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Follow the links below to find material targeted to the unit's elements, performance criteria, required skills and knowledge

Elements and Performance Criteria

1. Clarify brief and instructions
   • Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required
   • Check subject matter questions to be investigated
2. Investigate claim
   • Determine method of investigation
   • Collect and organise required information to make logical case
   • Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable
   • Record all data and information progressively and accurately
   • File and store securely all original documents, tapes, photographs and other material
   • Prepare and communicate appropriate changes in brief or instructions
   • Comply with any changes in brief or instructions
3. Report on investigation
   • Prepare and transmit comprehensive reports according to reporting guidelines
   • Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person
   • Give facts and justification for conclusions to insurer’s nominated person
   • Make recommendations for action, with appropriate justifications, where required

Performance Evidence

Evidence of the ability to:

use appropriate investigation methodologies and maintain accurate records

comply with relevant legislation and regulatory requirements in investigating a claim

produce complete and accurate investigation reports

provide detailed scoping for investigating insurance claims including in-scope and out-of-scope areas

develop options to resolve issues or problems that have the potential to impact on work outcomes during investigations.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once

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Knowledge Evidence

To complete the unit requirements safely and effectively, the individual must:

outline key requirements of industry sector legal obligations and organisational procedures in relation to investigating claims

describe and implement appropriate investigation methods including:

interviews

surveillance

internet research

document authentication

observation

identify key features of relevant legislation, regulatory guidelines and industry sector codes of practice as they apply to:

insurance contracts

consumer protection

privacy

insurance investigation

explain the importance of report writing conventions in insurance investigations.

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