This unit may be relevant for case managers and technical managers and applied within the claims handling area of the personal injury management sector.

ELEMENT

PERFORMANCE CRITERIA

1. Prepare for hearings of disputes

1.1. Review of decision is made by contacting the person, relevant parties and the treating doctor where relevant, and considering any new/additional information provided

1.2. Additional information is obtained from relevant parties as required and provided to stakeholders

1.3. All parties affected by the decision are clearly and promptly advised of their review rights in accordance with legislative requirements

2. Present cases at conciliation conferences

2.1. Appropriate forms are completed in accordance with conciliation office requirements and referred to the conciliation office

2.2. Conciliation conference is arranged to bring the parties to agreement and reach conciliation

2.3. Formal notification documenting the outcome of conciliation, including any disputes is provided to all relevant parties

3. Present case in court/tribunal/review hearings

3.1. Courts are provided with all relevant documentation prior to pre-hearing conference

3.2. Insurers manage matter before the court or tribunal in a matter that achieves the best and most expeditious resolution at minimum cost

Required skills

Well-developed communication skills to:

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

liaise with others, share information, listen and understand

negotiate and advocate for clients

make effective and clear presentations

write business reports

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

use internet information

well-developed literacy skills to:

read and interpret documentation from a variety of sources and record and consolidate relevant related information

interpret and apply policy

research and analysis skills for accessing and interpreting relevant information

effective interpersonal skills

organisation skills, including the ability to plan and sequence work

research skills

risk assessment skills

Required knowledge

common law, legal systems and procedures, relevant acts

organisation policy, procedures, underwriting guidelines and authorities

industry and organisation policy wording

industry compliance requirements

relevant information technology and communications systems

risk prevention methods and application

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 comply with industry and organisation obligations and objectives

negotiate effectively on behalf of the organisation and build client relationships

understand conciliation and review hearing procedures and requirements

effectively prepare for and represent the agent's or insurer's interests at review hearings.

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.

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.

Relevant parties may include:

employer and industry associations

family members

medical and like providers

workers compensation, personal injury authority

self insurer

the authorised insurer

the community

the employer

unions and union representatives.

Conciliation conferences may include:

formal legal proceedings

informal meetings between the disputing parties.

Disputes may involve:

insurer's procedures including failure to meet response time limits set for both informal and formal disputes resolution made direct to the insurer by any of the parties involved in the claim

liability

medical and like providers/panels.

Documentation may include:

assessor's reports and reports from medical and like providers

medical panels

rehabilitation providers

the employer.

Unit sector

Personal injury management

This unit contains employability skills.