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Follow the links below to find material targeted to the unit's elements, performance criteria, required skills and knowledge

Elements and Performance Criteria

1. Receive instructions from client
   • Establish comprehensive terms of reference or instructions that meet requirements of relevant parties prior to engagement
   • Promptly advise relevant parties of decisions to accept or reject terms of reference or instructions and reasons for such decisions
   • Negotiate, confirm and clearly document acceptable terms and instructions that are within client or organisational policy and legislative guidelines, codes of practice and personal authorities
2. Establish relevant facts
   • Thoroughly, systematically and accurately collect facts, evidence and information relevant to circumstances of loss, damage or injury
   • Identify information deficiencies and obtain additional from appropriate sources
   • Assess validity of loss situation and/or claim fairly and impartially against reported circumstances, available evidence, facts and information
   • Determine insurance cover for loss, damage or injury where applicable and review policy conditions to ensure loss falls within policy coverage
   • Establish contractual and/or other obligations of each party to circumstances under enquiry
   • Accurately and consistently identify fraud indicators
   • Organise all relevant facts, evidence and information, and document confidentially into coherent body of case knowledge
3. Plan and implement loss investigation
   • Analyse available facts, evidence and information to determine viable course of action and appropriate investigative activities
   • Assess investigative activities for appropriateness to loss situation and compliance with relevant legislation, codes of practice, insurers, client, organisational or other guidelines
   • Identify and determine requirements for urgent action to protect client interests
   • Establish appropriate and confidential channels of communication with clients and other relevant parties
   • Establish and maintain professional and cordial relationships with all relevant parties during investigation
   • Establish and maintain comprehensive records of investigative activities, methodology and time spent during investigations
4. Preserve evidence
   • Progressively collate all evidence gathered, and record promptly and accurately
   • Preserve evidence gathered by appropriate means for subsequent assessment and enquiry
5. Liaise with authorities
   • Liaise with all appropriate authorities whenever and wherever required
   • Receive clearance or authorisation for investigative activities from appropriate authorities, where required, and record promptly
6. Verify and document information
   • Regularly review facts, evidence and information gathered and assess for thoroughness and consistency
   • Employ all appropriate methods within client, organisational, legislative, code of practice or other guidelines to clarify conflicting evidence or information
   • Promptly and accurately document and record investigative actions, procedures and outcomes
7. Appoint specialists
   • Promptly and accurately determine need to appoint specialist assistance and convey to client and other relevant parties
   • Engage appointed specialists as required and brief thoroughly

Performance Evidence

Evidence of the ability to:

receive instructions and establish relevant facts

plan and coordinate loss investigations

apply loss adjusting principles and practice, and investigative practices and guidelines relevant to various types of insurance loss or damage

use fraud detection, control and prevention principles to check validity of claims

accurately document activities and liaise effectively with relevant authorities and specialists.

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

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Knowledge Evidence

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

identify and describe the types and categories of insurance policies

outline 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

fraud detection, control and prevention principles

rules of evidence, and information gathering and documenting principles

insurable interest

investigative practices and guidelines

loss adjusting principles and practice

policy coverage and requirements

principles of cost estimating

subrogation

explain relevant contract and commercial law principles, and the key features of insurance law

identify and explain the key features of relevant legislation and industry codes of practice

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

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