Application
This unit describes the skills and knowledge required to convey decisions to ensure stakeholders receive accurate, timely advice regarding the legal liability and indemnity of a claim.
It applies to individuals working in roles that require high level communication, analysis and decision-making skills to provide advice on the legal liability and indemnity of a claim to key stakeholders.
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. Monitor claims to support decision-making process | 1.1 Establish monitoring procedures to ensure that validity of claim is assessed against organisational and policy acceptance criteria for relevant type and category of policy 1.2 Monitor claims practices to ensure that information used to determine claim validity is accurate, comprehensive and authentic |
2. Decide on legal liability and indemnity of claim | 2.1 Review relevant information and data to determine legal liability and indemnity of claim 2.2 Make decisions that comply with relevant legislation, organisational procedures and underwriting guidelines 2.3 Review decisions to ensure accuracy and that compliance requirements are fully met |
3. Provide stakeholders with accurate, timely advice regarding legal liability and indemnity of claim | 3.1 Provide stakeholders with consistent, accurate and timely advice regarding claim 3.2 Provide technical and non-technical claims advice to claims specialists, including review of outgoing correspondence and negotiation and settlement strategies, as appropriate 3.3 Provide stakeholders with accurate and timely advice regarding legal liability and indemnity of claim 3.4 Convey decisions within timeframes to ensure performance targets are achieved |
4. Review decisions and identify any required policy or procedural changes | 4.1 Evaluate and review decisions against requirements and outcomes on regular basis 4.2 Ensure review process identifies extent to which decisions support process of accepting and managing claim 4.3 Ensure review process identifies extent to which decisions support setting of accurate claim portfolio reserves 4.4 Document circumstances of claims and decisions concerning legal liability and indemnity of claim for consideration in portfolio review 4.5 Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate |
5. Update records | 5.1 Document actions, procedures and outcomes, and record promptly and accurately 5.2 Maintain finalised documentation according to organisational policy and legislative requirements and codes of practice, as applicable |
Evidence of Performance
Evidence of the ability to:
effectively establish and implement monitoring processes
make decisions on legal liability and indemnity within given parameters
advise clients of decisions in a timely manner
initiate changes to policies and procedures to better support organisational goals
document all aspects of the process
apply organisational policy and procedures, and comply with legislation, regulations and industry codes of practice in the determination and provision of legal and indemnity advice associated with a claim.
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:
explain the claims management process
outline data analysis techniques and procedures
identify and outline key features of relevant legislation, regulatory guidelines and industry sector codes of practice as they apply to legal liability and indemnity in insurance claims
outline information technology and communications systems
explain the principles and practice of loss adjustment
outline key features of organisational policy, procedures, insurance guidelines and levels of authority
outline and explain the importance of wording of insurance policies in keeping with the organisation or industry sector
explain risk prevention and loss minimisation methods and application
identify types and categories of insurance policies.
Assessment Conditions
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:
organisational records
organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
a range of common technology and software.
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 | 1.2, 2.1, 2.3, 3.2, 4.1 | Critically analyses complex documentation from a variety of sources and consolidates information relating to specific criteria to determine requirements |
Writing | 3.1, 3.2, 3.3, 3.4, 4.1, 4.4, 5.1, 5.2 | Accurately records information and prepares correspondence and documentation using clear language and organisational formats and protocols Writes, edits and proofreads documents to ensure clarity of meaning, and accuracy and consistency of information |
Oral Communication | 3.1, 3.2, 3.3, 3.4 | Clearly explains detailed information using language, tone and pace appropriate to the audience Clarifies information effectively using active listening and questioning |
Numeracy | 3.2, 3.3 | Performs mathematical calculations to analyse financial data and statistics to accurately advise on cost of claims and liability |
Navigate the world of work | 1.1, 4.1-4.3, 4.5 | Takes full responsibility for following policies, procedures and legislative requirements and identifies organisational implications of new legislation or regulation Modifies or develops organisational policy and procedures to comply with legislative requirements and organisational goals |
Interact with others | 3.1- 3.4 | Implements strategies for a diverse range of colleagues and clients to build rapport and foster strong relationships Collaborates with others, sharing information to build strong work groups and avoid behaviours that are not conducive to a productive environment |
Get the work done | 1.1, 1.2, 2.2, 2.3, 3.1, 3.2, 3.4, 4.1-4.5, 5.2 | 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 Makes critical decisions quickly and intuitively in complex situations, taking into consideration a range of variables including the outcomes of previous decisions Investigates new and innovative ideas as a means to continuously improve work practices and processes through consultation, and formal and analytical thinking Uses digital technologies to access, enter, check and store information required to complete work tasks |
Sectors
Insurance services