List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Receive instructions from client | 1.1 Establish comprehensive terms of reference or instructions that meet requirements of relevant parties prior to engagement 1.2 Promptly advise relevant parties of decisions to accept or reject terms of reference or instructions and reasons for such decisions 1.3 Negotiate, confirm and clearly document acceptable terms and instructions that are within client or organisational policy and legislative guidelines, codes of practice and personal authorities |
2. Establish relevant facts | 2.1 Thoroughly, systematically and accurately collect facts, evidence and information relevant to circumstances of loss, damage or injury 2.2 Identify information deficiencies and obtain additional from appropriate sources 2.3 Assess validity of loss situation and/or claim fairly and impartially against reported circumstances, available evidence, facts and information 2.4 Determine insurance cover for loss, damage or injury where applicable and review policy conditions to ensure loss falls within policy coverage 2.5 Establish contractual and/or other obligations of each party to circumstances under enquiry 2.6 Accurately and consistently identify fraud indicators 2.7 Organise all relevant facts, evidence and information, and document confidentially into coherent body of case knowledge |
3. Plan and implement loss investigation | 3.1 Analyse available facts, evidence and information to determine viable course of action and appropriate investigative activities 3.2 Assess investigative activities for appropriateness to loss situation and compliance with relevant legislation, codes of practice, insurers, client, organisational or other guidelines 3.3 Identify and determine requirements for urgent action to protect client interests 3.4 Establish appropriate and confidential channels of communication with clients and other relevant parties 3.5 Establish and maintain professional and cordial relationships with all relevant parties during investigation 3.6 Establish and maintain comprehensive records of investigative activities, methodology and time spent during investigations |
4. Preserve evidence | 4.1 Progressively collate all evidence gathered, and record promptly and accurately 4.2 Preserve evidence gathered by appropriate means for subsequent assessment and enquiry |
5. Liaise with authorities | 5.1 Liaise with all appropriate authorities whenever and wherever required 5.2 Receive clearance or authorisation for investigative activities from appropriate authorities, where required, and record promptly |
6. Verify and document information | 6.1 Regularly review facts, evidence and information gathered and assess for thoroughness and consistency 6.2 Employ all appropriate methods within client, organisational, legislative, code of practice or other guidelines to clarify conflicting evidence or information 6.3 Promptly and accurately document and record investigative actions, procedures and outcomes |
7. Appoint specialists | 7.1 Promptly and accurately determine need to appoint specialist assistance and convey to client and other relevant parties 7.2 Engage appointed specialists as required and brief thoroughly |
Evidence of the ability to:
receive instructions and establish relevant facts
plan and coordinate loss investigations
apply loss adjusting principles and practice, and investigative practices and guidelines relevant to various types of insurance loss or damage
use fraud detection, control and prevention principles to check validity of claims
accurately document activities and liaise effectively with relevant authorities and specialists.
Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.
To complete the unit requirements safely and effectively, the individual must:
identify and describe the types and categories of insurance policies
outline key features of:
business mathematics and statistics relevant to assessing insurance loss
data analysis techniques and procedures
identify and explain the key features of insurance loss, including:
claims management
fraud detection, control and prevention principles
rules of evidence, and information gathering and documenting principles
insurable interest
investigative practices and guidelines
loss adjusting principles and practice
policy coverage and requirements
principles of cost estimating
subrogation
explain relevant contract and commercial law principles, and the key features of insurance law
identify and explain the key features of relevant legislation and industry codes of practice
identify and describe the roles, responsibilities and jurisdiction of specialists and other authorities.
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance loss adjusting field of work and include access to:
organisational records
organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
common office equipment, technology, software and consumables.
Assessors must satisfy NVR/AQTF assessor requirements.