Elements and Performance Criteria
- Establish the requirements of legal proceedings for an insurance claim
- Comprehensive terms of reference or instructions relevant to the legal proceedings for the non-routine and complex claim are established
- Terms of reference are checked to ensure they are within organisation and legislative guidelines, codes of practice and personal authorities and are clearly documented
- Roles and responsibilities of all parties involved in the legal proceedings for the claim are negotiated, confirmed and documented
- Requirements and procedures of legal systems involved in the claim proceedings, including domestic and/or other relevant countries, are clarified
- Provide relevant claims information to the legal team
- Legal team representatives are identified and information requirements confirmed
- Options for obtaining the legal data/information are discussed and sources of legal data/information are identified
- Facts, evidence and information relevant to claims proceedings, is collected thoroughly, systematically and accurately
- Historical data is researched, as required
- Legal data/information is analysed for relevance
- Information deficiencies are identified and additional information is sought from appropriate sources
- Legal data and information is provided to legal team in compliance with organisation policies and procedures, compliance, ethical and legal requirements and within required timeframes and authorities
- Support the legal process from a claims/underwriting perspective
- Instructions for and receipt of legal advice pertaining to the claim occurs as required
- Liaison with legal team, doctors or other relevant parties occurs as required to expedite insurance claim resolution
- Documents passed as part of the legal proceedings comply with organisation, regulatory and legislative considerations
- Timelines are negotiated for provision of relevant documents to the legal team and adhered to
- Insurers manage matter before the court in a matter that achieves the best and most expeditious resolution at minimum cost
- All appropriate methods within organisation, legislative, codes of practice or other guidelines are employed to clarify conflicting evidence or information
- All actions, procedures and outcomes in supporting the legal team are documented and recorded promptly
- Participate in settlement arrangements
- Participation in mediation and negotiation activities occurs, as required
- Meeting is arranged with instructing legal practitioner to discuss settlement meeting and to review settlement documents
- Settlement meeting is attended at prescribed venue
- Documentation is checked to ensure it is correct
- Documentation is exchanged with the appropriate parties
- Letter of confirmation of settlement is drafted, forwarded to instructing legal practitioner for review and despatched to relevant parties
- Relevant documents are registered/lodged/recorded as appropriate
- Stakeholders are informed of outcome
- Report outcomes and update records