Google Links

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

Elements and Performance Criteria

1. Monitor claims to support decision-making process
   • Establish monitoring procedures to ensure that validity of claim is assessed against organisational and policy acceptance criteria for relevant type and category of policy
   • Monitor claims practices to ensure that information used to determine claim validity is accurate, comprehensive and authentic
2. Decide on legal liability and indemnity of claim
   • Review relevant information and data to determine legal liability and indemnity of claim
   • Make decisions that comply with relevant legislation, organisational procedures and underwriting guidelines
   • Review decisions to ensure accuracy and that compliance requirements are fully met
3. Provide stakeholders with accurate, timely advice regarding legal liability and indemnity of claim
   • Provide stakeholders with consistent, accurate and timely advice regarding claim
   • Provide technical and non-technical claims advice to claims specialists, including review of outgoing correspondence and negotiation and settlement strategies, as appropriate
   • Provide stakeholders with accurate and timely advice regarding legal liability and indemnity of claim
   • Convey decisions within timeframes to ensure performance targets are achieved
4. Review decisions and identify any required policy or procedural changes
   • Evaluate and review decisions against requirements and outcomes on regular basis
   • Ensure review process identifies extent to which decisions support process of accepting and managing claim
   • Ensure review process identifies extent to which decisions support setting of accurate claim portfolio reserves
   • Document circumstances of claims and decisions concerning legal liability and indemnity of claim for consideration in portfolio review
   • Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate
5. Update records
   • Document actions, procedures and outcomes, and record promptly and accurately
   • Maintain finalised documentation according to organisational policy and legislative requirements and codes of practice, as applicable

Performance Evidence

Evidence of the ability to:

effectively establish and implement monitoring processes

make decisions on legal liability and indemnity within given parameters

advise clients of decisions in a timely manner

initiate changes to policies and procedures to better support organisational goals

document all aspects of the process

apply organisational policy and procedures, and comply with legislation, regulations and industry codes of practice in the determination and provision of legal and indemnity advice associated with a claim.

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

---

Knowledge Evidence

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

explain the claims management process

outline data analysis techniques and procedures

identify and outline key features of relevant legislation, regulatory guidelines and industry sector codes of practice as they apply to legal liability and indemnity in insurance claims

outline information technology and communications systems

explain the principles and practice of loss adjustment

outline key features of organisational policy, procedures, insurance guidelines and levels of authority

outline and explain the importance of wording of insurance policies in keeping with the organisation or industry sector

explain risk prevention and loss minimisation methods and application

identify types and categories of insurance policies.

---