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

FNSPIM512 Mapping and Delivery Guide
Negotiate settlements for medical indemnity claims

Version 1.0
Issue Date: May 2024


Qualification -
Unit of Competency FNSPIM512 - Negotiate settlements for medical indemnity claims
Description
Employability Skills
Learning Outcomes and Application This unit describes the skills and knowledge required to negotiate and settle claims within a medical indemnity context. It involves liaison and negotiation with key stakeholders to determine an agreed settlement.It applies to individuals who use specialised legal and medical knowledge to make judgements within their level of responsibility. They work independently and in teams and take responsibility for settling claims within a structured organisational framework. No licensing, legislative or certification requirements apply to this unit at the time of publication.
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, policies and procedures.

Assessors of this unit must satisfy the requirements for assessors in applicable vocational education and training legislation, frameworks and/or standards.

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: Prepare terms and conditions of settlement
  • Review analysis of claims information in files and organisational systems relating to causation and liability
  • Review calculations used to determine quantum including settlement amount and adjust if necessary based on case notes and previous relevant cases
  • Identify and assess settlement options to determine the most cost effective course of action according to organisational guidelines
  • Seek advice on settlement options with technical and/or legal advisors if required
  • Determine settlement terms, within limits of delegated authority, that meet legislative obligations and organisational and government policy requirements
       
Element: Negotiate settlement terms and conditions
  • Prepare and accurately document settlement terms and conditions prior to negotiations according to organisational policies and procedures and relevant legislation
  • Negotiate settlement terms and conditions with key stakeholders, working with legal advisers if required, according to regulatory obligations and organisational policies and procedures
  • Make adjustments to settlement terms and conditions if required
       
Element: Manage cases where litigation or disputation arises
  • Refer settlements that cannot be agreed to mediation or legal adviser or provider according to organisational procedures
  • Prepare instructions for legal adviser or provider using organisational templates and guidelines
  • Provide all relevant documents and information to involved parties according to legal or court requirements
  • Manage disagreements promptly and professionally to achieve the best outcome at minimum financial and other costs
       
Element: Monitor settlement progress and finalise medical indemnity claim
  • Monitor progress of all claims negotiations using calendar and organisational tools
  • Provide stakeholders with accurate and timely advice regarding claim negotiations and proceedings
  • Obtain agreement on settlement and discharge or close the claim to ensure potential for further liability is eliminated
  • Document cases thoroughly and accurately and update all records according to organisational procedures and regulatory requirements
       


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. Prepare terms and conditions of settlement

1.1 Review analysis of claims information in files and organisational systems relating to causation and liability

1.2 Review calculations used to determine quantum including settlement amount and adjust if necessary based on case notes and previous relevant cases

1.3 Identify and assess settlement options to determine the most cost effective course of action according to organisational guidelines

1.4 Seek advice on settlement options with technical and/or legal advisors if required

1.5 Determine settlement terms, within limits of delegated authority, that meet legislative obligations and organisational and government policy requirements

2. Negotiate settlement terms and conditions

2.1 Prepare and accurately document settlement terms and conditions prior to negotiations according to organisational policies and procedures and relevant legislation

2.2 Negotiate settlement terms and conditions with key stakeholders, working with legal advisers if required, according to regulatory obligations and organisational policies and procedures

2.3 Make adjustments to settlement terms and conditions if required

3. Manage cases where litigation or disputation arises

3.1 Refer settlements that cannot be agreed to mediation or legal adviser or provider according to organisational procedures

3.2 Prepare instructions for legal adviser or provider using organisational templates and guidelines

3.3 Provide all relevant documents and information to involved parties according to legal or court requirements

3.4 Manage disagreements promptly and professionally to achieve the best outcome at minimum financial and other costs

4. Monitor settlement progress and finalise medical indemnity claim

4.1 Monitor progress of all claims negotiations using calendar and organisational tools

4.2 Provide stakeholders with accurate and timely advice regarding claim negotiations and proceedings

4.3 Obtain agreement on settlement and discharge or close the claim to ensure potential for further liability is eliminated

4.4 Document cases thoroughly and accurately and update all records according to organisational procedures and regulatory requirements

Evidence of the ability to:

prepare terms and conditions of settlement for medical indemnity claims

negotiate settlements for medical indemnity claims with relevant parties

provide case instructions for legal providers in claims proceeding to court.

monitor progress and finalise medical claim settlement

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:

discuss key principles of equal employment opportunity, equity and diversity in the context of medical indemnity

describe the types and key features of medical indemnity insurance policy coverage and terms and conditions

outline risk management in a medical indemnity context

outline organisational procedures for medical indemnity claims settlement negotiation including the use of case law

explain organisational systems and administrative requirements for data entry and filing including coding requirements

provide an overview of medical indemnity claims processes within the Australian court system including the role of coronial inquests

list and describe key legal terminology used in the medical indemnity sector

explain the roles and responsibilities of legal providers in medical indemnity claims management

provide a brief overview of the principles of cost estimating in claims assessments

explain criteria used to determine medical indemnity settlement payments

describe analysis tools used to assess medical indemnity claims and to calculate losses or damages

describe organisational arrangements for delegations of authority

outline obligations and options for settlement under current legislation.

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. Prepare terms and conditions of settlement

1.1 Review analysis of claims information in files and organisational systems relating to causation and liability

1.2 Review calculations used to determine quantum including settlement amount and adjust if necessary based on case notes and previous relevant cases

1.3 Identify and assess settlement options to determine the most cost effective course of action according to organisational guidelines

1.4 Seek advice on settlement options with technical and/or legal advisors if required

1.5 Determine settlement terms, within limits of delegated authority, that meet legislative obligations and organisational and government policy requirements

2. Negotiate settlement terms and conditions

2.1 Prepare and accurately document settlement terms and conditions prior to negotiations according to organisational policies and procedures and relevant legislation

2.2 Negotiate settlement terms and conditions with key stakeholders, working with legal advisers if required, according to regulatory obligations and organisational policies and procedures

2.3 Make adjustments to settlement terms and conditions if required

3. Manage cases where litigation or disputation arises

3.1 Refer settlements that cannot be agreed to mediation or legal adviser or provider according to organisational procedures

3.2 Prepare instructions for legal adviser or provider using organisational templates and guidelines

3.3 Provide all relevant documents and information to involved parties according to legal or court requirements

3.4 Manage disagreements promptly and professionally to achieve the best outcome at minimum financial and other costs

4. Monitor settlement progress and finalise medical indemnity claim

4.1 Monitor progress of all claims negotiations using calendar and organisational tools

4.2 Provide stakeholders with accurate and timely advice regarding claim negotiations and proceedings

4.3 Obtain agreement on settlement and discharge or close the claim to ensure potential for further liability is eliminated

4.4 Document cases thoroughly and accurately and update all records according to organisational procedures and regulatory requirements

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
Review analysis of claims information in files and organisational systems relating to causation and liability 
Review calculations used to determine quantum including settlement amount and adjust if necessary based on case notes and previous relevant cases 
Identify and assess settlement options to determine the most cost effective course of action according to organisational guidelines 
Seek advice on settlement options with technical and/or legal advisors if required 
Determine settlement terms, within limits of delegated authority, that meet legislative obligations and organisational and government policy requirements 
Prepare and accurately document settlement terms and conditions prior to negotiations according to organisational policies and procedures and relevant legislation 
Negotiate settlement terms and conditions with key stakeholders, working with legal advisers if required, according to regulatory obligations and organisational policies and procedures 
Make adjustments to settlement terms and conditions if required 
Refer settlements that cannot be agreed to mediation or legal adviser or provider according to organisational procedures 
Prepare instructions for legal adviser or provider using organisational templates and guidelines 
Provide all relevant documents and information to involved parties according to legal or court requirements 
Manage disagreements promptly and professionally to achieve the best outcome at minimum financial and other costs 
Monitor progress of all claims negotiations using calendar and organisational tools 
Provide stakeholders with accurate and timely advice regarding claim negotiations and proceedings 
Obtain agreement on settlement and discharge or close the claim to ensure potential for further liability is eliminated 
Document cases thoroughly and accurately and update all records according to organisational procedures and regulatory requirements 

Forms

Assessment Cover Sheet

FNSPIM512 - Negotiate settlements for medical indemnity claims
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

FNSPIM512 - Negotiate settlements for medical indemnity claims

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: