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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. Establish need to appoint specialist to undertake assessment
   • Review thoroughly, systematically and accurately, the facts, evidence and information, including fraud indicators, relevant to circumstances of loss, damage and injury
   • Identify promptly and advise client and other relevant parties of need to appoint specialist assistance to undertake financial, medical or psychological assessment
2. Organise financial, medical or psychological assessments
   • Engage appointed specialists, as required, and thoroughly brief them on requirements
   • Monitor assessment activity progress and report to relevant parties, as appropriate, within set timelines
3. Analyse data for claims assessments
   • Analyse and assess financial, medical or psychological assessment data for thoroughness and consistency
   • Use analysis tools to assess financial, medical and/or psychological assessments to calculate loss damages
   • Assess fairly and impartially validity of loss situation and/or claims against assessment data, and analyse against reported circumstances, available evidence, facts and information
   • Review insurance cover and policy conditions to ensure loss falls within policy coverage
4. Report results
   • Document and report assessment actions, procedures and outcomes, and record promptly and accurately
   • Ensure reporting includes recommendations on validity of claim and recovery amounts in relation to assessment and other relevant data
   • Provide stakeholders with accurate and timely advice regarding financial, medical or psychological assessment for claim proceedings

Performance Evidence

Evidence of the ability to:

interpret and identify circumstances in which specialist assistance should be sought for the resolution of a claim

correctly analyse claims information to determine the need for specialist assistance

engage specialist assistance as appropriate

monitor the specialist assessment activity

interpret and report on the outcomes of the advice in relation to the claim.

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:

describe methods, practices and guidelines for performing data analysis

describe ‘claims management’ as it applies to specialist circumstances

identify policy coverage and requirements

outline the principles of cost estimating in claims assessments

identify and explain key features of relevant legislation, regulatory guidelines and industry sector codes of practice

explain the roles and responsibilities of financial, medical and psychological specialists

describe the types and/or categories of insurance policies associated with financial, medical and psychological claims

describe analysis tools used to assess financial, medical and/or psychological assessments to calculate loss damages.

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