Unit of Competency Mapping – Information for Teachers/Assessors – Information for Learners

FNSPIM302 Mapping and Delivery Guide
Determine claim liability

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSPIM302 - Determine claim liability
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to process a personal injury claim in accordance with organisational guidelines and procedures. It encompasses all aspects of processing a claim, including possible claim rejection.It applies to individuals who use specialised knowledge and follow structured approaches using limited discretion and judgement within the claims management function.Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Refer to the FNS Implementation Guide Companion Volume or the relevant regulator for specific guidance on requirements.
Duration and Setting X weeks, nominally xx hours, delivered in a classroom/online/blended learning setting.

Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the personal injury management field of work and include access to:

office equipment, technology, software and consumables

organisational records, policy and procedures.

Assessors must satisfy NVR/AQTF assessor requirements.
Prerequisites/co-requisites
Competency Field
Development and validation strategy and guide for assessors and learners Student Learning Resources Handouts
Activities 		Slides
PPT 		Assessment 1 Assessment 2 Assessment 3 Assessment 4
Elements of Competency Performance Criteria              
Element: Receive and clarify claim information
  • Enter claim information into relevant organisational systems
  • Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures
  • Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel
  • Advise clients of organisational claims procedures and respond to queries in an appropriate manner
  • Check claim information for accuracy and validity in accordance with organisational policy and procedures
       
Element: Determine status of claim
  • Analyse all information against regulatory requirements and organisational guidelines to determine liability
  • Refer claims to internal or external specialists where required and in accordance with organisational guidelines
       
Element: Accept or reject claim
  • Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes
  • Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority
  • Determine decision on liability, considering review and feedback from external stakeholders
       
Element: Document liability decision
  • Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice
  • Communicate reasons for decisions promptly to clients and other relevant stakeholders
  • Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate
       


Evidence Required

List the assessment methods to be used and the context and resources required for assessment. Copy and paste the relevant sections from the evidence guide below and then re-write these in plain English.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive and clarify claim information

1.1 Enter claim information into relevant organisational systems

1.2 Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures

1.3 Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel

1.4 Advise clients of organisational claims procedures and respond to queries in an appropriate manner

1.5 Check claim information for accuracy and validity in accordance with organisational policy and procedures

2. Determine status of claim

2.1 Analyse all information against regulatory requirements and organisational guidelines to determine liability

2.2 Refer claims to internal or external specialists where required and in accordance with organisational guidelines

3. Accept or reject claim

3.1 Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes

3.2 Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority

3.3 Determine decision on liability, considering review and feedback from external stakeholders

4. Document liability decision

4.1 Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice

4.2 Communicate reasons for decisions promptly to clients and other relevant stakeholders

4.3 Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate

Evidence of the ability to:

receive and clarify information and determine the status of a claim using organisational guidelines and regulatory requirements

document liability decision using organisational guidelines, and demonstrating knowledge of relevant Acts and regulations and organisational policies and procedures

analyse information to draw meaningful conclusions and determine correct action.

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

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

interpret and describe the key features of insurance policies, reports and related documents

describe the key analysis and research methods used to determine claim liability

categorise data into meaningful terms

outline the major steps in claim liability decision-making processes

describe the key features relevant to determining claim liability of:

insurance policies, reports and related documents

organisational claims processing software

organisational operating procedures

relevant workers compensation, personal injury Acts and regulatory requirements.

Submission Requirements

List each assessment task's title, type (eg project, observation/demonstration, essay, assignment, checklist) and due date here

Assessment task 1: [title]      Due date:

(add new lines for each of the assessment tasks)

Assessment Tasks

Copy and paste from the following data to produce each assessment task. Write these in plain English and spell out how, when and where the task is to be carried out, under what conditions, and what resources are needed. Include guidelines about how well the candidate has to perform a task for it to be judged satisfactory.

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Receive and clarify claim information

1.1 Enter claim information into relevant organisational systems

1.2 Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures

1.3 Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel

1.4 Advise clients of organisational claims procedures and respond to queries in an appropriate manner

1.5 Check claim information for accuracy and validity in accordance with organisational policy and procedures

2. Determine status of claim

2.1 Analyse all information against regulatory requirements and organisational guidelines to determine liability

2.2 Refer claims to internal or external specialists where required and in accordance with organisational guidelines

3. Accept or reject claim

3.1 Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes

3.2 Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority

3.3 Determine decision on liability, considering review and feedback from external stakeholders

4. Document liability decision

4.1 Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice

4.2 Communicate reasons for decisions promptly to clients and other relevant stakeholders

4.3 Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate

Copy and paste from the following performance criteria to create an observation checklist for each task. When you have finished writing your assessment tool every one of these must have been addressed, preferably several times in a variety of contexts. To ensure this occurs download the assessment matrix for the unit; enter each assessment task as a column header and place check marks against each performance criteria that task addresses.

Observation Checklist

Tasks to be observed according to workplace/college/TAFE policy and procedures, relevant legislation and Codes of Practice Yes No Comments/feedback
Enter claim information into relevant organisational systems 
Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures 
Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel 
Advise clients of organisational claims procedures and respond to queries in an appropriate manner 
Check claim information for accuracy and validity in accordance with organisational policy and procedures 
Analyse all information against regulatory requirements and organisational guidelines to determine liability 
Refer claims to internal or external specialists where required and in accordance with organisational guidelines 
Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes 
Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority 
Determine decision on liability, considering review and feedback from external stakeholders 
Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice 
Communicate reasons for decisions promptly to clients and other relevant stakeholders 
Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate 

Forms

Assessment Cover Sheet

FNSPIM302 - Determine claim liability
Assessment task 1: [title]

Student name:

Student ID:

I declare that the assessment tasks submitted for this unit are my own work.

Student signature:

Result: Competent Not yet competent

Feedback to student

 

 

 

 

 

 

 

 

Assessor name:

Signature:

Date:

Assessment Record Sheet

FNSPIM302 - Determine claim liability

Student name:

Student ID:

Assessment task 1: [title] Result: Competent Not yet competent

(add lines for each task)

Feedback to student:

 

 

 

 

 

 

 

 

Overall assessment result: Competent Not yet competent

Assessor name:

Signature:

Date:

Student signature:

Date: