This unit applies to job roles in the loss adjusting sector and may be applied within organisations of various sizes and across a range of customer bases.

ELEMENT

PERFORMANCE CRITERIA

1. Determine whether loss is covered by insurance or other criteria

1.1. Relevant evidence, facts and information are collected accurately and thoroughly

1.2. Insurance policy conditions are reviewed to determine whether loss falls within policy coverage

2. Apply and analyse established facts

2.1. Validity of claim is assessed against reported circumstances and policy specifications

2.2. Fraud indicators are identified accurately and consistently

2.3. Appropriate analysis techniques are applied and data is prioritised and assessed thoroughly

2.4. Data analysis techniques and procedures are documented and recorded promptly and accurately

3. Determine extent of loss/damage/injury

3.1. Extent of liability and loss is determined against available evidence and facts and in accordance with legislative and/or insurers, or client, or organisation policy and guidelines

3.2. Extent of loss/damage determined is consistent with the assessment of and nature of claim and is within legislative, insurer, client or organisation constraints

4. Establish recovery rights

4.1. All other contributory insurances are identified

4.2. All cases for potential subrogation action are identified and assessed

4.3. Sources and rights of recovery are identified and likelihood of recovery success is evaluated

4.4. Recovery demands are correctly issued where necessary

Required knowledge

business mathematics and statistics

claims management

data analysis techniques/procedures

insurable interest

loss adjusting principles and practice

policy coverage/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/categories of insurance policies

The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.

Overview of assessment

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Evidence of the ability to:

maintain and use thorough knowledge of types and categories of insurance policies, industry codes of practice and relevant legislation

apply loss adjusting principles and practice

effectively use data analysis and evaluation techniques.

Context of and specific resources for assessment

Assessment must ensure:

competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment

access to and the use of a range of common office equipment, technology, software and consumables

access to organisation records

access to organisational policies and procedures.

Method of assessment

A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, are appropriate for this unit:

evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency

observing processes and procedures in workplaces

verbal or written questioning on underpinning knowledge and skills

evaluating samples of work

accessing and validating third party reports

setting and reviewing workplace projects and business simulations or scenarios.

Guidance information for assessment

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.

Types and categories of insurance policies include:

accidental damage

additional benefits

boiler explosion

burglary/theft

business interruption

commercial

construction risks

crop

defined events

domestic

fidelity

fire and perils

Industrial Special Risks (ISR)

liability

livestock

machinery breakdown

money

multi-risk

other personal lines

package contracts

sprinkler leakage

transit

travel.

Documentation may include:

reasons for adopting/incorporating certain evidence/information preferred over other evidence/information

reference to all evidence/information considered

the basis on which the decision was determined.

Liability includes:

broadform

construction

directors and officers

environment

pollution

products

professional indemnity

public.

Relevant legislation may include:

building or construction

Consumer Credit Code

contract law

environmental

hazardous materials

Insurance Agents and Brokers Act

Insurance Contracts Act

motor vehicle

occupational health and safety (OHS)

Privacy Act

secrecy laws

Trade Practices Act.

Client or organisation policy and guidelines may include:

Australasian Institute of Chartered Loss Adjusters (AICLA) Charter of Objects and Professional Conduct

claims

clerical

codes of practice

complaints and dispute resolution procedures

information technology and administrative systems

loss

loss recovery

policies and procedures in relation to risks.

Sources of recovery may include:

liable parties

other insurers

sale of goods

salvage and disposal.

Rights of recovery may include:

contribution

industry agreements

reinsurance

salvage

subrogation.

Unit sector

Insurance loss adjusting

This unit contains employability skills.