Application
This unit describes the skills and knowledge required to use high level analytical, liaison and planning skills to interact with clients, authorities and specialists in coordinating loss investigations that determine the extent of loss, damage or injury.
It applies to individuals who, within their level of responsibility, use specialised knowledge and organisational skills to coordinate a range of activities to ensure thorough and accurate completion of activities.
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.
Elements and Performance Criteria
ELEMENT | PERFORMANCE CRITERIA |
Elements describe the essential outcomes. | Performance criteria describe the performance needed to demonstrate achievement of the element. |
1. Receive instructions from client | 1.1 Establish comprehensive terms of reference or instructions that meet requirements of relevant parties prior to engagement 1.2 Promptly advise relevant parties of decisions to accept or reject terms of reference or instructions and reasons for such decisions 1.3 Negotiate, confirm and clearly document acceptable terms and instructions that are within client or organisational policy and legislative guidelines, codes of practice and personal authorities |
2. Establish relevant facts | 2.1 Thoroughly, systematically and accurately collect facts, evidence and information relevant to circumstances of loss, damage or injury 2.2 Identify information deficiencies and obtain additional from appropriate sources 2.3 Assess validity of loss situation and/or claim fairly and impartially against reported circumstances, available evidence, facts and information 2.4 Determine insurance cover for loss, damage or injury where applicable and review policy conditions to ensure loss falls within policy coverage 2.5 Establish contractual and/or other obligations of each party to circumstances under enquiry 2.6 Accurately and consistently identify fraud indicators 2.7 Organise all relevant facts, evidence and information, and document confidentially into coherent body of case knowledge |
3. Plan and implement loss investigation | 3.1 Analyse available facts, evidence and information to determine viable course of action and appropriate investigative activities 3.2 Assess investigative activities for appropriateness to loss situation and compliance with relevant legislation, codes of practice, insurers, client, organisational or other guidelines 3.3 Identify and determine requirements for urgent action to protect client interests 3.4 Establish appropriate and confidential channels of communication with clients and other relevant parties 3.5 Establish and maintain professional and cordial relationships with all relevant parties during investigation 3.6 Establish and maintain comprehensive records of investigative activities, methodology and time spent during investigations |
4. Preserve evidence | 4.1 Progressively collate all evidence gathered, and record promptly and accurately 4.2 Preserve evidence gathered by appropriate means for subsequent assessment and enquiry |
5. Liaise with authorities | 5.1 Liaise with all appropriate authorities whenever and wherever required 5.2 Receive clearance or authorisation for investigative activities from appropriate authorities, where required, and record promptly |
6. Verify and document information | 6.1 Regularly review facts, evidence and information gathered and assess for thoroughness and consistency 6.2 Employ all appropriate methods within client, organisational, legislative, code of practice or other guidelines to clarify conflicting evidence or information 6.3 Promptly and accurately document and record investigative actions, procedures and outcomes |
7. Appoint specialists | 7.1 Promptly and accurately determine need to appoint specialist assistance and convey to client and other relevant parties 7.2 Engage appointed specialists as required and brief thoroughly |
Evidence of Performance
Evidence of the ability to:
receive instructions and establish relevant facts
plan and coordinate loss investigations
apply loss adjusting principles and practice, and investigative practices and guidelines relevant to various types of insurance loss or damage
use fraud detection, control and prevention principles to check validity of claims
accurately document activities and liaise effectively with relevant authorities and specialists.
Note: If a specific volume or frequency is not stated, then evidence must be provided at least once.
Evidence of Knowledge
To complete the unit requirements safely and effectively, the individual must:
identify and describe the types and categories of insurance policies
outline key features of:
business mathematics and statistics relevant to assessing insurance loss
data analysis techniques and procedures
identify and explain the key features of insurance loss, including:
claims management
fraud detection, control and prevention principles
rules of evidence, and information gathering and documenting principles
insurable interest
investigative practices and guidelines
loss adjusting principles and practice
policy coverage and requirements
principles of cost estimating
subrogation
explain relevant contract and commercial law principles, and the key features of insurance law
identify and explain the key features of relevant legislation and industry codes of practice
identify and describe the roles, responsibilities and jurisdiction of specialists and other authorities.
Assessment Conditions
Assessment must be conducted in a safe environment where evidence gathered demonstrates consistent performance of typical activities experienced in the insurance loss adjusting field of work and include access to:
organisational records
organisational policy, procedures, legislation and regulations as they relate to contracts of insurance
common office equipment, technology, software and consumables.
Assessors must satisfy NVR/AQTF assessor requirements.
Foundation Skills
This section describes language, literacy, numeracy and employment skills incorporated in the performance criteria that are required for competent performance.
Skill | Performance Criteria | Description |
Reading | 1.3, 2.1-2.6, 3.1-3.3, 6.1, 6.2 | Critically analyses complex documentation from a variety of sources and consolidates information relating to specific criteria to determine requirements |
Writing | 1.1-1.3, 2.5, 2.7, 3.6, 4.1, 5.2, 6.3, 7.1, 7.2 | Accurately records information and writes detailed notes using required format, spelling and grammar, terminology and conventions specific to requirements Reports specific information logically and revises and updates documentation based on outcomes of action |
Oral Communication | 1.2, 1.3, 3.5, 5.1, 7.1, 7.2 | Conveys information using language, tone and pace appropriate to the audience and environment Uses listening and questioning techniques to elicit the views and opinions of others and to confirm understanding |
Numeracy | 2.3, 2.4, 3.1, 3.6 | Interprets numerical and financial information against a range of criteria to calculate and estimate loss |
Navigate the world of work | 1.3, 2.4, 3.2, 3.4, 6.2 | Takes full responsibility for following policies, procedures and legislative requirements and identifies organisational implications of new legislation or regulation |
Interact with others | 1.2, 1.3, 2.1, 3.4, 3.5, 5.1, 5.2, 7.1 | Implements strategies for a diverse range of colleagues and clients to build rapport and foster strong relationships Elicits feedback and provides feedback to others |
Get the work done | 1.1, 1.2, 2.1-2.6, 3.1-3.3, 3.6, 4.2, 5.2, 6.1, 6.2, 7.1, 7.2 | Accepts responsibility for planning and sequencing complex tasks and workload, negotiating key aspects with others and taking into account capabilities, efficiencies and effectiveness Applies systematic and analytical decision-making processes for complex and non-routine situations Makes critical decisions quickly and intuitively in complex situations, taking into consideration a range of variables, including the outcomes of previous decisions Monitors progress schedules and reviews and changes them to meet new demands and priorities Uses the main features and functions of digital tools to complete work tasks and access information |
Sectors
Insurance loss adjusting