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

Describe the control of fraud in Long-term Insurance 
SAQA US ID UNIT STANDARD TITLE
119261  Describe the control of fraud in Long-term Insurance 
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 4  NQF Level 04  3 
REGISTRATION STATUS REGISTRATION START DATE REGISTRATION END DATE SAQA DECISION NUMBER
Passed the End Date -
Status was "Reregistered" 		 2018-07-01  2023-06-30  SAQA 06120/18 
LAST DATE FOR ENROLMENT LAST DATE FOR ACHIEVEMENT
2026-06-30   2029-06-30  

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 replaces: 
US ID Unit Standard Title Pre-2009 NQF Level NQF Level Credits Replacement Status
14318  Describe the control of fraud in Long Term Insurance  Level 4  NQF Level 04  3   

PURPOSE OF THE UNIT STANDARD 
This Unit Standard introduces the concept of fraud and its control in Long-term Insurance. It is intended for Long-term underwriters, claims assessors, intermediaries and learners in policy servicing, service centres, legal departments and new business.

The qualifying learner is capable of:
  • Describing fraud as it occurs in Long-term insurance.
  • Explaining legal aspects relating to fraud in Long-term insurance.
  • Describing internal processes around the investigation of fraud in Long-term insurance.
  • Analysing trends and the impact of fraud in Long-term insurance.
  • Explaining control mechanisms used to contain fraud in Long-term insurance. 
    		•

    LEARNING ASSUMED TO BE IN PLACE AND RECOGNITION OF PRIOR LEARNING 
  • Communication at NQF Level 3.
  • Mathematical Literacy at NQF Level 3.
  • Computer Literacy at NQF Level 3. 
    		•

    UNIT STANDARD RANGE 
  • Parties who could commit fraud include employees, policyholders, brokers/intermediaries, fund managers and Trustees.
  • Fraudulent activity could be identified in claims, reports, phone calls, private investigators, internal and external auditors, information received and other documents.
  • Legislation governing fraud includes, where applicable: The Law of Evidence; the role of the Long-term Ombudsman; the Long-term Insurance Act and LOA codes; the Medical Schemes Act; Income Tax Act; Health Professionals' Act; Long-term Insurance Act; Pharmacy Act; Law of Contract; Policy Holder Protection and FAIS legislation.
  • The impact of fraud on Long-term insurance includes restrictions and policy fees.
  • Measures to control fraud could include: Tracking names of applicants; public information from the Department of Home Affairs; tracking commission history and the S referencing of intermediaries.
  • Insurance business includes, but is not limited to: Underwriting; claims assessing; policy servicing; pricing and sales. 
    		•

    Specific Outcomes and Assessment Criteria: 

    SPECIFIC OUTCOME 1 
    Describe fraud as it occurs in Long-term insurance. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The concept of fraud is explained with authentic Long-term insurance examples. 

    ASSESSMENT CRITERION 2 
    Areas in the industry where fraud could be committed are identified for Long-term insurance and an indication is given of the parties who could be involved in fraud for each possible area. 

    ASSESSMENT CRITERION 3 
    Possible indicators of fraudulent activity are identified and an indication is given of further evidence required to substantiate fraud in each case. 

    ASSESSMENT CRITERION 4 
    A portfolio of evidence of fraud is collected for three case studies involving at least three different parties. 

    SPECIFIC OUTCOME 2 
    Explain legal aspects relating to fraud in Long-term insurance. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Legislation governing fraud is identified as it applies in Long-term insurance. 

    ASSESSMENT CRITERION 2 
    The legal recourse available to Long-term insurers in cases of fraud is identified with authentic examples of each. 

    ASSESSMENT CRITERION 3 
    The consequences of committing insurance fraud are explained for at least three different parties. 

    ASSESSMENT CRITERION 4 
    The impact of fraud is explained in relation to the impact that it has on insurance business. 

    SPECIFIC OUTCOME 3 
    Describe internal processes around the investigation of fraud in Long-term insurance. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    The internal policy relating to fraud is described for a particular Long-term insurer. 

    ASSESSMENT CRITERION 2 
    The procedure followed if fraud is suspected is explained with reference to a particular Long-term insurer. 

    ASSESSMENT CRITERION 3 
    The process followed in order to gather evidence and present a case is described with reference to a particular Long-term insurer. 

    ASSESSMENT CRITERION 4 
    Tools that are available for information management are described with reference to a particular Long-term insurer. 

    ASSESSMENT CRITERION 5 
    The importance of confidentiality in an assessment investigation is explained and an indication is given of the possible consequences if there is a breach of confidence. 

    SPECIFIC OUTCOME 4 
    Analyse trends and the impact of fraud in Long-term insurance. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    A case study of a data set is compiled and trends in the data are identified to provide a benchmark against which to measure suspicious incidences in own work situation. 

    ASSESSMENT CRITERION 2 
    Data is analysed to establish trends in statistics generated by a Long-term insurer. 

    ASSESSMENT CRITERION 3 
    A recommendation for possible corrective measures is made, based on an identified trend or suspicious incident. 

    SPECIFIC OUTCOME 5 
    Explain control mechanisms used to contain fraud in Long-term insurance. 

    ASSESSMENT CRITERIA     

    ASSESSMENT CRITERION 1 
    Possible control measures that could be used to manage fraud are listed for at least three parties. 

    ASSESSMENT CRITERION 2 
    The risk if a Long-term insurer does not implement adequate control measures is explained with reference to the Long-term insurer, providers and policyholders. 


    UNIT STANDARD ACCREDITATION AND MODERATION OPTIONS 
  • An individual wishing to be assessed (including through RPL) against this unit standard may apply to an assessment agency, assessor or provider institution accredited by the relevant ETQA or an ETQA that has a Memorandum of Understanding with the relevant ETQA.
  • Anyone assessing a learner against this unit standard must be registered as an assessor with the relevant ETQA or with an ETQA that has a Memorandum of Understanding with the relevant ETQA.
  • Any institution offering learning that will enable achievement of this unit standard or assessing this unit standard must be accredited as a provider with the relevant ETQA, or with an ETQA that has a Memorandum of Understanding with the relevant ETQA.
  • Moderation of assessment will be conducted by the relevant ETQA according to the policies and guidelines for assessment and moderation of that ETQA, at its discretion, in terms of agreements reached about assessment and moderation between various ETQAs (including professional bodies). 
    		•

    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 able to identify and solve problems in recommending possible corrective measures when suspicious incidences or trends are identified. 

    UNIT STANDARD CCFO COLLECTING 
    Learners are able to collect, organise and critically evaluate information in gathering evidence and presenting a case and to describe the control of fraud in Long-term insurance. 

    UNIT STANDARD CCFO COMMUNICATING 
    Learners are able to communicate effectively in explaining concepts and the consequences of fraud and presenting a portfolio of evidence. 

    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 using a computer system to manage fraud. 

    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 in understanding the effect of fraud in Long-term insurance on different parties. 

    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 
    This unit standard replaces unit standard 14318, "Describe the control of fraud in Long Term Insurance", Level 4, 3 credits. 

    QUALIFICATIONS UTILISING THIS UNIT STANDARD: 
      ID QUALIFICATION TITLE PRE-2009 NQF LEVEL NQF LEVEL STATUS END DATE PRIMARY OR DELEGATED QA FUNCTIONARY
    Core  49649   Further Education and Training Certificate: Long-term Insurance  Level 4  NQF Level 04  Passed the End Date -
    Status was "Reregistered"     		 2023-06-30  INSETA 
    Elective  49529   Further Education and Training Certificate: Long-Term Risk Assessment  Level 4  NQF Level 04  Passed the End Date -
    Status was "Reregistered"     		 2023-06-30  INSETA 
    Elective  66613   Further Education and Training Certificate: Wealth Management  Level 4  NQF Level 04  Passed the End Date -
    Status was "Reregistered"     		 2023-06-30  As per Learning Programmes recorded against this Qual 


    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.