Unit of Competency Mapping – Information for Teachers/Assessors – Information for Learners

FNSILA501 Mapping and Delivery Guide
Plan and implement loss investigation

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSILA501 - Plan and implement loss investigation
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to use high level analytical, liaison and planning skills to interact with clients, authorities and specialists in coordinating loss investigations that determine the extent of loss, damage or injury.It applies to individuals who, within their level of responsibility, use specialised knowledge and organisational skills to coordinate a range of activities to ensure thorough and accurate completion of activities.Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance loss adjusting field of work and include access to:

organisational records

organisational policy, procedures, legislation and regulations as they relate to contracts of insurance

common office equipment, technology, software and consumables.

Assessors must satisfy NVR/AQTF assessor requirements.

Prerequisites/co-requisites
Competency Field
Development and validation strategy and guide for assessors and learners Student Learning Resources Handouts
Activities 		Slides
PPT 		Assessment 1 Assessment 2 Assessment 3 Assessment 4
Elements of Competency Performance Criteria              
Element: Receive instructions from client
  • Establish comprehensive terms of reference or instructions that meet requirements of relevant parties prior to engagement
  • Promptly advise relevant parties of decisions to accept or reject terms of reference or instructions and reasons for such decisions
  • Negotiate, confirm and clearly document acceptable terms and instructions that are within client or organisational policy and legislative guidelines, codes of practice and personal authorities
       
Element: Establish relevant facts
  • Thoroughly, systematically and accurately collect facts, evidence and information relevant to circumstances of loss, damage or injury
  • Identify information deficiencies and obtain additional from appropriate sources
  • Assess validity of loss situation and/or claim fairly and impartially against reported circumstances, available evidence, facts and information
  • Determine insurance cover for loss, damage or injury where applicable and review policy conditions to ensure loss falls within policy coverage
  • Establish contractual and/or other obligations of each party to circumstances under enquiry
  • Accurately and consistently identify fraud indicators
  • Organise all relevant facts, evidence and information, and document confidentially into coherent body of case knowledge
       
Element: Plan and implement loss investigation
  • Analyse available facts, evidence and information to determine viable course of action and appropriate investigative activities
  • Assess investigative activities for appropriateness to loss situation and compliance with relevant legislation, codes of practice, insurers, client, organisational or other guidelines
  • Identify and determine requirements for urgent action to protect client interests
  • Establish appropriate and confidential channels of communication with clients and other relevant parties
  • Establish and maintain professional and cordial relationships with all relevant parties during investigation
  • Establish and maintain comprehensive records of investigative activities, methodology and time spent during investigations
       
Element: Preserve evidence
  • Progressively collate all evidence gathered, and record promptly and accurately
  • Preserve evidence gathered by appropriate means for subsequent assessment and enquiry
       
Element: Liaise with authorities
  • Liaise with all appropriate authorities whenever and wherever required
  • Receive clearance or authorisation for investigative activities from appropriate authorities, where required, and record promptly
       
Element: Verify and document information
  • Regularly review facts, evidence and information gathered and assess for thoroughness and consistency
  • Employ all appropriate methods within client, organisational, legislative, code of practice or other guidelines to clarify conflicting evidence or information
  • Promptly and accurately document and record investigative actions, procedures and outcomes
       
Element: Appoint specialists
  • Promptly and accurately determine need to appoint specialist assistance and convey to client and other relevant parties
  • Engage appointed specialists as required and brief thoroughly
       


Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive instructions from client

1.1 Establish comprehensive terms of reference or instructions that meet requirements of relevant parties prior to engagement

1.2 Promptly advise relevant parties of decisions to accept or reject terms of reference or instructions and reasons for such decisions

1.3 Negotiate, confirm and clearly document acceptable terms and instructions that are within client or organisational policy and legislative guidelines, codes of practice and personal authorities

2. Establish relevant facts

2.1 Thoroughly, systematically and accurately collect facts, evidence and information relevant to circumstances of loss, damage or injury

2.2 Identify information deficiencies and obtain additional from appropriate sources

2.3 Assess validity of loss situation and/or claim fairly and impartially against reported circumstances, available evidence, facts and information

2.4 Determine insurance cover for loss, damage or injury where applicable and review policy conditions to ensure loss falls within policy coverage

2.5 Establish contractual and/or other obligations of each party to circumstances under enquiry

2.6 Accurately and consistently identify fraud indicators

2.7 Organise all relevant facts, evidence and information, and document confidentially into coherent body of case knowledge

3. Plan and implement loss investigation

3.1 Analyse available facts, evidence and information to determine viable course of action and appropriate investigative activities

3.2 Assess investigative activities for appropriateness to loss situation and compliance with relevant legislation, codes of practice, insurers, client, organisational or other guidelines

3.3 Identify and determine requirements for urgent action to protect client interests

3.4 Establish appropriate and confidential channels of communication with clients and other relevant parties

3.5 Establish and maintain professional and cordial relationships with all relevant parties during investigation

3.6 Establish and maintain comprehensive records of investigative activities, methodology and time spent during investigations

4. Preserve evidence

4.1 Progressively collate all evidence gathered, and record promptly and accurately

4.2 Preserve evidence gathered by appropriate means for subsequent assessment and enquiry

5. Liaise with authorities

5.1 Liaise with all appropriate authorities whenever and wherever required

5.2 Receive clearance or authorisation for investigative activities from appropriate authorities, where required, and record promptly

6. Verify and document information

6.1 Regularly review facts, evidence and information gathered and assess for thoroughness and consistency

6.2 Employ all appropriate methods within client, organisational, legislative, code of practice or other guidelines to clarify conflicting evidence or information

6.3 Promptly and accurately document and record investigative actions, procedures and outcomes

7. Appoint specialists

7.1 Promptly and accurately determine need to appoint specialist assistance and convey to client and other relevant parties

7.2 Engage appointed specialists as required and brief thoroughly

Evidence of the ability to:

receive instructions and establish relevant facts

plan and coordinate loss investigations

apply loss adjusting principles and practice, and investigative practices and guidelines relevant to various types of insurance loss or damage

use fraud detection, control and prevention principles to check validity of claims

accurately document activities and liaise effectively with relevant authorities and specialists.

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

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

identify and describe the types and categories of insurance policies

outline key features of:

business mathematics and statistics relevant to assessing insurance loss

data analysis techniques and procedures

identify and explain the key features of insurance loss, including:

claims management

fraud detection, control and prevention principles

rules of evidence, and information gathering and documenting principles

insurable interest

investigative practices and guidelines

loss adjusting principles and practice

policy coverage and requirements

principles of cost estimating

subrogation

explain relevant contract and commercial law principles, and the key features of insurance law

identify and explain the key features of relevant legislation and industry codes of practice

identify and describe the roles, responsibilities and jurisdiction of specialists and other authorities.

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assignment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive instructions from client

1.1 Establish comprehensive terms of reference or instructions that meet requirements of relevant parties prior to engagement

1.2 Promptly advise relevant parties of decisions to accept or reject terms of reference or instructions and reasons for such decisions

1.3 Negotiate, confirm and clearly document acceptable terms and instructions that are within client or organisational policy and legislative guidelines, codes of practice and personal authorities

2. Establish relevant facts

2.1 Thoroughly, systematically and accurately collect facts, evidence and information relevant to circumstances of loss, damage or injury

2.2 Identify information deficiencies and obtain additional from appropriate sources

2.3 Assess validity of loss situation and/or claim fairly and impartially against reported circumstances, available evidence, facts and information

2.4 Determine insurance cover for loss, damage or injury where applicable and review policy conditions to ensure loss falls within policy coverage

2.5 Establish contractual and/or other obligations of each party to circumstances under enquiry

2.6 Accurately and consistently identify fraud indicators

2.7 Organise all relevant facts, evidence and information, and document confidentially into coherent body of case knowledge

3. Plan and implement loss investigation

3.1 Analyse available facts, evidence and information to determine viable course of action and appropriate investigative activities

3.2 Assess investigative activities for appropriateness to loss situation and compliance with relevant legislation, codes of practice, insurers, client, organisational or other guidelines

3.3 Identify and determine requirements for urgent action to protect client interests

3.4 Establish appropriate and confidential channels of communication with clients and other relevant parties

3.5 Establish and maintain professional and cordial relationships with all relevant parties during investigation

3.6 Establish and maintain comprehensive records of investigative activities, methodology and time spent during investigations

4. Preserve evidence

4.1 Progressively collate all evidence gathered, and record promptly and accurately

4.2 Preserve evidence gathered by appropriate means for subsequent assessment and enquiry

5. Liaise with authorities

5.1 Liaise with all appropriate authorities whenever and wherever required

5.2 Receive clearance or authorisation for investigative activities from appropriate authorities, where required, and record promptly

6. Verify and document information

6.1 Regularly review facts, evidence and information gathered and assess for thoroughness and consistency

6.2 Employ all appropriate methods within client, organisational, legislative, code of practice or other guidelines to clarify conflicting evidence or information

6.3 Promptly and accurately document and record investigative actions, procedures and outcomes

7. Appoint specialists

7.1 Promptly and accurately determine need to appoint specialist assistance and convey to client and other relevant parties

7.2 Engage appointed specialists as required and brief thoroughly

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Establish comprehensive terms of reference or instructions that meet requirements of relevant parties prior to engagement 
Promptly advise relevant parties of decisions to accept or reject terms of reference or instructions and reasons for such decisions 
Negotiate, confirm and clearly document acceptable terms and instructions that are within client or organisational policy and legislative guidelines, codes of practice and personal authorities 
Thoroughly, systematically and accurately collect facts, evidence and information relevant to circumstances of loss, damage or injury 
Identify information deficiencies and obtain additional from appropriate sources 
Assess validity of loss situation and/or claim fairly and impartially against reported circumstances, available evidence, facts and information 
Determine insurance cover for loss, damage or injury where applicable and review policy conditions to ensure loss falls within policy coverage 
Establish contractual and/or other obligations of each party to circumstances under enquiry 
Accurately and consistently identify fraud indicators 
Organise all relevant facts, evidence and information, and document confidentially into coherent body of case knowledge 
Analyse available facts, evidence and information to determine viable course of action and appropriate investigative activities 
Assess investigative activities for appropriateness to loss situation and compliance with relevant legislation, codes of practice, insurers, client, organisational or other guidelines 
Identify and determine requirements for urgent action to protect client interests 
Establish appropriate and confidential channels of communication with clients and other relevant parties 
Establish and maintain professional and cordial relationships with all relevant parties during investigation 
Establish and maintain comprehensive records of investigative activities, methodology and time spent during investigations 
Progressively collate all evidence gathered, and record promptly and accurately 
Preserve evidence gathered by appropriate means for subsequent assessment and enquiry 
Liaise with all appropriate authorities whenever and wherever required 
Receive clearance or authorisation for investigative activities from appropriate authorities, where required, and record promptly 
Regularly review facts, evidence and information gathered and assess for thoroughness and consistency 
Employ all appropriate methods within client, organisational, legislative, code of practice or other guidelines to clarify conflicting evidence or information 
Promptly and accurately document and record investigative actions, procedures and outcomes 
Promptly and accurately determine need to appoint specialist assistance and convey to client and other relevant parties 
Engage appointed specialists as required and brief thoroughly 

Forms

Assessment Cover Sheet

FNSILA501 - Plan and implement loss investigation
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

FNSILA501 - Plan and implement loss investigation

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: