NTISthis.com

Evidence Guide: PSPIM403A - Make claim determinations

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

 

PSPIM403A - Make claim determinations

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

Assess claim

  1. Available information is assessed in accordance with legislation, policy and procedures to establish if it is sufficient for a determination to be made.
  2. Additional information required to make the determination is identified, where necessary.
  3. Additional information is obtained in accordance with legislation, policy and procedures.
  4. Information is re-assessed to lead to further investigation or is judged sufficient to proceed in making a determination.
  5. Where information is insufficient, a decision to defer is made in accordance with legislation and organisational procedures and interim payments are considered/authorised where applicable.
Available information is assessed in accordance with legislation, policy and procedures to establish if it is sufficient for a determination to be made.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Additional information required to make the determination is identified, where necessary.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Additional information is obtained in accordance with legislation, policy and procedures.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Information is re-assessed to lead to further investigation or is judged sufficient to proceed in making a determination.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Where information is insufficient, a decision to defer is made in accordance with legislation and organisational procedures and interim payments are considered/authorised where applicable.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Make a determination

  1. Claimant's eligibility to claim under the legislation is confirmed and the reported condition is confirmed as compensable under the legislation.
  2. Details of the claim are assessed to ensure they qualify for payment.
  3. The claim is accepted or rejected based on all available evidence in accordance with legislation, policy and procedures.
  4. Notional weekly earnings are calculated where required.
  5. The claimant and other relevant parties are advised in writing of the decision, and advice contains all information required by the legislation.
  6. Case files/records are completed and contain comprehensive details of the claim and justification for the decision in accordance with legislation, policy and procedures.
Claimant's eligibility to claim under the legislation is confirmed and the reported condition is confirmed as compensable under the legislation.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Details of the claim are assessed to ensure they qualify for payment.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

The claim is accepted or rejected based on all available evidence in accordance with legislation, policy and procedures.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Notional weekly earnings are calculated where required.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

The claimant and other relevant parties are advised in writing of the decision, and advice contains all information required by the legislation.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Case files/records are completed and contain comprehensive details of the claim and justification for the decision in accordance with legislation, policy and procedures.

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

The Evidence Guide specifies the evidence required to demonstrate achievement in the unit of competency as a whole. It must be read in conjunction with the Unit descriptor, Performance Criteria, the Range Statement and the Assessment Guidelines for the Public Sector Training Package.

Units to be assessed together

Pre-requisite units that must be achieved prior to this unit:Nil

Co-requisite units that must be assessed with this unit:Nil

Co-assessed units that may be assessed with this unit to increase the efficiency and realism of the assessment process include, but are not limited to:

PSPETHC401A Uphold and support the values and principles of public service

PSPGOV402B Deliver and monitor service to clients

PSPGOV406B Gather and analyse information

PSPGOV408A Value diversity

PSPGOV422A Apply government processes

PSPLEGN401A Encourage compliance with legislation in the public sector

Overview of evidence requirements

In addition to integrated demonstration of the elements and their related performance criteria, look for evidence that confirms:

the knowledge requirements of this unit

the skill requirements of this unit

application of the Employability Skills as they relate to this unit (see Employability Summaries in Qualifications Framework)

claim determinations made in a range of (3 or more) contexts (or occasions, over time)

Resources required to carry out assessment

These resources include:

legislation, policy, procedures and protocols relating to injury management

case studies and workplace scenarios to capture the range of situations likely to be encountered when determining compensation claims

Where and how to assess evidence

Valid assessment of this unit requires:

a workplace environment or one that closely resembles normal work practice and replicates the range of conditions likely to be encountered when assessing compensation claims, including coping with difficulties, irregularities and breakdowns in routine

claim determinations made in a range of (3 or more) contexts (or occasions, over time)

Assessment methods should reflect workplace demands, such as literacy, and the needs of particular groups, such as:

people with disabilities

people from culturally and linguistically diverse backgrounds

Aboriginal and Torres Strait Islander people

women

young people

older people

people in rural and remote locations

Assessment methods suitable for valid and reliable assessment of this competency may include, but are not limited to, a combination of 2 or more of:

case studies

portfolios

questioning

scenarios

authenticated evidence from the workplace and/or training courses such as prepared letters/documents relating to application of the legislation

For consistency of assessment

Evidence must be gathered over time in a range of contexts to ensure the person can achieve the unit outcome and apply the competency in different situations or environments

Required Skills and Knowledge

This section describes the essential skills and knowledge and their level, required for this unit.

Skill requirements

Look for evidence that confirms skills in:

applying legislation, regulations and policies relating to determination of compensation claims

assessing the sufficiency of information and the requirement for further investigation

analysing information and making judgments

calculating average/normal/notional weekly earnings and lump sum payments

calculating interim payments

reading and applying complex information such as legislation and regulations

using communication with a diverse range of people including employers, unions, workplace supervisors, medical advisers, legal advisers, insurer/self-insurer

responding to diversity, including gender and disability

applying procedures relating to occupational health and safety and environment in the context of injury management

Knowledge requirements

Look for evidence that confirms knowledge and understanding of:

legislation, regulations, policies, procedures and guidelines relating to determination of claims

privacy legislation

freedom of information legislation

procedures to ensure confidentiality and security of information

eligibility and compensable conditions under the legislation

expenses that may be claimed

non-economic loss

medical terminology

documentary requirements of a claim

organisational standards for claim determinations

range of payment options under the legislation

equal employment opportunity, equity and diversity principles

public sector legislation such as occupational health and safety and environment in the context of injury management

Range Statement

The Range Statement provides information about the context in which the unit of competency is carried out. The variables cater for differences between States and Territories and the Commonwealth, and between organisations and workplaces. They allow for different work requirements, work practices and knowledge. The Range Statement also provides a focus for assessment. It relates to the unit as a whole. Text in bold italics in the Performance Criteria is explained here.

Available informationmay include:

injury report form

motor vehicle accident report

compensation claim form

prescribed medical certificate

information that confirms reported condition is compensable under the legislation

Legislation, policy and proceduresmay include:

workers rehabilitation/compensation legislation

privacy legislation

procedures to ensure confidentiality and security of information

freedom of information legislation

organisation policy

performance standards

claims management manual

public sector standards

codes of conduct

codes of ethics

Additional information may be required from:

worker

worker representative

supervisor of work area

treating medical practitioner

independent practitioner - independent medical examination

legal adviser

Information may be obtained via

direct enquiry (telephone, face-to-face)

written correspondence

factual investigator

section of the legislation/claims management manual on claim determination

Interim paymentsare:

payments made before a determination is made

for income maintenance or other expenses

Interim paymentsmay involve:

deciding whether or not to pay in accordance with policy

authorisation in accordance with policy

documentation and notification

cessation when required

recovery as a debt under certain circumstances

Eligibility includes:

claimant is a worker/employee under the legislation

injury/illness is employment related

Condition may include:

an illness or injury considered compensable under the legislation, where there is a relationship between the illness/injury and the employment of the worker

Compensable means:

an injury or illness for which workers compensation benefits are payable

Details of the claimmay include:

weekly/fortnightly payments

expenses, such as:

medical or other allowed treatment or advice

chemist

travel

investigation

legal

rehabilitation

property changes

accommodation

lump sum payment for non economic loss, such as:

pain and suffering

loss of amenities of life

loss of expectation of life

other loss or detriment of a non-economic nature (permanent disability)

Acceptance or rejectionmay be based on:

requirements of the Act and regulations, for example:

the particulars of the injury/illness and the cause/s stated in supporting medical certificates and other documents

knowledge of the workplace and work practices

experience in the injury management process

judgment that the claim may be fraudulent and referred for formal investigation

Weekly earnings are:

average/normal weekly earnings

the amount a worker could reasonably have expected to earn if not injured

Parties to be informed may include:

claimant

employer

rehabilitation coordinator

case manager

union

medical adviser/other health professionals

workplace supervisor

insurer/self-insurer

WorkCover

Comcare

Information required may include:

reference to the claim for compensation and the claimed medical condition

circumstances alleged by the worker and the date of occurrence

worker's right for a review of the determination (by a tribunal) should they disagree with the decision if it is rejected, or the rate of weekly payments determined by the employer if it is accepted

name and number of a contact person should the worker wish to discuss the determination

when a claim is rejected:

reference to those sections of the Act dealing with making a determination and upon which the rejection is based

the fact/s on which the determination is made

the grounds on which the claim is rejected

Case files/records:

may be used in evidence at tribunals and courts

must be complete and contain all contacts between the parties, including records of telephone calls, meetings etc