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: 

Present a case to substantiate a decision to repudiate a high risk Long- Term claim in a legal action 
SAQA US ID UNIT STANDARD TITLE
120071  Present a case to substantiate a decision to repudiate a high risk Long- Term claim in a legal action 
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 assess Long-Term risk including Reinsurers, Senior Claims Assessors and Senior Underwriters.

The qualifying learner is capable of:
  • Interpreting information relating to a specific case.
  • Applying the reasonable man test to make a decision about a specific case.
  • Presenting a case with supporting documentation. 

  • 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:
  • Documents required to support a decision include, but are not limited to, original medical examination. Claim forms, employer's certificate, history of sick leave, declarations, other supporting evidence. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Interpret information relating to a specific case. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    A claim file is analysed to determine what additional documentation is required to make a decision. 

    ASSESSMENT CRITERION 2 
    Relevant medical information relating to a case is analysed for anti-selection. 

    ASSESSMENT CRITERION 3 
    The LOA data base is mined for relevant information and records. 

    ASSESSMENT CRITERION 4 
    Impairments or diseases that could impact on a claim are identified and the implications for that claim or a future claim are indicated with examples. 

    SPECIFIC OUTCOME 2 
    Apply the reasonable man test to make a decision about a specific case. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The reasonable man test is explained in the context of underwriting and making a claims decision. 

    ASSESSMENT CRITERION 2 
    The reasonable mans test is applied to a Long-Term insurance contract to assess the validity of a contested claim. 

    ASSESSMENT CRITERION 3 
    Medical reasons for disability are compared to a contractual definition of disability with reference to same, similar and any occupation disability. 

    ASSESSMENT CRITERION 4 
    Court rulings are analysed to identify potential implications for assessing claims and flaws in product development. 

    SPECIFIC OUTCOME 3 
    Present a case with supporting documentation. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    An argument is developed to substantiate a decision relating to a contested claim. 

    ASSESSMENT CRITERION 2 
    The necessary documents are collated to support a decision. 

    ASSESSMENT CRITERION 3 
    The case is presented verbally in a formal legal environment. 

    ASSESSMENT CRITERION 4 
    Information is clarified in response to impromptu questions. 


    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 make decisions about a contested claim. 

    UNIT STANDARD CCFO ORGANISING 
    The learner is able organise his/her activities responsibly and effectively conducting the required research and collating documentation. 

    UNIT STANDARD CCFO COLLECTING 
    The learner is able collect, organise and critically evaluate information in substantiating a decision about a contested claim. 

    UNIT STANDARD CCFO COMMUNICATING 
    The learner is able communicate effectively in analysing, documenting and presenting information about a contested claim. 

    UNIT STANDARD CCFO SCIENCE 
    The learner is able using a computer effectively to research information and mine the LOA data base. 

    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.