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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. Calculate claim entitlement
   • Gather and evaluate information to determine amount of loss suffered by customer
   • Determine settlement terms according to policy wording, legislation and codes of practice
2. Negotiate and communicate settlement terms
   • Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate
   • Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods
   • Undertake negotiation in endeavour to reach mutual agreement on valuation
   • Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly
3. Document liability decisions
   • Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice
   • Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable
   • Send claims documentation to reinsurers
4. Finalise settlement
   • Make or give instructions for payments within the required timeframe once settlement is reached
   • Obtain settlement release from customer and/or third party, as applicable
   • Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable
   • Initiate recovery action from reinsurers, if applicable
   • Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable

Performance Evidence

Evidence of the ability to:

evaluate information and then calculate the claim entitlement

engage in negotiation with the customer to determine agreed settlement

prepare all required documentation and file as appropriate.

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:

state the accountability requirements of individuals involved with insurance settlements and identify the level at which settlements should be referred to senior staff

outline key features of organisational policy and procedures required for processing insurance claims

outline key features of relevant legislation, regulation and codes of practice that apply to insurance claims

define the term ‘policy coverage’ and state how it relates to the settlement of insurance claims.

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