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SOUTH AFRICAN QUALIFICATIONS AUTHORITY 
REGISTERED UNIT STANDARD THAT HAS PASSED THE END DATE: 

Assess a long term insurance claim 
SAQA US ID UNIT STANDARD TITLE
14431  Assess 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 4  NQF Level 04  2 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Passed the End Date -
Status was "Registered" 		 2001-12-05  2004-12-05  SAQA 0639/01 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2005-12-05   2008-12-05  

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 is replaced by: 
US ID Unit Standard Title Pre-2009 NQF Level NQF Level Credits Replacement Status
117104  Administer a long term insurance claim  Level 3  NQF Level 03  2   

PURPOSE OF THE UNIT STANDARD 
This unit standard is intended for people who work in long term insurance and who are required to understand how claims are processed.

The qualifying learner is capable of:
  • Collating the documents required to process a long term insurance claim.
  • Analysing a long term insurance claim and confirming the payment amount.
  • Interpreting evidence and making a decision to accept, refer 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 3 and the unit standard Underwrite a standard risk in long term insurance: level 4. 

    UNIT STANDARD RANGE 
    The typical scope of this unit standard is:
  • Claims include benefits for death, funeral, retirement, maturity, disability and additional illness/disease related benefits.
  • Checking for validity includes checking that the product is in force 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 assess a long term insurance claim. 

    ASSESSMENT CRITERIA     

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

    ASSESSMENT CRITERION 2 
    2. The relevant documents required by the circumstances of an event are identified and supporting documentation that may be required in terms of legislation or industry requirements is collected and presented in a portfolio for at least 5 claims or case studies. 

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

    ASSESSMENT CRITERION 4 
    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 
    5. The implications if records are not updated accurately are explained with reference to the consequences for the policyholder and the organisation. 

    SPECIFIC OUTCOME 2 
    Analyse a claim and confirm the payment amount. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. The documents for the five claims in the portfolio are analysed to ensure that they have been completed correctly. 

    ASSESSMENT CRITERION 2 
    2. Policy conditions, fund rules and medical information applicable to the claims are analysed and applied to the five claims or case studies. 

    ASSESSMENT CRITERION 3 
    3. Legal applications, industry agreements and practices associated with the payment of claims are explained and applied to the five claims or case studies. 

    ASSESSMENT CRITERION 4 
    4. The benefit amount of each of the five claims or case studies is confirmed according to the provisions of the specific contracts. 

    SPECIFIC OUTCOME 3 
    Judge whether the cause of the event matches the predicted profile. 
    OUTCOME NOTES 
    Use the trends and predictions established by underwriting at acceptance to judge whether the cause of the event matches the predicted profile. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. The cause of death is judged against the expected mortality and morbidity profiles used in underwriting. 

    ASSESSMENT CRITERION 2 
    2. Significant variations from the underwriting profile are identified and evidence is obtained to support or clarify the variation. 

    SPECIFIC OUTCOME 4 
    Interpret evidence and make a decision to accept or reject the claim. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. The evidence in the five claims or case studies is interpreted and a decision or recommendation is made in each case. 

    ASSESSMENT CRITERION 2 
    2. The basic checks for fraud are explained and applied to the five claims or case studies and an indication is given of the action that can be taken if fraud is confirmed. 

    ASSESSMENT CRITERION 3 
    3. A final decision is made and supported on whether to accept, refer to an outside professional or reject the claim for each of the five claims or case studies. 

    ASSESSMENT CRITERION 4 
    4. The implications if fraud is suspected and proved is explained with reference to the claimant and the organisation. 

    SPECIFIC OUTCOME 5 
    Implement and communicate the decision. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    1. Reasons why a claim will/not be paid out are given for each of the five claims or case studies and the decision is communicated to the claimant in a role play. 

    ASSESSMENT CRITERION 2 
    2. The documents required once a decision is accepted by the claimant are identified and the decision is communicated in writing with the required documentation. 

    ASSESSMENT CRITERION 3 
    3. The payment options available under specific products are explained for each of the five claims or case studies. 

    ASSESSMENT CRITERION 4 
    4. The prescribed method of payment for specific claims applicable to long term insurance benefits is explained and applied to the five claims or case studies. 

    ASSESSMENT CRITERION 5 
    5. Records of the five claims or case studies are updated using a specified system. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
    This unit standard will be internally assessed by the provider and moderated by a moderator registered by INSQA or a relevant accredited ETQA. The mechanisms and requirements for moderation are contained in the document obtainable from INSQA, INSQA framework for assessment and moderation. 


    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, refer or reject a claim. 

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

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

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are able to communicate effectively using visual, mathematics and language skills in the modes of oral and/or written presentations in calculating the payment amount, and informing the claimant of the decision in role play and in writing. 

    UNIT STANDARD CCFO SCIENCE 
    Learners are able to use science and technology effectively and critically showing responsibility towards the environment and the health of others in accessing information to assess 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 recognising that problem-solving contexts do not exist in isolation 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 and aesthetically sensitive across a range of social contexts in conveying a decision to a claimant. 

    UNIT STANDARD NOTES 
    This unit standard has been replaced by 117104, "Administer a long term claim", Level 3, 2 credits.

    Practical work experience:
    Before being credited with this unit standard learners are required to have a minimum of 20 hours experience in claims assessing and processing. 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Elective  20774   National Certificate: Insurance: Long Term: Risk Assessment  Level 4  NQF Level 04  Passed the End Date -
    Status was "Registered"     		 2004-12-05  Was INSETA until Last Date for Achievement 


    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.
     
    NONE 


    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.