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Evidence Guide: FNSISV511 - Settle non-routine and complex 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

 

FNSISV511 - Settle non-routine and complex claims

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

Determine terms and conditions of settlement

  1. Determine and evaluate non-routine aspects of claim in light of policy wording and general policy of organisation
  2. Follow organisational claims procedures for non-routine and complex claims, where required
  3. Determine settlement terms according to policy wording, legislation, organisational operating procedures and codes of practice, taking into account non-routine aspects of claim and parties involved
  4. Identify type and level of variation to standard claims settlement to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied
Determine and evaluate non-routine aspects of claim in light of policy wording and general policy of organisation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Follow organisational claims procedures for non-routine and complex claims, where required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Determine settlement terms according to policy wording, legislation, organisational operating procedures and codes of practice, taking into account non-routine aspects of claim and parties involved

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify type and level of variation to standard claims settlement to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Negotiate and communicate settlement terms

  1. Advise promptly client and/or relevant party terms and conditions of settlement offer according to claims procedures
  2. Consider response by client and/or relevant party to terms of settlement offer to assess whether adjustment is required
  3. Negotiate settlement terms, where required, to reach mutual agreement, meet obligations and minimise unnecessary loss to organisation
  4. Support negotiated settlements with suitable documentation that clearly states agreements reached
  5. Modify terms of settlement offer as necessary and advise client and/or relevant party promptly
Advise promptly client and/or relevant party terms and conditions of settlement offer according to claims procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Consider response by client and/or relevant party to terms of settlement offer to assess whether adjustment is required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Negotiate settlement terms, where required, to reach mutual agreement, meet obligations and minimise unnecessary loss to organisation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Support negotiated settlements with suitable documentation that clearly states agreements reached

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Modify terms of settlement offer as necessary and advise client and/or relevant party promptly

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Document liability decisions

  1. Clearly communicate decisions to relevant parties in manner required by legislation, operating procedures and codes of practice
  2. Document decisions in such a way as to determine basis on which decision was reached and all evidence and information that was considered
  3. Communicate to relevant personnel any aspects of claim relevant to policy wording and general organisational policy
Clearly communicate decisions to relevant parties in manner required by legislation, 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 all evidence and information that was considered

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Communicate to relevant personnel any aspects of claim relevant to policy wording and general organisational policy

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Finalise settlement

  1. Make final payments in required timeframe once settlement is reached
  2. Obtain settlement release from client and/or third party, as applicable
  3. Obtain discharge to ensure any potential for further liability is eliminated
Make final payments in required timeframe once settlement is reached

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Obtain discharge to ensure any potential for further liability is eliminated

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Identify any required changes to policy or procedures

  1. Document circumstances of claim for consideration in portfolio review
  2. Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate
Document circumstances of claim for consideration in portfolio review

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Report findings and update records

  1. Document actions, procedures and outcomes and record promptly and accurately
  2. Provide stakeholders with accurate and timely advice regarding claim settlement
  3. Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable
Document actions, procedures and outcomes and record promptly and accurately

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Provide stakeholders with accurate and timely advice regarding claim settlement

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. Determine terms and conditions of settlement

1.1 Determine and evaluate non-routine aspects of claim in light of policy wording and general policy of organisation

1.2 Follow organisational claims procedures for non-routine and complex claims, where required

1.3 Determine settlement terms according to policy wording, legislation, organisational operating procedures and codes of practice, taking into account non-routine aspects of claim and parties involved

1.4 Identify type and level of variation to standard claims settlement to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied

2. Negotiate and communicate settlement terms

2.1 Advise promptly client and/or relevant party terms and conditions of settlement offer according to claims procedures

2.2 Consider response by client and/or relevant party to terms of settlement offer to assess whether adjustment is required

2.3 Negotiate settlement terms, where required, to reach mutual agreement, meet obligations and minimise unnecessary loss to organisation

2.4 Support negotiated settlements with suitable documentation that clearly states agreements reached

2.5 Modify terms of settlement offer as necessary and advise client and/or relevant party promptly

3. Document liability decisions

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

3.2 Document decisions in such a way as to determine basis on which decision was reached and all evidence and information that was considered

3.3 Communicate to relevant personnel any aspects of claim relevant to policy wording and general organisational policy

4. Finalise settlement

4.1 Make final payments in required timeframe once settlement is reached

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

4.3 Obtain discharge to ensure any potential for further liability is eliminated

5. Identify any required changes to policy or procedures

5.1 Document circumstances of claim for consideration in portfolio review

5.2 Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate

6. Report findings and update records

6.1 Document actions, procedures and outcomes and record promptly and accurately

6.2 Provide stakeholders with accurate and timely advice regarding claim settlement

6.3 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. Determine terms and conditions of settlement

1.1 Determine and evaluate non-routine aspects of claim in light of policy wording and general policy of organisation

1.2 Follow organisational claims procedures for non-routine and complex claims, where required

1.3 Determine settlement terms according to policy wording, legislation, organisational operating procedures and codes of practice, taking into account non-routine aspects of claim and parties involved

1.4 Identify type and level of variation to standard claims settlement to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied

2. Negotiate and communicate settlement terms

2.1 Advise promptly client and/or relevant party terms and conditions of settlement offer according to claims procedures

2.2 Consider response by client and/or relevant party to terms of settlement offer to assess whether adjustment is required

2.3 Negotiate settlement terms, where required, to reach mutual agreement, meet obligations and minimise unnecessary loss to organisation

2.4 Support negotiated settlements with suitable documentation that clearly states agreements reached

2.5 Modify terms of settlement offer as necessary and advise client and/or relevant party promptly

3. Document liability decisions

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

3.2 Document decisions in such a way as to determine basis on which decision was reached and all evidence and information that was considered

3.3 Communicate to relevant personnel any aspects of claim relevant to policy wording and general organisational policy

4. Finalise settlement

4.1 Make final payments in required timeframe once settlement is reached

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

4.3 Obtain discharge to ensure any potential for further liability is eliminated

5. Identify any required changes to policy or procedures

5.1 Document circumstances of claim for consideration in portfolio review

5.2 Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate

6. Report findings and update records

6.1 Document actions, procedures and outcomes and record promptly and accurately

6.2 Provide stakeholders with accurate and timely advice regarding claim settlement

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

Evidence of the ability to:

recognise claims that are non-routine and complex

determine settlement terms by evaluating available data and through negotiation

document future revised terms of claim based on review of non-routine claims and communicate to relevant people

manage financial transactions and settlement documentation

modify or report on potential changes to organisational policy and procedures to protect the organisation from future losses

document and file all activities for future reference.

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:

outline the key features of organisational policy, procedures, insurance guidelines, levels of authority and accountabilities relevant to non-routine and complex claims

describe the application of legal precedents

identify dispute resolution bodies

state the level and conditions at which claim should be referred to senior staff

explain organisational business objectives relative to non-routine and complex claims

outline the key features of relevant legislation, regulatory guidelines and industry sector compliance requirements and codes of practice as they apply to:

insurance contracts

insurance claims

consumer protection

define the rights of subrogation (the more complex the claim, the more parties may be involved)

identify the roles, responsibilities and jurisdiction of specialists and other authorities

discuss the types and categories of insurance policies and insurance trends in non-routine and complex claims.