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. Assess claim and determine liability | 1.1 Gather claim information from a range of sources in accordance with organisation guidelines and legislative requirements 1.2 Review validity of claim in accordance with organisation and legislative requirements 1.3 Return invalid claims or information to claimant for correction 1.4 Enter claims into organisation claims management system in accordance with organisation guidelines, codes of practice and time requirements 1.5 Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities |
2. Identify potential risk indicators | 2.1 Identify areas of risk within claim from the injured person or the service provider 2.2 Use information collected during the claims registration process to assess the risk of the claim 2.3 Follow organisational procedures and use appropriate tools to identify and manage risks factors that may escalate 2.4 Follow organisation procedures for escalation |
3. Facilitate interaction and consult with stakeholders | 3.1 Plan and implement strategies in consultation with stakeholders 3.2 Document referral process with stakeholders’ involvement 3.3 Record stakeholder interaction in accordance with legislative and organisation standards 3.4 Record agreed actions and undertakings as outlined by stakeholders 3.5 Identify and document contingency and corrective action plans 3.6 Determine medical liability in consultation with stakeholders and related parties 3.7 Prepare case for conference in accordance with organisation guidelines 3.8 Undertake agreed actions as a result of conferencing |
Evidence of the ability to:
collect accurate information during the claims registration process, in particular the return to work (RTW), return to health status of the claim and the nature of the injury
assess claims, determine entitlements and identify any fraud indicators within claim applications
facilitate interaction with relevant stakeholders, demonstrating knowledge of organisational claims processing requirements
interpret and apply relevant legislative requirements regarding claims processing.
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:
explain the operations of organisational claims management information technology systems
describe the key features of organisational policy and procedures as they relate to the capture, processing and management of personal injury claims
identify a range of potential risk and fraud indicators relevant to personal injury claims
describe the key features of relevant personal injury legislation
identify and describe the key roles of relevant stakeholder parties within the personal injury sectors to manage personal injury claims effectively.
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.