Application
This unit describes the skills required to assess compensation claims for employment related injuries in order to make a determination. It includes assessing the claim and making a determination.
This unit applies to those working in the area of worker compensation claim assessment.
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 independently, 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. Assess claim | 1.1 Assess available information to establish if it is sufficient for a determination to be made. 1.2 Identify additional information required, if any, to make the determination. 1.3 Obtain additional information. 1.4 Re-assess information to determine if it is sufficient or if further investigation is required. 1.5 Make a decision to defer where information is insufficient, and consider interim payments where applicable. |
2. Make a determination | 2.1 Confirm the claimant’s eligibility and the reported condition as compensable under the legislation. 2.2 Assess details of the claim to ensure they qualify for payment. 2.3 Accept or reject the claim based on all available evidence. 2.4 Calculate notional weekly earnings where required. 2.5 Advise the claimant and other relevant parties in writing of the decision, and ensure advice contains all information required by the legislation. 2.6 Complete case records ensuring they contain comprehensive details of the claim and justification for the decision. |
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 determination of compensation claims
assessing the sufficiency of information and the requirement for further investigation
analysing information and making judgments
calculating interim payments
reading and applying complex information
using communication with a diverse range of people including employers, unions, workplace supervisors, medical advisers, legal advisers, insurer/self-insurer
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 determination of claims
privacy legislation
freedom of information legislation
procedures to ensure confidentiality and security of information
eligibility and compensable conditions under the legislation
expenses that may be claimed
non-economic loss
medical terminology
documentary requirements of a claim
organisational standards for claim determinations
range of payment options under the legislation
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