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SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD: 

Apply technical knowledge to advise Intermediaries on Long-Term insurance claims 
SAQA US ID UNIT STANDARD TITLE
120064  Apply technical knowledge to advise Intermediaries on Long-Term insurance claims 
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 who are required to communicate with and support Intermediaries and Call Centre Agents to enable Intermediaries and others to give informed advice about Long-Term insurance claims. It will be useful for Reinsurers, Actuarial Students, Product Developers, and Senior Claims Assessors.

The qualifying learner is capable of:
  • Applying product knowledge to interpret and explain the viability of a claim.
  • Explaining an insurers claims practices.
  • Explaining LOA protocols and guidelines to interpret a claims decision.
  • Explaining an unfavourable claims decision. 

  • LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
    Learners should be competent in Communication and Mathematical Literacy at Level 4. It is assumed that learners are competent in the Unit Standards in the FETC: Long-Term Risk Assessment. 

    UNIT STANDARD RANGE 
    The typical scope of this Unit Standard is:
  • Claims not covered by a specific product include, but are not limited to suicide exclusions, specific benefits and exclusions, definitions of disability and disability benefits.
  • Medical protocols are cardiac, mental depression, psychological, back, myalgia and chronic fatigue syndrome.
  • Reasons for not paying a claim include, but are not limited to, the impact of non disclosure on the validity of a contract, inadequate medical evidence to prove the validity of a claim and the application of specific exclusions.
  • Additional requirements apply to back, mental, cardiac and strokes. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Apply product knowledge to interpret and explain the viability of a claim. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Case studies are interpreted and explained to illustrate how the viability of a claim is determined with reference to a specific product. 

    ASSESSMENT CRITERION 2 
    The Intermediary is facilitated to interpret exclusions in a specific policy to enable the Intermediary to give informed advice about lodging a claim. 

    ASSESSMENT CRITERION 3 
    Advice on the viability of a claim not covered by a specific product is given for three different scenarios. 

    SPECIFIC OUTCOME 2 
    Explain an insurer's claims practices. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The different forms required for different products are explained for different types of claims and an indication is given of additional documentation required to initially lodge a claim. 

    ASSESSMENT CRITERION 2 
    The process to be followed in lodging a claim is outlined with reference to the receipt of the required evidence and existing service level agreements. 

    ASSESSMENT CRITERION 3 
    Ways in which a Claims Administrator can assist an Intermediary in the claims process are explained for a specific insurer. 

    SPECIFIC OUTCOME 3 
    Explain the use of LOA protocols and guidelines interpret a claims decision. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Reasons why a benefit may be restricted or not paid out are explained with reference to the relevant LOA protocols and guidelines. 

    ASSESSMENT CRITERION 2 
    LOA medical protocols or procedures for assessing claims are explained and an indication is given of the effect of them protocols on an insurer's claims practices. 

    SPECIFIC OUTCOME 4 
    Explain an unfavourable claims decision. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Additional requirements to support a claim are communicated and reasons for the additional information are substantiated for five different scenarios. 

    ASSESSMENT CRITERION 2 
    A claims decision is communicated to the Intermediary in plain language. 

    ASSESSMENT CRITERION 3 
    The logic behind a decision is explained in terms of the reason for not paying the claim. 

    ASSESSMENT CRITERION 4 
    Reasons for the deferment of a claim are explained with examples. 


    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 
    The learner is able to identify and solve problems in which responses show that responsible decisions using critical and creative thinking have been made explaining the logic behind a claims decision. 

    UNIT STANDARD CCFO COLLECTING 
    The learner is able to collect, organise and critically evaluate information in preparing to communicate information to an Intermediary. 

    UNIT STANDARD CCFO COMMUNICATING 
    The learner is able to communicate effectively in communicating information on a specific claims decision to an Intermediary and in advising an Intermediary on claims. 

    UNIT STANDARD CCFO DEMONSTRATING 
    The learner is able to demonstrate an understanding of the world as a set of related systems by explaining the relationship non disclosure and the validity of a contract. 

    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  49860   National Diploma: Financial Services: Long-Term Risk Assessment  Level 5  NQF Level 05  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. 



    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.