Assessor Resource

FNSISV509A
Analyse financial, medical and psychological claims assessments

Assessment tool

Version 1.0
Issue Date: May 2024


This unit applies to job roles involving specialist knowledge and functions in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases. It may be applied to areas of claims assessment involving personal injury, long-term settlement and/or complex claims.

This unit describes the performance outcomes, skills and knowledge required to arrange financial, medical or psychological assessments to support the claims assessment process and to analyse and report on the results.

This unit is applicable to individuals working within enterprises and job roles subject to licensing, legislative, regulatory or certification requirements including legislation administered by the Australian Securities and Investments Commission (ASIC).

You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)

Employability Skills

This unit contains employability skills.



Evidence Required

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.

The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.

Overview of assessment

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Evidence of the ability to:

interpret and adapt to circumstances in which specialist assistance should be sought in resolution of a claim

analyse claims information to determine the need for specialist assistance and application of skills to monitor the specialist assistance and interpret and report on the outcomes of the specialist advice in relation to the claim context.

Context of and specific resources for assessment

Assessment must ensure:

competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment

access to and the use of a range of common office equipment, technology, software and consumables

access to organisation records

access to organisation policies and procedures.

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, are appropriate for this unit:

evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency

observing processes and procedures in workplaces

verbal or written questioning on underpinning knowledge and skills

evaluating samples of work

accessing and validating third party reports

setting and reviewing workplace projects and business simulations or scenarios.

Guidance information for assessment

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

Required skills

highly developed communication skills to:

determine and confirm information, using questioning and active listening as required

relate effectively to customers

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

well-developed numeracy and IT skills to:

perform calculations related to achieving required outcomes

use computer applications (word processing, spreadsheet, database, specific purpose computer systems) to assist in achieving required outcomes

access and update records electronically

access web-based information services

well-developed literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information

learning skills to maintain knowledge of changes to compliance legislation and requirements

problem solving skills to identify any issues that have the potential to impact on work outcomes and to develop options to resolve these issues when they arise

self-management skills for complying with ethical, legal and procedural requirements research and analysis skills for accessing and interpreting relevant information

organisational skills, including the ability to plan and sequence work

Required knowledge

analysis practices and guidelines

claims management

data analysis techniques/procedures

policy coverage/requirements

principles of cost estimating

relevant legislation and industry codes of practice

roles/responsibilities of financial, medical and psychological specialists

types/categories of insurance policies

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Specialist assistance may include:

accountants

chemists

consultants

legal

medical personnel

psychologist/psychiatrist

valuers.

Assessment activities may include:

consultation

credit and character checks

desktop and other research

financial checks

interviews

medical/physical examinations

psychological testing

surveys

valuations.

Documentation may include:

reasons for adopting/incorporating certain data/information preferred over other data/information

records of assessment documents/findings/reports

records of telephone conversations

reference to all assessment data/information considered

specialist/other correspondence related to the assessment process

the basis on which recommendations on the assessment outcome in relation to the claim were determined.

Stakeholders may include:

claimants

claims managers/specialists

insurance broker

underwriters

other relevant parties.

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Facts, evidence and information, including fraud indicators, relevant to the circumstances of loss/damage/injury, are reviewed thoroughly, systematically and accurately 
The need to appoint specialist assistance to undertake a financial, medical, or psychological assessment is identified and determined promptly and accurately and conveyed to the client and other relevant parties 
Appointed specialists are engaged as required and thoroughly briefed 
Assessment activity progress is monitored and reported to relevant parties, as appropriate, and adherence to timelines ensured 
Financial, medical or psychological assessment data is analysed and assessed for thoroughness and consistency 
Analysis tools to assess financial, medical and/or psychological assessments are used to calculate loss damages 
Validity of loss situation and/or claims is assessed fairly and impartially against the assessment data and analysed against reported circumstances, available evidence, facts and information 
Insurance cover/policy conditions are reviewed to ensure loss falls within policy coverage 
Assessment actions, procedures and outcomes are documented and recorded promptly and accurately 
Reporting includes recommendations on the validity of the claim and recovery amounts in relation to the assessment and other relevant data 
Stakeholders are provided with accurate and timely advice regarding the financial, medical or psychological assessment for claim proceedings 

Forms

Assessment Cover Sheet

FNSISV509A - Analyse financial, medical and psychological claims assessments
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

FNSISV509A - Analyse financial, medical and psychological claims assessments

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: