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.
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. 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 Performance
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.
Evidence of Knowledge
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.
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
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.
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, 1.2 | Gathers, analyses and interprets simple to complex information from a range of sources and identifies relevant information and actions |
Writing | 2.1, 2.2, 3.2, 4.2, 4.4 | Produces texts of varying complexity using appropriate language, legal terminology and logical sequence to convey and record information accurately and effectively Writes, edits and proofreads case instructions to ensure clarity of meaning and accuracy and consistency of information |
Oral Communication | 2.2, 4.2 | Uses clear, specific language and correct medical and legal terminology to convey information and achieve required outcomes |
Numeracy | 1.2, 1.3 | Uses mathematical operations to perform financial calculations |
Navigate the world of work | 1.5, 3.3 | Recognises and follows legislative requirements, explicit and implicit protocols, policies and procedures and meets expectations associated with own role |
Interact with others | 1.4, 2.2, 3.4 | Selects and uses appropriate communication conventions and protocols to liaise with others Manages conflict through the recognition of contributing factors and by implementing strategies to resolve it |
Get the work done | 1.5, 2.3, 3.1, 4.1-4.3 | Applies systematic decision-making processes for complex and non-routine situations Organises, plans and sequences work activities Uses a range of digitally based technologies to access, extract and manage relevant information to achieve required outcomes |
Sectors
Personal injury management