List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Determine whether loss is covered by insurance or other criteria | 1.1 Accurately and thoroughly collect relevant evidence, facts and information 1.2 Review insurance policy conditions to determine whether loss falls within policy coverage |
2. Apply and analyse established facts | 2.1 Assess validity of claim against reported circumstances and policy specifications 2.2 Accurately and consistently identify fraud indicators 2.3 Apply appropriate analysis techniques, and prioritise and assess data thoroughly 2.4 Document data analysis techniques and procedures, and record promptly and accurately |
3. Determine extent of loss, damage or injury | 3.1 Determine extent of liability and loss against available evidence and facts and in accordance with legislative and/or insurers, or client, or organisational policy and guidelines 3.2 Ensure extent of loss or damage determined is consistent with assessment of and nature of claim, and is within legislative, insurer, client or organisational constraints |
4. Establish recovery rights | 4.1 Identify all other contributory insurances 4.2 Identify and assess all cases for potential subrogation action 4.3 Identify sources and rights of recovery and evaluate likelihood of recovery success 4.4 Correctly issue recovery demands, where necessary |
Evidence of the ability to:
maintain and apply thorough knowledge of types and categories of insurance policies, industry codes of practice and relevant legislation
apply loss adjusting principles and practice to evaluate claims
effectively use data analysis and evaluation techniques to verify validity of claims.
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:
business mathematics and statistics relevant to assessing insurance loss
data analysis techniques and procedures
identify and explain the key features of insurance loss, including:
claims management
insurable interest
loss adjusting principles and practice
policy coverage and requirements
principles of cost estimating, recovery and salvage methods
relevant contract and commercial law principles
relevant insurance law legislation and industry codes of practice
subrogation
types or categories of insurance policies
explain the key requirements of industry codes of practice and relevant legislation
identify the types and categories of insurance policies within the domain of insurance loss adjusting
identify the types of liabilities to be considered in assessing loss.
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance loss adjusting field of work and include access to:
organisational records
organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
common office equipment, technology, software and consumables.
Assessors must satisfy NVR/AQTF assessor requirements.