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. Prepare for negotiation

1.1. All relevant issues and options for settlement are accurately identified in advance

1.2. Additional information to support identified options is obtained from relevant sources and parties

1.3. Cost-benefit analysis is carried out on the various options identified

1.4. Settlement options are documented and prepared accurately and in a professional format prior to negotiations, and are in accordance with client or organisation policy and guidelines and with relevant legislation or codes of practice

2. Attend meetings with involved parties

2.1. All information and data needed for settlement meetings are documented and prepared accurately and in a professional format prior to meetings

2.2. Meetings of involved parties are arranged and conducted in an orderly, courteous, and professional manner to ensure resolution of issues and settlement

2.3. Outcomes of meetings between involved parties are documented accurately and promptly and are conveyed to clients and all other parties

2.4. Wherever appropriate, all documents and information processed as part of the loss adjustment activities are made available to other involved parties promptly

3. Represent clients in cases where disputation arises

3.1. Clients or organisational interests are satisfactorily represented and all relevant documents and information are provided to other involved parties

3.2. Disputations are managed courteously and professionally to ensure the best and most expeditious outcome for clients or organisations at minimum monetary and other costs

Required skills

well-developed communication skills to:

interview, consult and negotiate with clients and others

determine and confirm information, using questioning and active listening as required

make effective presentations

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

numeracy and IT skills to:

perform calculations related to achieving required outcomes

use computer applications (word processing, spreadsheet, database, specific purpose computer systems) to assist in achieving required outcomes

access and update records electronically

access web-based information services

well-developed literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information

research and analysis skills for accessing and interpreting relevant information

organisational skills, including the ability to plan and sequence work

analytical, evaluative and deductive reasoning skills

Required knowledge

claims management processes and procedures

insurance and contract law principles

loss adjusting principles and practice

recovery

relevant legislation and industry codes of practice

relevant policy coverage and requirements

risk management and minimisation principles and techniques

salvage and disposal methods

subrogation

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

follow loss adjusting practices and principles

apply security practices and principles

use risk management/minimisation practices.

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.

Settlement may include:

acceptance or denial of claim

monetary pay out

reinstatement or replacement

repair

withdrawal of claim.

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.

Relevant legislation may include:

building or construction

Consumer Credit Codes

contracts law

environmental

hazardous materials

Insurance Agents and Brokers Act

Insurance Contracts Act

motor vehicle

occupational health and safety (OHS)

Privacy Act

Trade Practices Act.

Documents may include:

interview records

legal, government, professional and other documents

meeting notes

minutes

official, general and other correspondence

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

records of telephone conversations

reference to all evidence and information considered

reports from others such as loss adjusters, assessors, insurers, medical providers and others

the basis on which the decision was determined

time sheets.

Representing clients in disputations may involve:

formal legal proceedings

informal meetings between involved parties

more formal conciliation.

Costs may include:

administrative

legal

money

professional

reputation

time.

Unit sector

Insurance loss adjusting

ELEMENT

PERFORMANCE CRITERIA

This unit contains employability skills.