Unit of competency Outline

Date retreived
22/07/2026 2:05 AM AWST

Whilst all efforts are made to provide accurate and timely information from the relevant source/documentation, please be aware that the information supplied may not be the most current version. The accuracy of the detail has not been confirmed by the Department and therefore should not be relied upon without first confirming the contents.

Analyse and manage medical indemnity claims

Analyse and manage medical indemnity claims

Unit of competency
National Code
FNSPIM417
State Code
AWF23
TGA Status
Deleted
DTWD Status
Deleted
Current Release Number
1.00
Current Release Date
14/01/2016
View on TGA
State Implementation and Classification
Approved Date
12/05/2016
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
12/05/2016
Nominal Hours
65
Description
This unit describes the skills and knowledge required to analyse and evaluate claims within a medical indemnity context. It encompasses collecting, analysing and using appropriate evidence and criteria to determine cause and apportion liability.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 assessing claims within a structured organisational framework. No licensing, legislative or certification requirements apply to this unit at the time of publication.
Notes
Elements and Performance Criteria
1. Receive and organise information relating to medical indemnity claim
  • 1.1 Organise and collate information relating to the claim into a coherent file
  • 1.2 Enter relevant claim details in organisational systems
  • 1.3 Identify any information deficiencies and seek specific additional information from appropriate sources including medical experts
  • 1.4 Maintain confidentiality of information according to legislative requirements, industry principles and organisational requirements
2. Research claim and validate medical indemnity claim information
  • 2.1 Determine type of medical indemnity claim and the key parties involved
  • 2.2 Assess sufficiency and thoroughness of information supplied including expert medical evidence
  • 2.3 Determine if case needs to be referred to other personnel according to organisational delegation rules for cases with unresolved complexity, abnormalities, classification uncertainties or insufficient information
  • 2.4 Review claim information to determine legitimacy of claim including validity and coverage of insurance policy
  • 2.5 Review, segment and prioritise claims for assessment of liability
3. Assess medical indemnity claim to determine cause, liability and quantum
  • 3.1 Undertake thorough and systematic review and assessment of facts, expert medical evidence and information relevant to circumstances of the claim
  • 3.2 Consult with technical and/or claims advisers to clarify information and seek advice as required
  • 3.3 Follow organisational procedures and use analysis tools to assess evidence in determining cause and liability
  • 3.4 Apportion liability and determine quantum fairly and impartially within limits of delegated authority according to regulatory and organisational guidelines
4. Document decisions and determine quantum of claim settlement
  • 4.1 Record outcome of analysis documenting all relevant information used to support the decision-making process
  • 4.2 Use organisational tools and systems to determine quantum including claim settlement amount and note any additional considerations or exceptions
  • 4.3 Update organisational systems accurately with required information in a timely manner
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State Code National Code Title Type
AZI3 FNS42115 Certificate IV in Personal Injury Management Qualification