Elements and Performance Criteria
- Determine whether loss is covered by insurance or other criteria
- Apply and analyse established facts
- Validity of claim is assessed against reported circumstances and policy specifications
- Fraud indicators are identified accurately and consistently
- Appropriate analysis techniques are applied and data is prioritised and assessed thoroughly
- Data analysis techniques and procedures are documented and recorded promptly and accurately
- Determine extent of loss/damage/injury
- Extent of liability and loss is determined against available evidence and facts and in accordance with legislative and/or insurers, or client, or organisation policy and guidelines
- Extent of loss/damage determined is consistent with the assessment of and nature of claim and is within legislative, insurer, client or organisation constraints
- Establish recovery rights