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Elements and Performance Criteria

  1. Establish the requirements of legal proceedings for an insurance claim
  2. Provide relevant claims information to the legal team
  3. Support the legal process from a claims/underwriting perspective
  4. Participate in settlement arrangements
  5. Report outcomes and update records

Required Skills

Required skills

highlydeveloped communication skills to

determine and confirm information using questioning and active listening as required

relate effectively to customers

liaise with others share information listen and understand

use language and concepts appropriate to cultural differences

welldeveloped numeracy and IT skills to

perform calculations related to achieving required outcomes

use computer applications word processing spreadsheet database specific purpose computer systems to assist in achieving required outcomes

access and update records electronically

access webbased information services

welldeveloped literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information

learning skills to maintain knowledge of changes to compliance legislation and requirements

problem solving skills to identify any issues that have the potential to impact on work outcomes and to develop options to resolve these issues when they arise

selfmanagement skills for complying with ethical legal and procedural requirements research and analysis skills for accessing and interpreting relevant information

organisational skills including the ability to plan and sequence work

Required knowledge

claims management

contract and commercial law principles

data analysis techniques and procedures

insurance law relevant legal systems and procedures relevant acts

IT and communications systems

loss adjusting principles and practice

organisation policy procedures underwriting guidelines and authorities

policy coverage requirements and policy wording

relevant industry compliance requirements legislation and industry codes of practice

research methodologies and practices

risk preventionloss minimisation methods and application

roles responsibilities and jurisdiction of specialists and other authorities

rules of evidence and information gathering and documenting principles

types and categories of insurance policies

Evidence Required

The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria required skills and knowledge range statement and the Assessment Guidelines for the Training Package

Overview of assessment

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Evidence of the ability to

interpret and apply organisation policy and procedures and compliance with legislation and regulations and industry codes of practice in working with legal teams in all aspects of the managing the legal process associated with a claim and resolving the legal aspects of a claim

Context of and specific resources for assessment

Assessment must ensure

competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment

access to and the use of a range of common office equipment technology software and consumables

access to organisation records

access to organisation policies and procedures

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge The following examples in combination are appropriate for this unit

evaluating an integrated activity which combines the elements of competency for the unit or a cluster of related units of competency

observing processes and procedures in workplaces

verbal or written questioning on underpinning knowledge and skills

evaluating samples of work

accessing and validating third party reports

setting and reviewing workplace projects and business simulations or scenarios

Guidance information for assessment


Range Statement

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Terms of reference or instructions may include:

date and location of loss, damage or injury

estimate of loss, damage or injury

instructions for scope of information required

insurers reference

legal procedures and timelines associated with the claim

name of insured and initial contact

other parties involved

period of insurance

policy cover

policy number

proposed documents to be passed

type.

Non-routine and complex claims may involve:

claims involving legal procedures, including those that involve working across international boundaries

claims involving long-term settlements

complex claims involving major losses/bodily injury losses

complex technical determinations

high monetary impact

important client base.

Non-routine aspects may include:

disputes in other jurisdictions

special inclusions and exclusions.

Legal data and information may include:

claimant medical history

claimant medical records and reports

claimant test results

correspondence to a range of medical/hospital professionals on claimant related matters

forms

interview records

legal case reports

legal, government, professional and other documents

letters

meeting notes

minutes

official, general, other correspondence

policy documents (including current and archival policies relevant to the claim)

records of telephone conversations

reports from others such as loss adjusters, assessors, insurers, medical providers, rehabilitation providers and others as applicable

time sheets.

Sources of legal data/information may include:

employer and industry associations

employers

insurance brokers

legal team members

loss adjusters, specialist and other claims staff

medical and like providers

rehabilitation providers

relevant data bases and documentation:

legal

insurance

organisation

risk managers

the community

underwriters

union

work team members.

Historical data may include:

archival policies.

Documentation may include:

legal team reports, correspondence and records

legal, government, professional and other documents

meeting notes

minutes

official, general and other correspondence

reasons for recommending certain actions and decisions over others

records of telephone conversations

reference to all data and information considered

reports from others such as:

loss adjusters

assessors

insurers

medical providers

others

the basis on which the decision was determined.

Stakeholders may include:

broker or agent

claims managers and specialists

client

government or statutory authorities

insurance broker

insured

principal

reinsurers

third party

trustee

underwriters

other relevant parties.