Assessor Resource

FNSISV507
Implement claim recovery procedures

Assessment tool

Version 1.0
Issue Date: May 2024


This unit describes the skills and knowledge required to recover money relating to a claim. It encompasses the complete process, from initiating the recovery to finalisation of the claim.

It applies to individuals working in job roles such as underwriting, involving specialist knowledge and functions in a range of insurance sectors, and may be applied within organisations of various sizes and across a range of client bases.

Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.

You may want to include more information here about the target group and the purpose of the assessments (eg formative, summative, recognition)



Evidence Required

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. Establish viability of recovery

1.1 Identify sources and rights of recovery

1.2 Make accurate calculation of achievable recovery amounts

1.3 Evaluate extent of recovery success

2. Evaluate recovery methods

2.1 Determine benefit to organisation of using each of available recovery methods, following organisational operating procedures

2.2 Assess methods for compliance with relevant legislative and organisational policy requirements

2.3 Ensure recovery action selected is appropriate to circumstances of loss

2.4 Instigate recovery of correct amount from reinsurers, where appropriate

2.5 Appoint agents to undertake loss recovery, where necessary

3. Implement and monitor recovery progress

3.1 Issue demand to responsible party

3.2 Confirm knock for knock, if applicable

3.3 Utilise diary system to monitor follow up

3.4 Make referral to solicitor or other relevant service provider, if applicable

3.5 Implement and follow up recovery within specified timeframes and organisational guidelines

4. Negotiate recovery settlement

4.1 Negotiate recovery settlement on best terms according to organisational policy

4.2 Complete negotiation within timeframes and organisational procedures

5. Process monies

5.1 Check file to determine whether recovery money has been received

5.2 Prepare payment information and enter on system to facilitate payment of claim by finance department, where applicable

5.3 Pay promptly client’s share of recovery money, where applicable

5.4 Finalise claims according to legislation, regulations, organisational operating procedures and codes of practice, if applicable

6. Record outcome

6.1 Update promptly all relevant records and files to display recovery action, amounts and other pertinent detail

6.2 Advise underwriter of any special circumstances, if applicable

Evidence of the ability to:

collate information and determine the viability of a recovery

review options and determine a suitable claim recovery method

initiate recovery and monitor the progress

engage in negotiations to secure settlement conditions

calculate achievable recovery amounts

oversee the financial transactions of payments

maintain accurate records

make referrals to solicitors or other service providers for recoveries.

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:

identify and apply relevant legislation, regulatory guidelines and industry sector compliance requirements as they apply to:

insurance contracts

consumer protection

privacy

taxation laws

credit laws

describe the importance of the legal aspects of insurance agents and brokers

identify and describe legal precedents and previous organisational results for claims recovery

explain the importance of wording of insurance policies in keeping with the organisation or industry sector

outline organisational policy, procedures, insurance guidelines and levels of authority in claim recovery processes

explain relative industry sector hazards associated with claims recovery.

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.


Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assingnment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)


Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

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

1. Establish viability of recovery

1.1 Identify sources and rights of recovery

1.2 Make accurate calculation of achievable recovery amounts

1.3 Evaluate extent of recovery success

2. Evaluate recovery methods

2.1 Determine benefit to organisation of using each of available recovery methods, following organisational operating procedures

2.2 Assess methods for compliance with relevant legislative and organisational policy requirements

2.3 Ensure recovery action selected is appropriate to circumstances of loss

2.4 Instigate recovery of correct amount from reinsurers, where appropriate

2.5 Appoint agents to undertake loss recovery, where necessary

3. Implement and monitor recovery progress

3.1 Issue demand to responsible party

3.2 Confirm knock for knock, if applicable

3.3 Utilise diary system to monitor follow up

3.4 Make referral to solicitor or other relevant service provider, if applicable

3.5 Implement and follow up recovery within specified timeframes and organisational guidelines

4. Negotiate recovery settlement

4.1 Negotiate recovery settlement on best terms according to organisational policy

4.2 Complete negotiation within timeframes and organisational procedures

5. Process monies

5.1 Check file to determine whether recovery money has been received

5.2 Prepare payment information and enter on system to facilitate payment of claim by finance department, where applicable

5.3 Pay promptly client’s share of recovery money, where applicable

5.4 Finalise claims according to legislation, regulations, organisational operating procedures and codes of practice, if applicable

6. Record outcome

6.1 Update promptly all relevant records and files to display recovery action, amounts and other pertinent detail

6.2 Advise underwriter of any special circumstances, if applicable

Evidence of the ability to:

collate information and determine the viability of a recovery

review options and determine a suitable claim recovery method

initiate recovery and monitor the progress

engage in negotiations to secure settlement conditions

calculate achievable recovery amounts

oversee the financial transactions of payments

maintain accurate records

make referrals to solicitors or other service providers for recoveries.

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:

identify and apply relevant legislation, regulatory guidelines and industry sector compliance requirements as they apply to:

insurance contracts

consumer protection

privacy

taxation laws

credit laws

describe the importance of the legal aspects of insurance agents and brokers

identify and describe legal precedents and previous organisational results for claims recovery

explain the importance of wording of insurance policies in keeping with the organisation or industry sector

outline organisational policy, procedures, insurance guidelines and levels of authority in claim recovery processes

explain relative industry sector hazards associated with claims recovery.

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.

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Identify sources and rights of recovery 
Make accurate calculation of achievable recovery amounts 
Evaluate extent of recovery success 
Determine benefit to organisation of using each of available recovery methods, following organisational operating procedures 
Assess methods for compliance with relevant legislative and organisational policy requirements 
Ensure recovery action selected is appropriate to circumstances of loss 
Instigate recovery of correct amount from reinsurers, where appropriate 
Appoint agents to undertake loss recovery, where necessary 
Issue demand to responsible party 
Confirm knock for knock, if applicable 
Utilise diary system to monitor follow up 
Make referral to solicitor or other relevant service provider, if applicable 
Implement and follow up recovery within specified timeframes and organisational guidelines 
Negotiate recovery settlement on best terms according to organisational policy 
Complete negotiation within timeframes and organisational procedures 
Check file to determine whether recovery money has been received 
Prepare payment information and enter on system to facilitate payment of claim by finance department, where applicable 
Pay promptly client’s share of recovery money, where applicable 
Finalise claims according to legislation, regulations, organisational operating procedures and codes of practice, if applicable 
Update promptly all relevant records and files to display recovery action, amounts and other pertinent detail 
Advise underwriter of any special circumstances, if applicable 

Forms

Assessment Cover Sheet

FNSISV507 - Implement claim recovery procedures
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

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Date:


Assessment Record Sheet

FNSISV507 - Implement claim recovery procedures

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: