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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. Determine whether loss is covered by insurance or other criteria
   • Accurately and thoroughly collect relevant evidence, facts and information
   • Review insurance policy conditions to determine whether loss falls within policy coverage
2. Apply and analyse established facts
   • Assess validity of claim against reported circumstances and policy specifications
   • Accurately and consistently identify fraud indicators
   • Apply appropriate analysis techniques, and prioritise and assess data thoroughly
   • Document data analysis techniques and procedures, and record promptly and accurately
3. Determine extent of loss, damage or injury
   • 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
   • 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
   • Identify all other contributory insurances
   • Identify and assess all cases for potential subrogation action
   • Identify sources and rights of recovery and evaluate likelihood of recovery success
   • Correctly issue recovery demands, where necessary

Performance Evidence

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.

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Knowledge Evidence

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.

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