacts on insurance. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The policies, procedures and systems of an organisation are analysed to determine the measures that are in place to prevent and detect fraud. 

    ASSESSMENT CRITERION 2 
    The relationship between an organisation's policies and relevant legislation is explained and an indication is given of the consequences of non-compliance. 

    SPECIFIC OUTCOME 4 
    Present evidence of suspicious fraudulent activity. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The procedures and systems to be followed when fraud is suspected are explained for a specific organisation. 

    ASSESSMENT CRITERION 2 
    A suspicion is conveyed to the relevant level of authority or area of responsibility for investigation of fraud. 

    ASSESSMENT CRITERION 3 
    The potential impact of the fraudulent activity is explained with examples. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
  • Anyone assessing a candidate against this Unit Standard must be registered as an assessor with the relevant ETQA or ETQA where a Memorandum of Understanding (MOU) exists with the relevant ETQA.
  • Any institution offering learning that will enable achievement of this Unit Standard must be accredited as a provider through the relevant ETQA or ETQA where a Memorandum of Understanding (MOU) exists with the relevant ETQA.
  • Moderation of assessment will be overseen by the relevant ETQA according to the moderation guidelines and the agreed ETQA procedures. 

  • 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 capable of identifying and solving problems in which responses show that responsible decisions using critical and creative thinking have been made in presenting evidence of suspicious fraudulent activity. 

    UNIT STANDARD CCFO COLLECTING 
    Learners are capable of collecting, organising and critically evaluating information in following the procedures to report suspected fraudulent activities. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are able to communicate clearly in presenting evidence of suspicious fraudulent activity. 

    UNIT STANDARD CCFO DEMONSTRATING 
    Learners are able see the world as a set of related systems by identifying indicators of fraudulent activity and explaining the potential impact of fraud on an insurer. 

    UNIT STANDARD ASSESSOR CRITERIA 
    N/A 

    REREGISTRATION HISTORY 
    As per the SAQA Board decision/s at that time, this unit standard was Reregistered in 2012; 2015. 

    UNIT STANDARD NOTES 
    For the purpose of this Unit Standard:
  • Fraud is any unlawful act or omission by which a misrepresentation is made with the intention to defraud which causes actual prejudice or which is potentially prejudicial to another, whether or not there is personal benefit to the perpetrator.
  • Fraud should not be confused with theft, corruption or dishonesty.
    > Theft according to the common law of South Africa, is the unlawful misappropriation of movable property or money with the intention to steal.
    > Corruption according to the Prevention and Combating of Corrupt Activities Act, No 12 of 2004, as amended, is the abuse of a position of employment to gain an advantage in contravention of duty. It includes the offering/giving/soliciting or accepting of an inducement or reward for certain improper actions and any improper approach or solicitation, either directly or through a nominee to act in any way which could be to an entity's disadvantage.
    > Dishonesty is a generic term embracing all forms of conduct involving deception. In criminal law, a person cannot be convicted of dishonest conduct unless the conduct amounts to a recognised offence i.e. fraud, theft etc. In employment law, a premium is placed on honesty because conduct involving moral turpitude by employees damages the trust relationship on which the contract of employment is founded. The dishonest conduct of employees need not therefore amount to a criminal offence. It can consist of any act or omission which an employer is morally entitled to expect an employee to perform. This may include withholding information from the employer, or making a false statement or misrepresentation with the intention of deceiving the employer. (Reference: J Grogan in Dismissal 2002, page 116 Juta & Co Ltd). 

  • QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Core  61529   National Certificate: Loss Adjusting  Level 5  Level TBA: Pre-2009 was L5  Reregistered  2023-06-30  INSETA 
    Elective  57918   National Certificate: Short Term Insurance  Level 5  Level TBA: Pre-2009 was L5  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. African Resources & Financial Training (Pty) Ltd 
    2. Invuya Institute of Learning (Pty) Ltd 
    3. Masifunde Training Centre (Pty) Ltd 
    4. Ripple Effect 4 (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.