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: 

Conduct a short term insurance loss investigation 
SAQA US ID UNIT STANDARD TITLE
255854  Conduct a short term insurance loss investigation 
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  12 
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 investigate cases that may be multi-faceted and may require specialist knowledge and expertise, and extensive research and investigation. It will be useful for loss adjusters and senior short term insurance or reinsurance claims negotiators who may be independent parties who can negotiate settlement on behalf of an insurer.

The qualifying learner is capable of:
  • Interpreting an instruction to investigate a loss.
  • Planning an investigation.
  • Conducting an on-site investigation.
  • Assessing the damages.
  • Reporting on an investigation. 

  • 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:
  • Cases that may be high Rand value, time consuming, multi-faceted or of a technical nature that require specialist knowledge and expertise, and extensive research and investigation.
  • Documents include, but are not limited to, claim forms, policy wordings, instructions from the insurer, the proposal, agreement of loss and tender of settlement.
  • Quantum includes the application of Value Added Tax (VAT). 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Interpret an instruction to investigate a loss. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    An instruction is clarified and checked for completeness. 

    ASSESSMENT CRITERION 2 
    Relevant documents are analysed to establish whether the claim falls within the ambit of policy cover. 

    SPECIFIC OUTCOME 2 
    Plan an investigation. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Key people in the investigation are identified and a decision is made as to who should be interviewed and for what purpose. 

    ASSESSMENT CRITERION 2 
    Questions are asked to verify information prior to an on-site investigation. 

    ASSESSMENT CRITERION 3 
    The implications and consequences of different response times are explained with examples. 

    ASSESSMENT CRITERION 4 
    The context of an incident is analysed to determine the required logistics. 

    SPECIFIC OUTCOME 3 
    Conduct an on-site investigation. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Questions are asked to establish the background and circumstances of the incident. 

    ASSESSMENT CRITERION 2 
    Relevant information is gathered and recorded to support the investigation and provide evidence. 

    ASSESSMENT CRITERION 3 
    Previous claims or loss history is established and verified from the insured and the insurer. 

    SPECIFIC OUTCOME 4 
    Assess the damages. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The identity of the insured is determined in order to verify insurable interest. 

    ASSESSMENT CRITERION 2 
    The adequacy of the sum insured is determined against the value at risk. 

    ASSESSMENT CRITERION 3 
    Proximate cause is established to determine if there is an insured peril, unacceptable material hazard or moral hazard. 

    ASSESSMENT CRITERION 4 
    A decision to recommend an expert is made and substantiated based on the nature and complexity of the circumstances on site in order to clarify subrogation possibilities or suspicions. 

    ASSESSMENT CRITERION 5 
    The extent of the loss is scoped to establish potential quantum. 

    SPECIFIC OUTCOME 5 
    Report on an investigation. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    An expert report is interpreted and the findings relative to the incident are presented to the insurer with recommendations. 

    ASSESSMENT CRITERION 2 
    A claim is adjusted to determine quantum in terms of the policy. 

    ASSESSMENT CRITERION 3 
    Information from an investigation is collated and recommendations are made for settlement, rejection, potential recovery and/or damaged property for assessment. 

    ASSESSMENT CRITERION 4 
    A report is presented in the required format. 

    ASSESSMENT CRITERION 5 
    Suggestions are made to improve the risk with reference to the nature of the risk and future precautions. 


    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 planning an investigation, making a decision to engage an expert and recommending settlement. 

    UNIT STANDARD CCFO ORGANISING 
    Learners are capable of organising and managing their activities responsibly and effectively in working systematically and accurately while conducting a loss investigation. 

    UNIT STANDARD CCFO COLLECTING 
    Learners are capable of collecting, organising and critically evaluating information in assessing damages. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are capable of communicating clearly in presenting a report in the required format. 

    UNIT STANDARD CCFO SCIENCE 
    Learners are capable of using technology effectively and critically in conducting an on-site investigation and in using digital cameras and computer technology for administration and communication with clients and claimants. 

    UNIT STANDARD CCFO DEMONSTRATING 
    Learners are capable of seeing the world as a set of related systems in assessing damages and establishing proximate cause. 

    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
    Core  61529   National Certificate: Loss Adjusting  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.
     
    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.