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: 

Describe the investigation of fraud in short term insurance 
SAQA US ID UNIT STANDARD TITLE
243170  Describe the investigation of fraud in short term insurance 
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 Internal Audit Managers, Financial Managers, Directors of Companies, Risk Managers, Claims Assessors and Intermediaries. It enables learners to gather, analyse and interpret evidence of insurance fraud and to present and support their findings.

The qualifying learner is capable of:
  • Explaining fraud as it occurs in short term insurance.
  • Describing the kinds of evidence needed to prove fraud in short term insurance.
  • Making a decision based on available evidence.
  • Presenting information in support of a case. 

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

    UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is:
  • 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. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Explain fraud as it occurs in short term insurance. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The concept of fraud is explained as it is applied in South African criminal law. 

    ASSESSMENT CRITERION 2 
    The basic elements that constitute fraud are identified and policy conditions of cover are analysed to determine whether there could be a potential claim. 

    SPECIFIC OUTCOME 2 
    Describe the kinds of evidence needed to prove fraud. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Oral, visual and documentary sources of information that could be used as evidence are identified with reference to the way in which evidence is collected and the rights of the individual under the South African Constitution. 

    ASSESSMENT CRITERION 2 
    Questions are formulated to gather and verify information and confirm or refute an allegation. 

    ASSESSMENT CRITERION 3 
    Evidence is analysed and interpreted in order to identify discrepancies or irregularities and to identify evidence of personal financial gain or anticipated personal financial gain. 

    ASSESSMENT CRITERION 4 
    Situations where expert technical advice should be sought to verify an allegation are identified in case studies. 

    ASSESSMENT CRITERION 5 
    An electronic information system is used to source information. 

    SPECIFIC OUTCOME 3 
    Make a decision based on available evidence. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Information relating to a case is collated in a case file and notes on the progress of an investigation are compiled as a case file investigation diary. 

    ASSESSMENT CRITERION 2 
    A recommendation is made on how the case should proceed in terms of criminal action, civil action or no action. 

    SPECIFIC OUTCOME 4 
    Present information in support of a case. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    A sworn written statement/affidavit and supporting evidence is produced for use by the insurer and the police. 

    ASSESSMENT CRITERION 2 
    A written report and supporting evidence is produced for Human Resources, Accounts and Stock Records Departments. 

    ASSESSMENT CRITERION 3 
    A written report and supporting evidence is produced for the legal department. 

    ASSESSMENT CRITERION 4 
    Case studies are analysed to determine the form of report required in different situations. 


    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 able to identify and solve problems in which responses show that responsible decisions using critical have been made in recommending how a case should proceed. 

    UNIT STANDARD CCFO WORKING 
    Learners are able to work as members of a team in investigating fraud and dealing with different departments. 

    UNIT STANDARD CCFO COLLECTING 
    Learners are able to collect, organise and critically evaluate information in analysing evidence and policy documents, and collating information in a case file. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are able to communicate effectively in offering explanations, keeping notes on a case and presenting information in support of a case. 

    UNIT STANDARD CCFO SCIENCE 
    Learners are able to use science and technology effectively in using an electronic information system to source information. 

    UNIT STANDARD CCFO DEMONSTRATING 
    Learners are able to demonstrate an understanding of the world as a set of related systems in analysing information for discrepancies and irregularities. 

    UNIT STANDARD CCFO CONTRIBUTING 
    Learners are able to demonstrate cultural sensitivity in dealing with information and producing an affidavit. 

    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 
    N/A 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Elective  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.