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

FNSPIM504 Mapping and Delivery Guide
Manage impairment benefit claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSPIM504 - Manage impairment benefit claims
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to manage impairment benefit claims within the personal injury management context. It encompasses collecting, analysing and using appropriate information and criteria to assess and estimate the degree of impairment to calculate and pay the correct entitlement.It applies to individuals who have well-developed skills and a broad knowledge base of the sector, services and organisation, and take responsibility for case and/or technical management of impairment claims.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 personal injury management field of work and include access to:

office equipment, technology, software and consumables

relevant legislation and regulation

appropriate assessment criteria including AMA Guides, Gazetted Guidelines and case law

organisational records, policy and procedures.

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: Determine nature of impairment benefit claim and collect required information
  • Review impairment benefit claim to determine nature of claim and estimate degree of impairment
  • Determine type and sources of information and guidelines required to make impairment benefit liability decision
  • Collect information required for decision-making process, including accessing appropriate services and referrals to independent assessors as required
       
Element: Determine liability for impairment benefit
  • Undertake thorough and systematic review of facts, evidence and information relevant to circumstances of impairment claim
  • Follow organisational procedures to determine liability of claimed injury for impairment benefit
  • Use appropriate criteria and guidelines for basis of making sound and sustainable liability decision
       
Element: Manage impairment benefit claims process
  • Determine and apply appropriate legislative, regulatory and organisational policy and procedures to manage impairment benefit claims
  • Identify stakeholders in impairment benefit process and determine strategies to manage stakeholder relationships
  • Use appropriate IT systems to collect, analyse, store and access required information
  • Use appropriate criteria to calculate correct entitlement
  • Use effective and appropriate strategies to communicate impairment decisions to claimant
  • Pay entitlement and finalise claim according to organisational procedures
       


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. Determine nature of impairment benefit claim and collect required information

1.1 Review impairment benefit claim to determine nature of claim and estimate degree of impairment

1.2 Determine type and sources of information and guidelines required to make impairment benefit liability decision

1.3 Collect information required for decision-making process, including accessing appropriate services and referrals to independent assessors as required

2. Determine liability for impairment benefit

2.1 Undertake thorough and systematic review of facts, evidence and information relevant to circumstances of impairment claim

2.2 Follow organisational procedures to determine liability of claimed injury for impairment benefit

2.3 Use appropriate criteria and guidelines for basis of making sound and sustainable liability decision

3. Manage impairment benefit claims process

3.1 Determine and apply appropriate legislative, regulatory and organisational policy and procedures to manage impairment benefit claims

3.2 Identify stakeholders in impairment benefit process and determine strategies to manage stakeholder relationships

3.3 Use appropriate IT systems to collect, analyse, store and access required information

3.4 Use appropriate criteria to calculate correct entitlement

3.5 Use effective and appropriate strategies to communicate impairment decisions to claimant

3.6 Pay entitlement and finalise claim according to organisational procedures

Evidence of the ability to:

interpret and comply with legislative, regulatory and organisational requirements and procedures relating to impairment benefit claims

make sound decisions based on the application of appropriate criteria and the analysis of medical and other information to determine the degree of impairment

accurately calculate and pay the appropriate benefit

effectively communicate decisions to key stakeholders.

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:

define and describe a permanent impairment and a total loss injury

identify and describe the different types of impairment benefits

explain legislative and regulatory requirements applicable to personal injury insurance impairment claims management, including:

relevant primary federal, state or territory personal injury insurance legislation

other applicable federal, state or territory legislation governing areas such as privacy, records management, and disability and equal opportunity

outline industry protocols and organisational policy and procedures specific to impairment claims

explain the role of impairment assessment guidelines and criteria, including:

Gazetted Guidelines

American Medical Association (AMA) Guides

case law

outline the fundamental principles of application of assessment guides relating to:

spine

upper extremities

lower extremities

psychiatry

nervous system

hearing loss

ear, nose and throat (ENT)

respiratory

scarring and dermatology

describe the key sources of information, medical specialities and referral processes to independent assessors relevant to impairment benefits.

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. Determine nature of impairment benefit claim and collect required information

1.1 Review impairment benefit claim to determine nature of claim and estimate degree of impairment

1.2 Determine type and sources of information and guidelines required to make impairment benefit liability decision

1.3 Collect information required for decision-making process, including accessing appropriate services and referrals to independent assessors as required

2. Determine liability for impairment benefit

2.1 Undertake thorough and systematic review of facts, evidence and information relevant to circumstances of impairment claim

2.2 Follow organisational procedures to determine liability of claimed injury for impairment benefit

2.3 Use appropriate criteria and guidelines for basis of making sound and sustainable liability decision

3. Manage impairment benefit claims process

3.1 Determine and apply appropriate legislative, regulatory and organisational policy and procedures to manage impairment benefit claims

3.2 Identify stakeholders in impairment benefit process and determine strategies to manage stakeholder relationships

3.3 Use appropriate IT systems to collect, analyse, store and access required information

3.4 Use appropriate criteria to calculate correct entitlement

3.5 Use effective and appropriate strategies to communicate impairment decisions to claimant

3.6 Pay entitlement and finalise claim according to organisational procedures

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
Review impairment benefit claim to determine nature of claim and estimate degree of impairment 
Determine type and sources of information and guidelines required to make impairment benefit liability decision 
Collect information required for decision-making process, including accessing appropriate services and referrals to independent assessors as required 
Undertake thorough and systematic review of facts, evidence and information relevant to circumstances of impairment claim 
Follow organisational procedures to determine liability of claimed injury for impairment benefit 
Use appropriate criteria and guidelines for basis of making sound and sustainable liability decision 
Determine and apply appropriate legislative, regulatory and organisational policy and procedures to manage impairment benefit claims 
Identify stakeholders in impairment benefit process and determine strategies to manage stakeholder relationships 
Use appropriate IT systems to collect, analyse, store and access required information 
Use appropriate criteria to calculate correct entitlement 
Use effective and appropriate strategies to communicate impairment decisions to claimant 
Pay entitlement and finalise claim according to organisational procedures 

Forms

Assessment Cover Sheet

FNSPIM504 - Manage impairment benefit claims
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

FNSPIM504 - Manage impairment benefit claims

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: