Functional Assessments against policy criteria

Outcome

  • Written report
  • Test results for whether the policy criteria are met
  • Additional relevant information to support claims management

Method of delivery

Purpose of the Service

To assess the function of the individual against a set of criteria provided by the claims assessor

What is a Functional Assessment?

This assessment is individually designed according to each situation so that the assessor is able to objectively identify whether the individual meets the specific policy criteria. For example to ascertain whether a claimant meets the criteria for total and permanent disability or assessing Instrumental Activities of Daily Living (IADLs) for a critical illness policy.

The assessment would usually involve clinical examination followed by testing of the individual carrying out each of the specific activity criteria provided and observation of functional activities. Other elements may be included depending on the referrer's requirements.

A written report is provided with results of the testing and assessment and any recommendations or further information to assist the claims management.

Who is this suitable for?

This type of assessment is used where it is unclear whether a claimant meets specific policy criteria to assist the claims assessor to manage the claim.

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