Assessor Resource

PSPINM004
Make claim determinations

Assessment tool

Version 1.0
Issue Date: March 2024


This unit describes the skills required to assess compensation claims for employment related injuries in order to make a determination. It includes assessing the claim and making a determination.

This unit applies to those working in the area of worker compensation claim assessment.

The skills and knowledge described in this unit must be applied within the legislative, regulatory and policy environment in which they are carried out. Organisational policies and procedures must be consulted and adhered to.

Those undertaking this unit would work independently, while performing routine tasks in a range of familiar contexts.

No licensing, legislative or certification requirements apply to unit at the time of publication.

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.

ELEMENTS

PERFORMANCE CRITERIA

Elements describe the essential outcomes

Performance criteria describe the performance needed to demonstrate achievement of the element. Where bold italicised text is used, further information is detailed in the range of conditions section.

1. Assess claim

1.1 Assess available information to establish if it is sufficient for a determination to be made.

1.2 Identify additional information required, if any, to make the determination.

1.3 Obtain additional information.

1.4 Re-assess information to determine if it is sufficient or if further investigation is required.

1.5 Make a decision to defer where information is insufficient, and consider interim payments where applicable.

2. Make a determination

2.1 Confirm the claimant’s eligibility and the reported condition as compensable under the legislation.

2.2 Assess details of the claim to ensure they qualify for payment.

2.3 Accept or reject the claim based on all available evidence.

2.4 Calculate notional weekly earnings where required.

2.5 Advise the claimant and other relevant parties in writing of the decision, and ensure advice contains all information required by the legislation.

2.6 Complete case records ensuring they contain comprehensive details of the claim and justification for the decision.

Evidence required to demonstrate competence must satisfy all of the requirements of the elements and performance criteria. If not otherwise specified the candidate must demonstrate evidence of performance of the following on at least one occasion.

applying legislation, regulations and policies relating to determination of compensation claims

assessing the sufficiency of information and the requirement for further investigation

analysing information and making judgments

calculating interim payments

reading and applying complex information

using communication with a diverse range of people including employers, unions, workplace supervisors, medical advisers, legal advisers, insurer/self-insurer

Evidence required to demonstrate competence must satisfy all of the requirements of the elements and performance criteria. If not otherwise specified the depth of knowledge demonstrated must be appropriate to the job context of the candidate.

public sector legislation, including work health and safety, and environment

regulations, policies, procedures and guidelines relating to determination of claims

privacy legislation

freedom of information legislation

procedures to ensure confidentiality and security of information

eligibility and compensable conditions under the legislation

expenses that may be claimed

non-economic loss

medical terminology

documentary requirements of a claim

organisational standards for claim determinations

range of payment options under the legislation

This unit contains no specific industry-mandated assessment conditions. Guidance on suggested and recommended conditions and methods can be found in the Implementation Guide.

Assessors must satisfy the NVR/AQTF mandatory competency requirements for assessors.


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.

ELEMENTS

PERFORMANCE CRITERIA

Elements describe the essential outcomes

Performance criteria describe the performance needed to demonstrate achievement of the element. Where bold italicised text is used, further information is detailed in the range of conditions section.

1. Assess claim

1.1 Assess available information to establish if it is sufficient for a determination to be made.

1.2 Identify additional information required, if any, to make the determination.

1.3 Obtain additional information.

1.4 Re-assess information to determine if it is sufficient or if further investigation is required.

1.5 Make a decision to defer where information is insufficient, and consider interim payments where applicable.

2. Make a determination

2.1 Confirm the claimant’s eligibility and the reported condition as compensable under the legislation.

2.2 Assess details of the claim to ensure they qualify for payment.

2.3 Accept or reject the claim based on all available evidence.

2.4 Calculate notional weekly earnings where required.

2.5 Advise the claimant and other relevant parties in writing of the decision, and ensure advice contains all information required by the legislation.

2.6 Complete case records ensuring they contain comprehensive details of the claim and justification for the decision.

Evidence required to demonstrate competence must satisfy all of the requirements of the elements and performance criteria. If not otherwise specified the candidate must demonstrate evidence of performance of the following on at least one occasion.

applying legislation, regulations and policies relating to determination of compensation claims

assessing the sufficiency of information and the requirement for further investigation

analysing information and making judgments

calculating interim payments

reading and applying complex information

using communication with a diverse range of people including employers, unions, workplace supervisors, medical advisers, legal advisers, insurer/self-insurer

Evidence required to demonstrate competence must satisfy all of the requirements of the elements and performance criteria. If not otherwise specified the depth of knowledge demonstrated must be appropriate to the job context of the candidate.

public sector legislation, including work health and safety, and environment

regulations, policies, procedures and guidelines relating to determination of claims

privacy legislation

freedom of information legislation

procedures to ensure confidentiality and security of information

eligibility and compensable conditions under the legislation

expenses that may be claimed

non-economic loss

medical terminology

documentary requirements of a claim

organisational standards for claim determinations

range of payment options under the legislation

This unit contains no specific industry-mandated assessment conditions. Guidance on suggested and recommended conditions and methods can be found in the Implementation Guide.

Assessors must satisfy the NVR/AQTF mandatory competency requirements for assessors.

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
Assess available information to establish if it is sufficient for a determination to be made. 
Identify additional information required, if any, to make the determination. 
Obtain additional information. 
Re-assess information to determine if it is sufficient or if further investigation is required. 
Make a decision to defer where information is insufficient, and consider interim payments where applicable. 
Confirm the claimant’s eligibility and the reported condition as compensable under the legislation. 
Assess details of the claim to ensure they qualify for payment. 
Accept or reject the claim based on all available evidence. 
Calculate notional weekly earnings where required. 
Advise the claimant and other relevant parties in writing of the decision, and ensure advice contains all information required by the legislation. 
Complete case records ensuring they contain comprehensive details of the claim and justification for the decision. 
Assess available information to establish if it is sufficient for a determination to be made. 
Identify additional information required, if any, to make the determination. 
Obtain additional information. 
Re-assess information to determine if it is sufficient or if further investigation is required. 
Make a decision to defer where information is insufficient, and consider interim payments where applicable. 
Confirm the claimant’s eligibility and the reported condition as compensable under the legislation. 
Assess details of the claim to ensure they qualify for payment. 
Accept or reject the claim based on all available evidence. 
Calculate notional weekly earnings where required. 
Advise the claimant and other relevant parties in writing of the decision, and ensure advice contains all information required by the legislation. 
Complete case records ensuring they contain comprehensive details of the claim and justification for the decision. 

Forms

Assessment Cover Sheet

PSPINM004 - Make claim determinations
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

PSPINM004 - Make claim determinations

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: