Elements and Performance Criteria
- Determine terms and conditions of settlement
- Non-routine aspects of the claim are determined and evaluated in light of the policy wording and the general policy of the organisation
- Organisation claims procedures for non-routine/complex claims are followed where required
- Settlement terms are determined according to policy wording, legislation, organisation operating procedures and codes of practice, taking into account the non-routine aspects of the claim
- Type and level of variation to standard claims settlement is identified in order to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied
- Negotiate and communicate settlement terms
- Terms and conditions of settlement offer are promptly advised to client and/or relevant party, according to claims procedures
- Response by client and/or relevant party to terms of settlement offer is considered to assess whether adjustment is required
- Settlement terms are negotiated where required to reach mutual agreement, to meet obligations and to minimise unnecessary loss to the organisation
- Negotiated settlements are supported with suitable documentation that clearly states agreements reached
- Terms of settlement offer are modified as necessary and client and/or relevant party advised promptly
- Document liability decisions
- Decisions are clearly communicated to the relevant parties in a manner required by the legislation, operating procedures and codes of practice
- Decisions are documented in such a way as to determine the basis on which the decision was reached and all the evidence/information that was considered
- Any aspects of the claim relevant to policy wording and general organisation policy are communicated to relevant personnel
- Finalise settlement
- Identify any required changes to policy or procedures
- Report findings and update records
- Actions, procedures and outcomes are documented and recorded promptly and accurately
- Stakeholders are provided with accurate and timely advice regarding the claim settlement
- Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable