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Evidence Guide: FNSPIM512 - Negotiate settlements for medical indemnity claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSPIM512 - Negotiate settlements for medical indemnity claims

What evidence can you provide to prove your understanding of each of the following citeria?

Prepare terms and conditions of settlement

  1. Review analysis of claims information in files and organisational systems relating to causation and liability
  2. Review calculations used to determine quantum including settlement amount and adjust if necessary based on case notes and previous relevant cases
  3. Identify and assess settlement options to determine the most cost effective course of action according to organisational guidelines
  4. Seek advice on settlement options with technical and/or legal advisors if required
  5. Determine settlement terms, within limits of delegated authority, that meet legislative obligations and organisational and government policy requirements
Review analysis of claims information in files and organisational systems relating to causation and liability

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Negotiate settlement terms and conditions

  1. Prepare and accurately document settlement terms and conditions prior to negotiations according to organisational policies and procedures and relevant legislation
  2. Negotiate settlement terms and conditions with key stakeholders, working with legal advisers if required, according to regulatory obligations and organisational policies and procedures
  3. Make adjustments to settlement terms and conditions if required
Prepare and accurately document settlement terms and conditions prior to negotiations according to organisational policies and procedures and relevant legislation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Make adjustments to settlement terms and conditions if required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Manage cases where litigation or disputation arises

  1. Refer settlements that cannot be agreed to mediation or legal adviser or provider according to organisational procedures
  2. Prepare instructions for legal adviser or provider using organisational templates and guidelines
  3. Provide all relevant documents and information to involved parties according to legal or court requirements
  4. Manage disagreements promptly and professionally to achieve the best outcome at minimum financial and other costs
Refer settlements that cannot be agreed to mediation or legal adviser or provider according to organisational procedures

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Monitor settlement progress and finalise medical indemnity claim

  1. Monitor progress of all claims negotiations using calendar and organisational tools
  2. Provide stakeholders with accurate and timely advice regarding claim negotiations and proceedings
  3. Obtain agreement on settlement and discharge or close the claim to ensure potential for further liability is eliminated
  4. Document cases thoroughly and accurately and update all records according to organisational procedures and regulatory requirements
Monitor progress of all claims negotiations using calendar and organisational tools

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

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

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

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

Required Skills and Knowledge

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.