This unit requires the application of high level communication, analysis and decision making skills to the provision of advice on the legal liability and indemnity of a claim to key stakeholders (brokers, insured, underwriters, claimants, other relevant parties). It may be applied in the insurance sector of the financial services industry.

ELEMENT

PERFORMANCE CRITERIA

1. Monitor claims to support decision making process

1.1. Monitoring procedures are established to ensure that validity of a claim is assessed against organisation and policy acceptance criteria for relevant type and category of policy

1.2. Claims practices are monitored to ensure that information used to determine claim validity is accurate, comprehensive and authentic

2. Decide on the legal liability and indemnity of a claim

2.1. Relevant information/data is reviewed to determine the legal liability and indemnity of a claim

2.2. Decisions are determined in compliance with relevant legislation, organisation procedures and underwriting guidelines

2.3. Decisions are reviewed to ensure accuracy and compliance requirements are fully met

3. Provide stakeholders with accurate, timely advice regarding the legal liability and indemnity of a claim

3.1. Stakeholders are provided with consistent, accurate and timely advice regarding a claim

3.2. Technical and non-technical claims advice is provided to claims specialists, including review of outgoing correspondence and negotiation/settlement strategies as appropriate

3.3. Stakeholders are provided with accurate and timely advice regarding the legal liability and indemnity of the claim

3.4. Decisions are conveyed within timeframes that facilitate performance targets to be achieved

4. Review decisions and identify any required policy or procedural changes

4.1. Evaluation and review of decisions against requirements and outcomes is undertaken on a regular basis

4.2. Review process identifies extent to which decisions support process of accepting and managing a claim

4.3. Review process identifies extent to which decisions support setting of accurate claim portfolio reserves

4.4. Circumstances of claims and decisions concerning the legal liability and indemnity of the claim are documented for consideration in portfolio review

4.5. Changes to policy and procedures are instigated to minimise further loss in similar circumstances, if appropriate

5. Update records

5.1. Actions, procedures and outcomes are documented and recorded promptly and accurately

5.2. Finalised documentation is maintained according to organisation policy and legislative requirements and codes of practice, as applicable.

Required skills

highly developed communication skills to:

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

relate effectively to customers

liaise with others, share information, listen and understand

use language and concepts appropriate to cultural differences

well-developed 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

learning skills to maintain knowledge of changes to compliance legislation and requirements

problem solving skills to identify any issues that have the potential to impact on work outcomes and to develop options to resolve these issues when they arise

self-management skills for complying with ethical, legal and procedural requirements research and analysis skills for accessing and interpreting relevant information

organisational skills, including the ability to plan and sequence work

Required knowledge

claims management

data analysis techniques/procedures

insurance law, relevant legal systems and procedures, relevant acts

IT and communications systems

loss adjusting principles and practice

organisation policy, procedures, underwriting guidelines and authorities

policy coverage requirements and wording

relevant industry compliance requirements, legislation and industry codes of practice

risk prevention and loss minimisation methods and application

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:

interpret and apply organisation policy and procedures and compliance with legislation and regulations and industry codes of practice in the determination and provision of legal/indemnity advice associated with a claim.

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 organisation 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 policies include:

accidental damage

additional benefits

burglary/theft

business interruption

business special risks

commercial

commercial motor

construction risks

crop

defined events

directors and officers

domestic

electronic equipment

employee fraud

engineering plant

environment and pollution

fire and perils

general and products liability

glass

Industrial Special Risks (ISR)

livestock

machinery breakdown

money

multi-risk

other personal items

package contracts

personal accident and illness

professional indemnity

public liability

sprinkler leakage

transit

travel.

Relevant information/data may include:

claims files and database information

claims frequency

claims portfolio reports

claims settlement costs

legal, government, professional and other documents

loss ratios

official, general and other correspondence

premium income

reports from others such as:

loss adjusters

assessors

claims specialists

underwriters

reports on claims.

Stakeholders may include:

agents or brokers

claims staff

insured, claimants, other relevant parties

reinsurers

underwriters.

Documentation may include:

file notes

reports.

Unit sector

Insurance services

This unit contains employability skills.