Application
This unit requires the application of diagnostic and mathematical skills to determine liability and extent of loss. It relates to the analysis of information obtained through loss investigation and includes evaluation of recovery rights and success.
This unit requires the application of diagnostic and mathematical skills to determine liability and extent of loss. It relates to the analysis of information obtained through loss investigation and includes evaluation of recovery rights and success.
Prerequisites
Not applicable.
Elements and Performance Criteria
Elements and Performance Criteria | |||
Element | Performance Criteria | ||
1 | Determine whether loss is covered by insurance or other criteria | 1.1 | Relevant evidence, facts and information are collected accurately and thoroughly |
1.2 | Insurance policy/policies conditions are reviewed to determine whether loss falls within policy coverage | ||
2 | Apply and analyse established facts | 2.1 | Validity of claim is assessed against reported circumstances and policy specifications |
2.2 | Fraud indicators are identified accurately and consistently | ||
2.3 | Appropriate analysis techniques are applied and data is prioritised and assessed thoroughly | ||
2.4 | Data analysis techniques and procedures are documented and recorded promptly and accurately | ||
3 | Determine extent of loss/damage/injury | 3.1 | Extent of liability and loss is determined against available evidence and facts and in accordance with legislative and/or insurers, or client, or company policy and guidelines |
3.2 | Extent of loss/damage determined is consistent with the assessment of and nature of claim and is within legislative, insurers, client or company constraints | ||
4 | Establish recovery rights | 4.1 | All other contributory insurances are identified |
4.2 | All cases for potential subrogation action are identified and assessed | ||
4.3 | Sources and rights of recovery are identified and likelihood of recovery success is evaluated | ||
4.4 | Recovery demands are correctly issued where necessary |
Required Skills
REQUIRED KNOWLEDGE&SKILLS |
Knowledge requirements include: knowledge of the insurance industry contract and commercial law principles insurance law relevant legislation and industry codes of practice types/categories of insurance policies policy coverage/requirements loss adjusting principles and practice claims management principles of cost estimating salvage methods recovery subrogation insurable interest contribution data analysis techniques/procedures business mathematics and statistics |
Skills requirements include: analytical, evaluative and deductive reasoning problem solving calculation and estimating data analysis techniques/procedures record keeping communication and listening skills time management using computer databases, member/client databases and telecommunication devices maintaining currency of industry products and services knowledge |
Evidence Required
EVIDENCE GUIDE | |
Assessment of performance requirements in the unit should be undertaken in an industry context. The Evidence Guide identifies the critical aspects, knowledge and skills to be demonstrated to confirm competency for the unit. Competency is demonstrated by performance of all stated criteria including the Range Statement applicable to the workplace. | |
Overview of assessment requirements | |
To achieve competency in this unit, a person must be able to demonstrate: thorough knowledge of types and categories of insurance policies, industry codes of practice and relevant legislation loss adjusting principles and practice data analysis and evaluation techniques | |
Critical aspects of evidence | |
Evidence required for demonstration of consistent performance: | Competency is demonstrated by performance of all stated criteria including the Range Statement applicable to the particular workplace environment and should cover all necessary knowledge and skills requirements. |
Delivery/assessment relationship to other units: | This unit may be assessed independently, however demonstration of competency in the following unit is a prerequisite: FNSLOSS501B Plan and implement loss investigation. |
Assessment requirements | |
Method of assessment: | For valid and reliable assessment of this unit, evidence should be gathered through a range of methods to indicate consistent performance. |
Assessment of this unit of competence will usually include observation of processes and procedures, oral and/or written questioning on required knowledge and skills and other methods as required. | |
Context of assessment: | Assessment of performance requirements in this unit should be undertaken within the financial services industry context and should cover aspects of personal/financial responsibility and accountability. Aspects of competency, including the attainment of relevant knowledge and skills, may be assessed in a relevant workplace, a closely simulated work environment, or other appropriate means that clearly meet industry competency requirements. |
Resources required for assessment: | This unit may involve simulation equipment, facilities for workplace or simulated environment assessment, availability of qualified assessors. |
Range Statement
The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that will affect performance. The following variables may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts. If bold italicised text is shown in Performance Criteria, details of the text are provided in the Range Statement. | |
Types and categories of insurance policies include: | domestic multi risk defined events accidental damage |
liability additional benefits travel other personal lines commercial fire and perils business interruption package contracts Industrial Special Risks (ISR) construction risks machinery breakdown boiler explosion transit sprinkler leakage burglary/theft money fidelity livestock crop | |
Liability includes: | public products professional indemnity directors and officers construction environment pollution broadform |
Relevant legislation may include: | Insurance Contracts Act Insurance Agents and Brokers Act Consumer Credit Code Privacy Act Contracts Law Trade Practices Act secrecy laws |
industry codes of practice occupational health and safety (OH&S) environmental building or construction hazardous materials motor vehicle | |
Client or company policy and guidelines may include: | policies and procedures in relation to risks claims loss loss recovery codes of practice clerical information technology and administrative systems complaints and dispute resolution procedures Australian Institute of Chartered Loss Adjusters (AICLA) Charter of Objects and Professional Conduct |
Sources of recovery may include: | liable parties sale of goods salvage and disposal other insurers |
Rights of recovery may include: | subrogation salvage reinsurance contribution industry agreements |
Documentation may include: | reference to all evidence/information considered reasons for adopting/incorporating certain evidence/ information preferred over other evidence/information the basis on which the decision was determined |
The insurance industry should adopt a range of improved consumer protection policies and practices with respect to its use of genetic information (including family history) for underwriting purposes. New laws and practices should ensure that: genetic information is only used in a scientifically reliable and actuarially sound manner; reasons are provided for any unfavourable underwriting decision; industry complaints handling processes are strengthened and extended to cover underwriting decisions; and industry education and training about genetics are improved. |
Sectors
Not applicable.
Employability Skills
The required outcomes described in this unit of competency contain applicable facets of employability skills. The Employability Skills Summary for the qualification in which this unit of competency is packaged, will assist in identifying employability skills requirements.
The required outcomes described in this unit of competency contain applicable facets of employability skills. The Employability Skills Summary for the qualification in which this unit of competency is packaged, will assist in identifying employability skills requirements.
Licensing Information
Not applicable.