PSPINM002
Conduct initial claim assessments


Application

This unit describes the skills required to undertake initial assessment of compensation claims for employment related injuries. It includes receiving and acknowledging claims, and assessing rehabilitation need (for referral).

This unit applies to those working in the area of initial assessment of compensation claims. Staff of the employer undertakes this role.

The skills and knowledge described in this unit must be applied within the legislative, regulatory and policy environment in which they are carried out. Organisational policies and procedures must be consulted and adhered to.

Those undertaking this unit would work under supervision, while performing routine tasks in a range of familiar contexts.

No licensing, legislative or certification requirements apply to unit at the time of publication.


Elements and Performance Criteria

ELEMENTS

PERFORMANCE CRITERIA

Elements describe the essential outcomes

Performance criteria describe the performance needed to demonstrate achievement of the element. Where bold italicised text is used, further information is detailed in the range of conditions section.

1. Receive and acknowledge claims

1.1 Assess completeness of claim.

1.2 Obtain missing information.

1.3 Undertake risk streaming of claims.

1.4 Conduct initial assessment to confirm that the employee is a ‘worker’ under the Act and that the reported condition is compensable under the legislation.

1.5 Acknowledge the claim within required timeframes.

1.6 Collate data for determining weekly earnings and payments, if claim is accepted or deferred.

2. Assess need for rehabilitation referral

2.1 Copy and forward documentation when referral is required for rehabilitation assessment.

2.2 Review assessments if circumstances change.

2.3 Progress claim for investigation and determination.

Evidence of Performance

Evidence required to demonstrate competence must satisfy all of the requirements of the elements and performance criteria. If not otherwise specified the candidate must demonstrate evidence of performance of the following on at least one occasion.

applying legislation, regulations and policies relating to initial assessment of compensation claims

reading and applying complex information, including legislation and regulations


Evidence of Knowledge

Evidence required to demonstrate competence must satisfy all of the requirements of the elements and performance criteria. If not otherwise specified the depth of knowledge demonstrated must be appropriate to the job context of the candidate.

public sector legislation, including work health and safety, and environment

regulations, policies, procedures and guidelines relating to injury management

privacy legislation

freedom of information legislation

procedures to ensure confidentiality and security of information

requirements for referrals for rehabilitation assessment

definitions of eligible workers and disabilities under the legislation

medical terminology

documentary requirements of a claim

organisational standards for responding to claims


Assessment Conditions

This unit contains no specific industry-mandated assessment conditions. Guidance on suggested and recommended conditions and methods can be found in the Implementation Guide.

Assessors must satisfy the NVR/AQTF mandatory competency requirements for assessors.


Foundation Skills

Foundation skills are embedded within the elements and performance criteria of this unit.


Competency Field

Injury management