SAQA

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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
14318	Describe the control of fraud in Long Term Insurance
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	3
REGISTRATION STATUS		REGISTRATION START DATE	REGISTRATION END DATE	SAQA DECISION NUMBER
Passed the End Date - Status was "Reregistered"		2004-12-02	2005-10-12	SAQA 1657/04
LAST DATE FOR ENROLMENT		LAST DATE FOR ACHIEVEMENT
2006-10-12		2009-10-12

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
119261	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.

The qualifying learner is capable of:
! Describing fraud as it occurs in long term insurance.
! Demonstrating knowledge and understanding of legal aspects relating to fraud in long term insurance.
! Demonstrating knowledge and understanding of 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

There is open access to this unit standard. Learners should be competent in Communication and Mathematical Literacy at Level 3.

UNIT STANDARD RANGE

The typical scope of this unit standard is:

1. Parties who could commit fraud include employees, policyholders, brokers/intermediaries fund managers and Trustees.
2. Fraudulent activity could be identified in claims, reports, phone calls, private investigators, internal and external auditors, information received and other documents.
3. Legislation governing fraud includes 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.
4. The impact of fraud on long term insurance includes restrictions and policy fees.
5. Legislation includes the Law of Evidence, the role of the long term Ombudsman, the Long Term Insurance Act and LOA codes.
6. Measures to control fraud could include tracking names of applicants, public information from the Department of Home Affairs, tracking commission history and the S rating of intermediaries.

Specific Outcomes and Assessment Criteria:

SPECIFIC OUTCOME 1

Describe fraud as it occurs in long term insurance.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. The concept of fraud is explained with authentic examples.

ASSESSMENT CRITERION 2

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

3. Three possible indicators of fraudulent activity are listed and an indication is given of how these could be identified in practice.

ASSESSMENT CRITERION 4

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

SPECIFIC OUTCOME 2

Demonstrate knowledge and understanding of legal aspects relating to fraud in long term insurance.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. Legislation governing fraud is identified as it applies in long term insurance.

ASSESSMENT CRITERION 2

2. The legal recourse available to long term insurers in cases of fraud are identified with authentic examples of each.

ASSESSMENT CRITERION 3

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

ASSESSMENT CRITERION 4

4. The impact of fraud is explained in relation to the impact that it has on underwriting.

SPECIFIC OUTCOME 3

Demonstrate knowledge and understanding of internal processes.

OUTCOME NOTES

Demonstrate knowledge and understanding of internal processes around the investigation of fraud in long term insurance.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

1. The internal policy relating to fraud is described for a particular long term insurer or case study.

ASSESSMENT CRITERION 2

2. The procedure followed if fraud is suspected is explained with reference to a particular long term insurer or case study.

ASSESSMENT CRITERION 3

3. The process followed in order to gather evidence and present a case is described with reference to a particular long term insurer or a case study.

ASSESSMENT CRITERION 4

4. Tools that are available for information management are described with reference to a particular long term insurer or a case study.

ASSESSMENT CRITERION 5

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

SPECIFIC OUTCOME 4

Analyse trends and the impact of fraud in long term insurance.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

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

2. Data is analysed to establish trends in statistics generated by a long term insurer.

ASSESSMENT CRITERION 3

3. A recommendation for possible corrective measures is made based on an identified trend or suspicious incidence.

ASSESSMENT CRITERION 4

4. The potential impact if fraud is not identified and managed is described for a particular case study.

SPECIFIC OUTCOME 5

Explain control mechanisms used to contain fraud in long term insurance.

ASSESSMENT CRITERIA

ASSESSMENT CRITERION 1

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

ASSESSMENT CRITERION 2

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 policy holders.

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 recommending possible corrective measures when suspicious incidences or trends are identified.

UNIT STANDARD CCFO WORKING

Learners are able to work as a member of a team in following procedures relating to fraud.

UNIT STANDARD CCFO ORGANISING

Learners are able to organise and manage themselves effectively by becoming responsible citizens in identifying incidences of fraud in long term insurance.

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 and the risk if adequate control measures are not in place.

UNIT STANDARD CCFO CONTRIBUTING

Learners are able to act as a responsible citizen in understanding the concept and impact of fraud on long term insurance.

UNIT STANDARD NOTES

This unit standard has been replaced by unit standard, 119261 which is "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	20773	National Certificate: Long Term Insurance	Level 4	NQF Level 04	Passed the End Date - Status was "Registered"	2004-12-05	INSETA
Elective	48493	National Certificate: Financial Services: Wealth Management	Level 4	NQF Level 04	Passed the End Date - Status was "Registered"	2007-02-11	Was INSETA until Last Date for Achievement
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.

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