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. Clarify brief and instructions | 1.1 Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required 1.2 Check subject matter questions to be investigated |
2. Investigate claim | 2.1 Determine method of investigation 2.2 Collect and organise required information to make logical case 2.3 Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable 2.4 Record all data and information progressively and accurately 2.5 File and store securely all original documents, tapes, photographs and other material 2.6 Prepare and communicate appropriate changes in brief or instructions 2.7 Comply with any changes in brief or instructions |
3. Report on investigation | 3.1 Prepare and transmit comprehensive reports according to reporting guidelines 3.2 Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person 3.3 Give facts and justification for conclusions to insurer’s nominated person 3.4 Make recommendations for action, with appropriate justifications, where required |
Evidence of the ability to:
use appropriate investigation methodologies and maintain accurate records
comply with relevant legislation and regulatory requirements in investigating a claim
produce complete and accurate investigation reports
provide detailed scoping for investigating insurance claims including in-scope and out-of-scope areas
develop options to resolve issues or problems that have the potential to impact on work outcomes during investigations.
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 key requirements of industry sector legal obligations and organisational procedures in relation to investigating claims
describe and implement appropriate investigation methods including:
interviews
surveillance
internet research
document authentication
observation
identify key features of relevant legislation, regulatory guidelines and industry sector codes of practice as they apply to:
insurance contracts
consumer protection
privacy
insurance investigation
explain the importance of report writing conventions in insurance investigations.
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance services field of work and include access to:
organisational records
organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
a range of common technology and software.
Assessors must satisfy NVR/AQTF assessor requirements.