Application
This unit describes the skills and knowledge required to manage impairment benefit claims within the personal injury management context. It encompasses collecting, analysing and using appropriate information and criteria to assess and estimate the degree of impairment to calculate and pay the correct entitlement.
It applies to individuals who have well-developed skills and a broad knowledge base of the sector, services and organisation, and take responsibility for case and/or technical management of impairment claims.
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. Determine nature of impairment benefit claim and collect required information | 1.1 Review impairment benefit claim to determine nature of claim and estimate degree of impairment 1.2 Determine type and sources of information and guidelines required to make impairment benefit liability decision 1.3 Collect information required for decision-making process, including accessing appropriate services and referrals to independent assessors as required |
2. Determine liability for impairment benefit | 2.1 Undertake thorough and systematic review of facts, evidence and information relevant to circumstances of impairment claim 2.2 Follow organisational procedures to determine liability of claimed injury for impairment benefit 2.3 Use appropriate criteria and guidelines for basis of making sound and sustainable liability decision |
3. Manage impairment benefit claims process | 3.1 Determine and apply appropriate legislative, regulatory and organisational policy and procedures to manage impairment benefit claims 3.2 Identify stakeholders in impairment benefit process and determine strategies to manage stakeholder relationships 3.3 Use appropriate IT systems to collect, analyse, store and access required information 3.4 Use appropriate criteria to calculate correct entitlement 3.5 Use effective and appropriate strategies to communicate impairment decisions to claimant 3.6 Pay entitlement and finalise claim according to organisational procedures |
Evidence of Performance
Evidence of the ability to:
interpret and comply with legislative, regulatory and organisational requirements and procedures relating to impairment benefit claims
make sound decisions based on the application of appropriate criteria and the analysis of medical and other information to determine the degree of impairment
accurately calculate and pay the appropriate benefit
effectively communicate decisions to key stakeholders.
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:
define and describe a permanent impairment and a total loss injury
identify and describe the different types of impairment benefits
explain legislative and regulatory requirements applicable to personal injury insurance impairment claims management, including:
relevant primary federal, state or territory personal injury insurance legislation
other applicable federal, state or territory legislation governing areas such as privacy, records management, and disability and equal opportunity
outline industry protocols and organisational policy and procedures specific to impairment claims
explain the role of impairment assessment guidelines and criteria, including:
Gazetted Guidelines
American Medical Association (AMA) Guides
case law
outline the fundamental principles of application of assessment guides relating to:
spine
upper extremities
lower extremities
psychiatry
nervous system
hearing loss
ear, nose and throat (ENT)
respiratory
scarring and dermatology
describe the key sources of information, medical specialities and referral processes to independent assessors relevant to impairment benefits.
Assessment Conditions
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
relevant legislation and regulation
appropriate assessment criteria including AMA Guides, Gazetted Guidelines and case law
organisational records, policy and procedures.
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 | 1.1-1.3, 2.1-2.3, 3.1, 3.2, 3.4 | Interprets and analyses documentation from a variety of sources and records and consolidates relevant related information |
Writing | 1.3, 3.5 | Creates a range of formal and informal texts following organisational procedures and protocols Uses specific information and language appropriate to the audience and purpose |
Oral Communication | 1.3, 3.5 | Clearly and effectively presents detailed information in verbal exchanges using language, tone and pace appropriate to the audience and purpose |
Numeracy | 2.4, 3.4, 3.6 | Accurately interprets statistics and information related to claims Performs calculations to achieve required outcomes |
Navigate the world of work | 2.2-2.4, 3.1, 3.6 | Operates according to relevant regulations, legislation and organisational protocols |
Get the work done | 1.3, 2.1, 2.3, 2.4, 3.3 | Organises, plans and sequences work activities Uses a range of digitally based technologies to access, extract and share relevant information to achieve required outcomes |
Sectors
Personal injury management