Application
This unit describes the skills and knowledge required to apply diagnostic and mathematical skills to determine liability and extent of loss. It encompasses analysis of information obtained through loss investigation and includes evaluation of recovery rights and success relating to a loss situation, and determining the extent of loss, damage or injury.
It applies to individuals who use specialised knowledge, analytical skills and systematic approaches and techniques for problem solving and evaluating information and data in a range of situations.
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.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Determine whether loss is covered by insurance or other criteria | 1.1 Accurately and thoroughly collect relevant evidence, facts and information 1.2 Review insurance policy conditions to determine whether loss falls within policy coverage |
2. Apply and analyse established facts | 2.1 Assess validity of claim against reported circumstances and policy specifications 2.2 Accurately and consistently identify fraud indicators 2.3 Apply appropriate analysis techniques, and prioritise and assess data thoroughly 2.4 Document data analysis techniques and procedures, and record promptly and accurately |
3. Determine extent of loss, damage or injury | 3.1 Determine extent of liability and loss against available evidence and facts and in accordance with legislative and/or insurers, or client, or organisational policy and guidelines 3.2 Ensure extent of loss or damage determined is consistent with assessment of and nature of claim, and is within legislative, insurer, client or organisational constraints |
4. Establish recovery rights | 4.1 Identify all other contributory insurances 4.2 Identify and assess all cases for potential subrogation action 4.3 Identify sources and rights of recovery and evaluate likelihood of recovery success 4.4 Correctly issue recovery demands, where necessary |
Evidence of Performance
Evidence of the ability to:
maintain and apply thorough knowledge of types and categories of insurance policies, industry codes of practice and relevant legislation
apply loss adjusting principles and practice to evaluate claims
effectively use data analysis and evaluation techniques to verify validity of claims.
Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.
Evidence of Knowledge
To complete the unit requirements safely and effectively, the individual must:
outline the 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
insurable interest
loss adjusting principles and practice
policy coverage and requirements
principles of cost estimating, recovery and salvage methods
relevant contract and commercial law principles
relevant insurance law legislation and industry codes of practice
subrogation
types or categories of insurance policies
explain the key requirements of industry codes of practice and relevant legislation
identify the types and categories of insurance policies within the domain of insurance loss adjusting
identify the types of liabilities to be considered in assessing loss.
Assessment Conditions
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.
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill | Performance Criteria | Description |
Reading | 1.1, 1.2, 2.1- 2.3, 3.1, 4.1-4.3 | Critically analyses complex documentation from a variety of sources and consolidates information relating to specific criteria to determine requirements |
Writing | 1.1, 2.4, 4.4 | Accurately records and completes organisational documents and correspondence using clear language and correct spelling, grammar and terminology |
Numeracy | 2.3, 3.1, 3.2 | Performs mathematical calculations to analyse financial information, costs and values to accurately determine performance |
Navigate the world of work | 2.1, 2.2, 3.1, 3.2, 4.1, 4.2 | Takes full responsibility for following policies, procedures and legislative requirements and identifies organisational implications of new legislation or regulations |
Get the work done | 1.1, 1.2, 2.2, 2.3, 3.1, 4.1-4.3 | Accepts responsibility for planning and sequencing complex tasks and workload, negotiating key aspects with others and taking into account capabilities, efficiencies and effectiveness Applies systematic and analytical decision-making processes for complex and non-routine situations Uses the main features and functions of digital tools to complete work tasks and access information |
Sectors
Insurance loss adjusting