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 and clarify claim information | 1.1 Enter claim information into relevant organisational systems 1.2 Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures 1.3 Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel 1.4 Advise clients of organisational claims procedures and respond to queries in an appropriate manner 1.5 Check claim information for accuracy and validity in accordance with organisational policy and procedures |
2. Determine status of claim | 2.1 Analyse all information against regulatory requirements and organisational guidelines to determine liability 2.2 Refer claims to internal or external specialists where required and in accordance with organisational guidelines |
3. Accept or reject claim | 3.1 Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes 3.2 Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority 3.3 Determine decision on liability, considering review and feedback from external stakeholders |
4. Document liability decision | 4.1 Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice 4.2 Communicate reasons for decisions promptly to clients and other relevant stakeholders 4.3 Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate |
Evidence of the ability to:
receive and clarify information and determine the status of a claim using organisational guidelines and regulatory requirements
document liability decision using organisational guidelines, and demonstrating knowledge of relevant Acts and regulations and organisational policies and procedures
analyse information to draw meaningful conclusions and determine correct action.
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:
interpret and describe the key features of insurance policies, reports and related documents
describe the key analysis and research methods used to determine claim liability
categorise data into meaningful terms
outline the major steps in claim liability decision-making processes
describe the key features relevant to determining claim liability of:
insurance policies, reports and related documents
organisational claims processing software
organisational operating procedures
relevant workers compensation, personal injury Acts and regulatory requirements.
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the personal injury management field of work and include access to:
office equipment, technology, software and consumables
organisational records, policy and procedures.
Assessors must satisfy NVR/AQTF assessor requirements.