Assessor Resource

FNSISV522
Work with legal teams to resolve non-routine and complex insurance claims

Assessment tool

Version 1.0
Issue Date: May 2024


This unit describes the skills and knowledge required to support legal proceedings to resolve non-routine and complex insurance claims. It involves establishing terms of reference for working with a legal team, providing timely and accurate information to support the legal proceedings for the claim, and participating in the settlement of a non-routine, complex claim that involves legal resolution.

The unit applies to those who work with legal teams to resolve non-routine, complex insurance claims, such as major losses, bodily injury losses and long-term settlement.

Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Users are advised to check with the relevant state and territory regulatory authorities to confirm those requirements.

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


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 candidate must demonstrate the ability to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including evidence of the ability to:

work with a legal team during the resolution of at least two different insurance claims, where:

at least one claim is a non-routine insurance claim

at least one claim is a complex insurance claim.

The candidate must be able to demonstrate knowledge to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including knowledge of:

legislative requirements, regulatory guidelines, organisational policies and procedures, and industry sector codes of practice that apply to legal proceedings involving complex insurance claim resolution

key features of claims management process

contract and commercial law principles relevant to insurance claim settlements

roles, responsibilities and jurisdiction of specialists and other authorities applicable to resolving complex insurance claims, including key roles of legal teams and other stakeholders, including medical personnel

data analysis techniques and procedures

loss adjusting principles and practices relevant to complex insurance claims

underwriting guidelines and levels of authority relevant to insurance claim settlements

insurance fundamentals and methods to interpret, comprehend and apply policy wording

international and domestic legal systems relevant to resolving complex insurance claims

fundamentals of mediation and negotiation activities related to complex insurance claims

research methodologies and practices relevant to resolving complex insurance claims

principles of managing matters before court in a cost efficient manner that focuses on beneficial outcomes for own organisation

principles of rules of evidence and information gathering, including importance of accurate documentation for legal proceedings

types and categories of insurance policies.

Skills in this unit must be demonstrated in a workplace or simulated environment where the conditions are typical of those in a working environment in this industry.

This includes access to:

organisational records

organisational policies, procedures, legislation and regulations as they relate to contracts of insurance

common technology and software required to resolve insurance claims.

Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.

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.

The candidate must demonstrate the ability to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including evidence of the ability to:

work with a legal team during the resolution of at least two different insurance claims, where:

at least one claim is a non-routine insurance claim

at least one claim is a complex insurance claim.

The candidate must be able to demonstrate knowledge to complete the tasks outlined in the elements, performance criteria and foundation skills of this unit, including knowledge of:

legislative requirements, regulatory guidelines, organisational policies and procedures, and industry sector codes of practice that apply to legal proceedings involving complex insurance claim resolution

key features of claims management process

contract and commercial law principles relevant to insurance claim settlements

roles, responsibilities and jurisdiction of specialists and other authorities applicable to resolving complex insurance claims, including key roles of legal teams and other stakeholders, including medical personnel

data analysis techniques and procedures

loss adjusting principles and practices relevant to complex insurance claims

underwriting guidelines and levels of authority relevant to insurance claim settlements

insurance fundamentals and methods to interpret, comprehend and apply policy wording

international and domestic legal systems relevant to resolving complex insurance claims

fundamentals of mediation and negotiation activities related to complex insurance claims

research methodologies and practices relevant to resolving complex insurance claims

principles of managing matters before court in a cost efficient manner that focuses on beneficial outcomes for own organisation

principles of rules of evidence and information gathering, including importance of accurate documentation for legal proceedings

types and categories of insurance policies.

Skills in this unit must be demonstrated in a workplace or simulated environment where the conditions are typical of those in a working environment in this industry.

This includes access to:

organisational records

organisational policies, procedures, legislation and regulations as they relate to contracts of insurance

common technology and software required to resolve insurance claims.

Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.
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
Establish comprehensive terms of reference and instructions applicable to legal proceedings for claim 
Identify terms of reference and confirm they are within organisational and legislative guidelines, codes of practice and personal authorities, and are documented accordingly 
Negotiate, confirm and document roles and responsibilities of parties involved in legal proceedings for claim 
Identify requirements and procedures of legal system involved in claim proceedings 
Identify legal team representatives and obtain information requirements 
Engage with legal team to identify legal data and information sources and discuss applicable options for obtaining requested legal data and information 
Obtain facts, evidence and information applicable to claims proceedings 
Research and analyse additional historical and legal data, as required 
Identify information deficiencies and seek additional information 
Provide legal data and information to legal team in compliance with organisational policies and procedures, and compliance, ethical and legal requirements 
Obtain instructions and receipt of legal advice pertaining to claim 
Communicate with legal teams and other applicable parties as required and expedite insurance claim resolution 
Negotiate timelines for provision of required documents to legal team within agreed timeframes 
Clarify conflicting evidence and information according to organisational and legislative requirements, codes of practice, and other relevant guidelines and ensure settlement payments comply with relevant policies 
Document all actions, procedures and outcomes in supporting legal team within required timeframes 
Participate in mediation and negotiation activities, as required 
Initiate meeting with instructing legal practitioner to discuss settlement meeting and review settlement documents 
Check and exchange documentation with required parties 
Draft letter of confirmation of settlement, and forward to instructing legal practitioner for review and despatch to required parties 
Inform stakeholders of claim outcome according to organisational policies and procedures 
Document and record actions, procedures and outcomes according to organisational policies and procedures, legislative requirements, and codes of practice 
Provide stakeholders with advice regarding claim settlement 

Forms

Assessment Cover Sheet

FNSISV522 - Work with legal teams to resolve non-routine and complex insurance claims
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

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Assessor name:

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Assessment Record Sheet

FNSISV522 - Work with legal teams to resolve non-routine and complex insurance claims

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:

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