Unit of competency Outline

Date retreived
24/07/2026 2:17 AM AWST

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Settle non-routine and complex claims

Settle non-routine and complex claims

Unit of competency
National Code
FNSISV511
State Code
AUS16
TGA Status
Replaced
DTWD Status
Transition (Replaced)
Current Release Number
1.00
Current Release Date
25/03/2015
View on TGA
State Implementation and Classification
Approved Date
16/09/2015
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
16/09/2015
Nominal Hours
30
Description
This unit describes the skills and knowledge required to settle non-routine and complex insurance claims, including the identification of non-standard issues, accessing all required information to allow a decision to be made, negotiation and finalisation of claims.It applies to individuals working in job roles involving specialist knowledge and functions in a range of insurance sectors and may be applied within organisations of various sizes and across a range of client bases.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.
Notes
Elements and Performance Criteria
1. Determine terms and conditions of settlement
  • 1.1 Determine and evaluate non-routine aspects of claim in light of policy wording and general policy of organisation
  • 1.2 Follow organisational claims procedures for non-routine and complex claims, where required
  • 1.3 Determine settlement terms according to policy wording, legislation, organisational operating procedures and codes of practice, taking into account non-routine aspects of claim and parties involved
  • 1.4 Identify type and level of variation to standard claims settlement to establish type of negotiation or mediation that may be required and to ensure logical, persuasive and technically correct claims interpretations can be applied
2. Negotiate and communicate settlement terms
  • 2.1 Advise promptly client and/or relevant party terms and conditions of settlement offer according to claims procedures
  • 2.2 Consider response by client and/or relevant party to terms of settlement offer to assess whether adjustment is required
  • 2.3 Negotiate settlement terms, where required, to reach mutual agreement, meet obligations and minimise unnecessary loss to organisation
  • 2.4 Support negotiated settlements with suitable documentation that clearly states agreements reached
  • 2.5 Modify terms of settlement offer as necessary and advise client and/or relevant party promptly
3. Document liability decisions
  • 3.1 Clearly communicate decisions to relevant parties in manner required by legislation, operating procedures and codes of practice
  • 3.2 Document decisions in such a way as to determine basis on which decision was reached and all evidence and information that was considered
  • 3.3 Communicate to relevant personnel any aspects of claim relevant to policy wording and general organisational policy
4. Finalise settlement
  • 4.1 Make final payments in required timeframe once settlement is reached
  • 4.2 Obtain settlement release from client and/or third party, as applicable
  • 4.3 Obtain discharge to ensure any potential for further liability is eliminated
5. Identify any required changes to policy or procedures
  • 5.1 Document circumstances of claim for consideration in portfolio review
  • 5.2 Instigate changes to policy and procedures to minimise further loss in similar circumstances, if appropriate
6. Report findings and update records
  • 6.1 Document actions, procedures and outcomes and record promptly and accurately
  • 6.2 Provide stakeholders with accurate and timely advice regarding claim settlement
  • 6.3 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable
No information
No information
Replaces
State Code National Code Title Type
D4249 FNSISV511A Settle non-routine and complex claims Unit of competency
Replaced By
State Code National Code Title Type
OCI52 FNSISV521 Settle non-routine and complex insurance claims Unit of competency
State Code National Code Title Type
AWE4 FNS51115 Diploma of General Insurance Qualification