Unit of competency Outline
Date retreived
23/07/2026 5:59 PM AWST
23/07/2026 5:59 PM 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.
Settle non-routine and complex claims
Settle non-routine and complex claims
Unit of competency
National Code
FNSISV511A
FNSISV511A
State Code
D4249
D4249
TGA Status
Replaced
Replaced
DTWD Status
Replaced
Replaced
State Implementation and Classification
Approved Date
29/07/2014
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
29/07/2014
Nominal Hours
30
Description
This unit describes the performance outcomes, 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.This unit is applicable to individuals working within enterprises and job roles subject to licensing, legislative, regulatory or certification requirements including legislation administered by the Australian Securities and Investments Commission (ASIC).
Notes
Elements and Performance Criteria
1. Determine terms and conditions of settlement
- 1.1. Non-routine aspects of the claim are determined and evaluated in light of the policy wording and the general policy of the organisation
- 1.2. Organisation claims procedures for non-routine/complex claims are followed where required
- 1.3. Settlement terms are determined according to policy wording, legislation, organisation operating procedures and codes of practice, taking into account the non-routine aspects of the claim
- 1.4. Type and level of variation to standard claims settlement is identified in order 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. Terms and conditions of settlement offer are promptly advised to client and/or relevant party, according to claims procedures
- 2.2. Response by client and/or relevant party to terms of settlement offer is considered to assess whether adjustment is required
- 2.3. Settlement terms are negotiated where required to reach mutual agreement, to meet obligations and to minimise unnecessary loss to the organisation
- 2.4. Negotiated settlements are supported with suitable documentation that clearly states agreements reached
- 2.5. Terms of settlement offer are modified as necessary and client and/or relevant party advised promptly
3. Document liability decisions
- 3.1. Decisions are clearly communicated to the relevant parties in a manner required by the legislation, operating procedures and codes of practice
- 3.2. Decisions are documented in such a way as to determine the basis on which the decision was reached and all the evidence/information that was considered
- 3.3. Any aspects of the claim relevant to policy wording and general organisation policy are communicated to relevant personnel
4. Finalise settlement
- 4.1. Once settlement is reached, final payments are made in the required timeframe
- 4.2. Settlement release is obtained from client and/or third party, as applicable
- 4.3. Discharge is obtained to ensure any potential for further liability is eliminated
5. Identify any required changes to policy or procedures
- 5.1. Circumstances of claim are documented for consideration in portfolio review
- 5.2. Changes to policy and procedures are instigated to minimise further loss in similar circumstances, if appropriate
6. Report findings and update records
- 6.1. Actions, procedures and outcomes are documented and recorded promptly and accurately
- 6.2. Stakeholders are provided with accurate and timely advice regarding the claim settlement
- 6.3. Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable
RANGE STATEMENT
The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.
Non-routine aspects may include:
disputes in other jurisdictions
special inclusions and exclusions.
Non-routine/complex claims may involve:
claims involving legal procedures, including those that involve working across international boundaries
claims involving long-term settlements
complex claims involving major losses and bodily injury losses
complex technical determinations
high monetary impact
important client base.
Settlement terms may include:
repair, replace or cash settle.
Client and/or relevant parties may include:
broker or agent
claimant or client
consultants
government or statutory authorities
insured
legal or other practitioners
manufacturers
medical
mortgagee
principal
reinsurer
subcontractor
suppliers
third party
trustee.
Adjustment may involve modifications of settlement terms based on:
new facts
negotiating the best terms.
Documentation may include:
legal, government, professional and other documents
meeting notes
minutes
official, general and other correspondence
reasons for recommending certain actions and settlement decisions over others
records of telephone conversations
reference to all data and information considered
reports from others such as loss adjusters, assessors, insurers, medical providers and others
the basis on which the decision was determined.
Stakeholders may include:
claimants
claims managers and specialists
insurance broker
reinsurers
underwriters
other relevant parties.
The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.
Non-routine aspects may include:
disputes in other jurisdictions
special inclusions and exclusions.
Non-routine/complex claims may involve:
claims involving legal procedures, including those that involve working across international boundaries
claims involving long-term settlements
complex claims involving major losses and bodily injury losses
complex technical determinations
high monetary impact
important client base.
Settlement terms may include:
repair, replace or cash settle.
Client and/or relevant parties may include:
broker or agent
claimant or client
consultants
government or statutory authorities
insured
legal or other practitioners
manufacturers
medical
mortgagee
principal
reinsurer
subcontractor
suppliers
third party
trustee.
Adjustment may involve modifications of settlement terms based on:
new facts
negotiating the best terms.
Documentation may include:
legal, government, professional and other documents
meeting notes
minutes
official, general and other correspondence
reasons for recommending certain actions and settlement decisions over others
records of telephone conversations
reference to all data and information considered
reports from others such as loss adjusters, assessors, insurers, medical providers and others
the basis on which the decision was determined.
Stakeholders may include:
claimants
claims managers and specialists
insurance broker
reinsurers
underwriters
other relevant parties.
EVIDENCE GUIDE
The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit
Evidence of the ability to:
interpret and apply organisation policy and procedures and compliance with legislation and regulations and industry codes of practice in identifying non-routine aspects of the claim and effecting an acceptable settlement.
Context of and specific resources for assessment
Assessment must ensure:
competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment
access to and the use of a range of common office equipment, technology, software and consumables
access to organisation records
access to organisation policies and procedures.
Method of assessment
A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, are appropriate for this unit:
evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency
observing processes and procedures in workplaces
verbal or written questioning on underpinning knowledge and skills
evaluating samples of work
accessing and validating third party reports
setting and reviewing workplace projects and business simulations or scenarios.
Guidance information for assessment
The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria, required skills and knowledge, range statement and the Assessment Guidelines for the Training Package.
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit
Evidence of the ability to:
interpret and apply organisation policy and procedures and compliance with legislation and regulations and industry codes of practice in identifying non-routine aspects of the claim and effecting an acceptable settlement.
Context of and specific resources for assessment
Assessment must ensure:
competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment
access to and the use of a range of common office equipment, technology, software and consumables
access to organisation records
access to organisation policies and procedures.
Method of assessment
A range of assessment methods should be used to assess practical skills and knowledge. The following examples, in combination, are appropriate for this unit:
evaluating an integrated activity, which combines the elements of competency for the unit, or a cluster of related units of competency
observing processes and procedures in workplaces
verbal or written questioning on underpinning knowledge and skills
evaluating samples of work
accessing and validating third party reports
setting and reviewing workplace projects and business simulations or scenarios.
Guidance information for assessment
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUS16 | FNSISV511 | Settle non-routine and complex claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| S727 | FNS51110 | Diploma of General Insurance | Qualification |