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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 terms and conditions of settlement
   • Determine and evaluate non-routine aspects of claim in light of policy wording and general policy of organisation
   • Follow organisational claims procedures for non-routine and complex claims, where required
   • Determine settlement terms according to policy wording, legislation, organisational operating procedures and codes of practice, taking into account non-routine aspects of claim and parties involved
   • Identify type and level of variation to standard claims settlement to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied
2. Negotiate and communicate settlement terms
   • Advise promptly client and/or relevant party terms and conditions of settlement offer according to claims procedures
   • Consider response by client and/or relevant party to terms of settlement offer to assess whether adjustment is required
   • Negotiate settlement terms, where required, to reach mutual agreement, meet obligations and minimise unnecessary loss to organisation
   • Support negotiated settlements with suitable documentation that clearly states agreements reached
   • Modify terms of settlement offer as necessary and advise client and/or relevant party promptly
3. Document liability decisions
   • Clearly communicate decisions to relevant parties in manner required by legislation, operating procedures and codes of practice
   • Document decisions in such a way as to determine basis on which decision was reached and all evidence and information that was considered
   • Communicate to relevant personnel any aspects of claim relevant to policy wording and general organisational policy
4. Finalise settlement
   • Make final payments in required timeframe once settlement is reached
   • Obtain settlement release from client and/or third party, as applicable
   • Obtain discharge to ensure any potential for further liability is eliminated
5. Identify any required changes to policy or procedures
   • Document circumstances of claim for consideration in portfolio review
   • Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate
6. Report findings and update records
   • Document actions, procedures and outcomes and record promptly and accurately
   • Provide stakeholders with accurate and timely advice regarding claim settlement
   • 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:

recognise claims that are non-routine and complex

determine settlement terms by evaluating available data and through negotiation

document future revised terms of claim based on review of non-routine claims and communicate to relevant people

manage financial transactions and settlement documentation

modify or report on potential changes to organisational policy and procedures to protect the organisation from future losses

document and file all activities for future reference.

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 organisational policy, procedures, insurance guidelines, levels of authority and accountabilities relevant to non-routine and complex claims

describe the application of legal precedents

identify dispute resolution bodies

state the level and conditions at which claim should be referred to senior staff

explain organisational business objectives relative to non-routine and complex claims

outline the key features of relevant legislation, regulatory guidelines and industry sector compliance requirements and codes of practice as they apply to:

insurance contracts

insurance claims

consumer protection

define the rights of subrogation (the more complex the claim, the more parties may be involved)

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

discuss the types and categories of insurance policies and insurance trends in non-routine and complex claims.

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