Assessor Resource

FNSPIM302A
Determine claim liability

Assessment tool

Version 1.0
Issue Date: May 2024


This unit applies to claims management job roles in the personal injury management sector.

This unit describes the performance outcomes, skills and knowledge required to process a personal injury claim in accordance with organisation guidelines and procedures. It encompasses all aspects of processing a claim including possible claim rejection.

This unit may apply to job roles subject to licensing, legislative, regulatory or certification requirements so Commonwealth, State or Territory requirements should be confirmed with the relevant body.

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:

receive and clarify information and determine the status of a claim using organisation guidelines and regulatory requirements

document liability decision using organisation guidelines, demonstrating knowledge of relevant Acts and regulations and organisation policies and procedures

analyse information to draw meaningful conclusions

read and interpret insurance policies, reports and related documents.

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.

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

communication skills to:

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

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

numeracy and IT skills to:

perform calculations related to achieving required outcomes

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

access and update records electronically

use internet information

literacy skills to:

read and interpret documentation from a variety of sources and record and consolidate relevant related information

interpret accountability requirements

manage organisation and claims classifications

understand organisation delegation and authority levels

follow organisation policies and procedures

understand policy coverage, interpretation and application

research and analysis skills for accessing and interpreting relevant information into meaningful terms

effective interpersonal skills

organisation skills, including the ability to plan and sequence work

Required knowledge

analysis and research methods

analysis and organising data into meaningful terms

decision making processes

insurance policies, reports and related documents

organisation claims processing software

organisation operating procedures to assist with determining claim liability

relevant workers compensation, personal injury Acts and regulatory requirements

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.

Claim information may include identifying:

data

policy

previous history with the organisation

risk.

Organisation procedures may include:

initiation of new claims

processing of routine claims.

Specialists may include organisation specialists or outside service providers such as:

accountants

allied health practitioners

investigators

legal providers

loss assessors

medical practitioners.

Referral procedures may involve:

referral to the next level of authority.

Decisions may involve:

consultation

fact finding

research.

Filing may include:

electronic

paper documents.

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
Claim information is received and entered into relevant organisation systems 
Claim is processed in accordance with required timeframes and according to relevant Acts, regulations and organisation procedures 
Correspondence is completed in accordance with organisation policies and procedures, and is allocated to relevant claims personnel 
Clients are advised of organisation claims procedures and queries are responded to in an appropriate manner 
Claim information is checked for accuracy and validity in accordance with organisation policies and procedures 
All information is analysed against regulatory requirements and organisation guidelines to determine liability 
Claims are referred to specialists where required and in accordance with organisation guidelines 
Liability decision is made in accordance with organisation guidelines, regulatory requirements, industry codes of practice and defined timeframes 
Referral procedures are observed where claim amounts are outside settlement and/or claims management authority 
Decision on liability is determined considering review and feedback from external stakeholders 
Liability decisions are communicated to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice 
Reasons for decisions are communicated promptly to clients and other relevant stakeholders 
Decisions are documented and filed to demonstrate the basis on which the claim decision was determined, including all evidence and information that was considered, where appropriate 

Forms

Assessment Cover Sheet

FNSPIM302A - Determine claim liability
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

FNSPIM302A - Determine claim liability

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: