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Evidence Guide: FNSISV309 - Settle insurance claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSISV309 - Settle insurance claims

What evidence can you provide to prove your understanding of each of the following citeria?

Calculate claim entitlement

  1. Gather and evaluate information to determine amount of loss suffered by customer
  2. Determine settlement terms according to policy wording, legislation and codes of practice
Gather and evaluate information to determine amount of loss suffered by customer

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine settlement terms according to policy wording, legislation and codes of practice

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Negotiate and communicate settlement terms

  1. Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate
  2. Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods
  3. Undertake negotiation in endeavour to reach mutual agreement on valuation
  4. Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly
Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Undertake negotiation in endeavour to reach mutual agreement on valuation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document liability decisions

  1. Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice
  2. Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable
  3. Send claims documentation to reinsurers
Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Send claims documentation to reinsurers

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Finalise settlement

  1. Make or give instructions for payments within the required timeframe once settlement is reached
  2. Obtain settlement release from customer and/or third party, as applicable
  3. Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable
  4. Initiate recovery action from reinsurers, if applicable
  5. Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable
Make or give instructions for payments within the required timeframe once settlement is reached

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Obtain settlement release from customer and/or third party, as applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Initiate recovery action from reinsurers, if applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Calculate claim entitlement

1.1 Gather and evaluate information to determine amount of loss suffered by customer

1.2 Determine settlement terms according to policy wording, legislation and codes of practice

2. Negotiate and communicate settlement terms

2.1 Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate

2.2 Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods

2.3 Undertake negotiation in endeavour to reach mutual agreement on valuation

2.4 Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly

3. Document liability decisions

3.1 Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice

3.2 Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable

3.3 Send claims documentation to reinsurers

4. Finalise settlement

4.1 Make or give instructions for payments within the required timeframe once settlement is reached

4.2 Obtain settlement release from customer and/or third party, as applicable

4.3 Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable

4.4 Initiate recovery action from reinsurers, if applicable

4.5 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable

Required Skills and Knowledge

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Calculate claim entitlement

1.1 Gather and evaluate information to determine amount of loss suffered by customer

1.2 Determine settlement terms according to policy wording, legislation and codes of practice

2. Negotiate and communicate settlement terms

2.1 Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate

2.2 Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods

2.3 Undertake negotiation in endeavour to reach mutual agreement on valuation

2.4 Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly

3. Document liability decisions

3.1 Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice

3.2 Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable

3.3 Send claims documentation to reinsurers

4. Finalise settlement

4.1 Make or give instructions for payments within the required timeframe once settlement is reached

4.2 Obtain settlement release from customer and/or third party, as applicable

4.3 Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable

4.4 Initiate recovery action from reinsurers, if applicable

4.5 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable

Evidence of the ability to:

evaluate information and then calculate the claim entitlement

engage in negotiation with the customer to determine agreed settlement

prepare all required documentation and file as appropriate.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.

To complete the unit requirements safely and effectively, the individual must:

state the accountability requirements of individuals involved with insurance settlements and identify the level at which settlements should be referred to senior staff

outline key features of organisational policy and procedures required for processing insurance claims

outline key features of relevant legislation, regulation and codes of practice that apply to insurance claims

define the term ‘policy coverage’ and state how it relates to the settlement of insurance claims.