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: 

Determine policy response to a specific incident 
SAQA US ID UNIT STANDARD TITLE
255858  Determine policy response to a specific incident 
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  10 
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 claims 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 finalisation on behalf of an insurer. It will enable learners to evaluate presented facts against the contents of a policy, measure variables against the standard and determine whether the policy will respond.

The qualifying learner is capable of:
  • Applying knowledge of the rules of contract.
  • Differentiating between the types of policy.
  • Applying policy conditions to the facts of an incident.
  • Making a recommendation to the principal regarding the application of the policy.
  • Implementing instructions from an insurer to conclude a short term insurance claim. 

  • 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:
  • Analysis of a contract includes, but is not limited to, legal capacity of parties, residual obligations and remedies applicable when a contract is breached.
  • Policy conditions include, but are not limited to, warranties, general terms and conditions, endorsements, exceptions and insured perils.
  • Types of policy include commercial, domestic and other specialised policies.
  • Undefined terminology includes, but is not limited to, proximate cause, duty of care, insurable interest and sudden and unforeseen.
  • Industry specific terminology includes, but is not limited to, excess, deductible, franchise, salvage, recovery, subrogation, full and final settlement, without prejudice, ex gratia, without admitting liability and first amount payable. 

  • Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Apply knowledge of the rules of contract. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The concept of a contract is explained with reference to rights and obligations of the contracting parties and the intention of the contract. 

    ASSESSMENT CRITERION 2 
    A contract is analysed to determine validity. 

    ASSESSMENT CRITERION 3 
    The rules of interpretation of contracts are applied to a short term insurance policy. 

    SPECIFIC OUTCOME 2 
    Differentiate between the types of policy. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    The fields of domestic and commercial cover are analysed and an indication is given of when each field is applicable. 

    ASSESSMENT CRITERION 2 
    The facts of a claim are analysed and an initial call is made as to the type of policy that could cover the event. 

    SPECIFIC OUTCOME 3 
    Apply policy conditions to the facts of an incident. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Policy conditions are applied to the facts of the claim to determine whether cover operates in a particular instance. 

    ASSESSMENT CRITERION 2 
    Undefined terminology used in insurance policies is explained with reference to application in a specific policy. 

    SPECIFIC OUTCOME 4 
    Make a recommendation to the principal regarding the application of the policy. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    A judgement is made as to whether or not there is a loss. 

    ASSESSMENT CRITERION 2 
    Recommendations are made for the settlement of a claim. 

    ASSESSMENT CRITERION 3 
    The implications of a decision to replace, pay in cash or repair are explained with examples. 

    SPECIFIC OUTCOME 5 
    Implement instructions from an insurer to conclude a short term insurance claim. 

    ASSESSMENT CRITERIA
     

    ASSESSMENT CRITERION 1 
    Documents required to finalise a claim settlement are completed with reference to signatories, contractual clauses and correct use of terminology. 

    ASSESSMENT CRITERION 2 
    Industry specific terminology is used in context and an indication is given of the implications and consequences of the use of incorrect terminology. 


    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 concluding the settlement of a claim. 

    UNIT STANDARD CCFO ORGANISING 
    Learners are capable of organising and managing their activities responsibly and effectively in working systematically and accurately to determine policy response to a specific incident. 

    UNIT STANDARD CCFO COLLECTING 
    Learners are capable of collecting, organising and critically evaluating information in identifying the type of policy that could cover an event and policy response to a specific incident. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are capable of communicating clearly in making a recommendation to the principal and explaining the implications of a decision. 

    UNIT STANDARD CCFO SCIENCE 
    Learners are capable of using technology effectively and critically in using in using computer technology for administration and communication with clients and claimants. 

    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.