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. Determine terms and conditions of settlement | 1.1 Determine and evaluate non-routine aspects of claim in light of policy wording and general policy of organisation 1.2 Follow organisational claims procedures for non-routine and complex claims, where required 1.3 Determine settlement terms according to policy wording, legislation, organisational operating procedures and codes of practice, taking into account non-routine aspects of claim and parties involved 1.4 Identify type and level of variation to standard claims settlement to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied |
2. Negotiate and communicate settlement terms | 2.1 Advise promptly client and/or relevant party terms and conditions of settlement offer according to claims procedures 2.2 Consider response by client and/or relevant party to terms of settlement offer to assess whether adjustment is required 2.3 Negotiate settlement terms, where required, to reach mutual agreement, meet obligations and minimise unnecessary loss to organisation 2.4 Support negotiated settlements with suitable documentation that clearly states agreements reached 2.5 Modify terms of settlement offer as necessary and advise client and/or relevant party promptly |
3. Document liability decisions | 3.1 Clearly communicate decisions to relevant parties in manner required by legislation, operating procedures and codes of practice 3.2 Document decisions in such a way as to determine basis on which decision was reached and all evidence and information that was considered 3.3 Communicate to relevant personnel any aspects of claim relevant to policy wording and general organisational policy |
4. Finalise settlement | 4.1 Make final payments in required timeframe once settlement is reached 4.2 Obtain settlement release from client and/or third party, as applicable 4.3 Obtain discharge to ensure any potential for further liability is eliminated |
5. Identify any required changes to policy or procedures | 5.1 Document circumstances of claim for consideration in portfolio review 5.2 Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate |
6. Report findings and update records | 6.1 Document actions, procedures and outcomes and record promptly and accurately 6.2 Provide stakeholders with accurate and timely advice regarding claim settlement 6.3 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable |
Evidence of the ability to:
recognise claims that are non-routine and complex
determine settlement terms by evaluating available data and through negotiation
document future revised terms of claim based on review of non-routine claims and communicate to relevant people
manage financial transactions and settlement documentation
modify or report on potential changes to organisational policy and procedures to protect the organisation from future losses
document and file all activities for future reference.
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:
outline the key features of organisational policy, procedures, insurance guidelines, levels of authority and accountabilities relevant to non-routine and complex claims
describe the application of legal precedents
identify dispute resolution bodies
state the level and conditions at which claim should be referred to senior staff
explain organisational business objectives relative to non-routine and complex claims
outline the key features of relevant legislation, regulatory guidelines and industry sector compliance requirements and codes of practice as they apply to:
insurance contracts
insurance claims
consumer protection
define the rights of subrogation (the more complex the claim, the more parties may be involved)
identify the roles, responsibilities and jurisdiction of specialists and other authorities
discuss the types and categories of insurance policies and insurance trends in non-routine and complex claims.
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:
organisational records
organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
a range of common technology and software.
Assessors must satisfy NVR/AQTF assessor requirements.