Elements and Performance Criteria
- Establish requirements of legal proceedings for insurance claim
- Establish comprehensive terms of reference or instructions relevant to legal proceedings for non-routine and complex claim
- Check terms of reference to ensure they are within organisational and legislative guidelines, codes of practice and personal authorities, and are clearly documented
- Negotiate, confirm and document roles and responsibilities of all parties involved in legal proceedings for claim
- Clarify requirements and procedures of legal systems involved in claim proceedings, including domestic and/or other relevant countries
- Provide relevant claims information to legal team
- Identify legal team representatives and confirm information requirements
- Discuss options for obtaining legal data and information, and identify sources of legal data and information
- Collect facts, evidence and information relevant to claims proceedings thoroughly, systematically and accurately
- Research historical data, as required
- Analyse legal data and information for relevance
- Identify information deficiencies and seek additional information from appropriate sources
- Provide legal data and information to legal team in compliance with organisational policy and procedures, compliance, ethical and legal requirements and within required timeframes and authorities
- Support legal process from claims perspective
- Ensure instructions for and receipt of legal advice pertaining to claim occurs as required
- Liaise with legal team, doctors or other relevant parties as required to expedite insurance claim resolution
- Ensure documents passed as part of legal proceedings comply with organisational, regulatory and legislative considerations
- Negotiate timelines for provision of relevant documents to legal team and ensure they are adhered to
- Ensure insurers manage matters before court in a manner that achieves best and most expeditious resolution and at minimum cost
- Employ all appropriate methods within organisational, legislative, codes of practice or other guidelines to clarify conflicting evidence or information
- Document all actions, procedures and outcomes in supporting legal team and record promptly
- Participate in settlement arrangements
- Participate in mediation and negotiation activities as required
- Arrange meeting with instructing legal practitioner to discuss settlement meeting and review settlement documents
- Attend settlement meeting at prescribed venue
- Check documentation to ensure it is correct
- Exchange documentation with appropriate parties
- Draft letter of confirmation of settlement, forward to instructing legal practitioner for review and despatch to relevant parties
- Register, lodge and record relevant documents as appropriate
- Inform stakeholders of outcome
- Report outcomes and update records