Unit of competency Outline

Date retreived
23/07/2026 2:00 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.

Assess and determine initial entitlements for personal injury claims

Assess and determine initial entitlements for personal injury claims

Unit of competency
National Code
FNSPIM314
State Code
OCZ57
TGA Status
Current
DTWD Status
Approved
Current Release Number
1.00
Current Release Date
02/02/2021
View on TGA
State Implementation and Classification
Approved Date
22/04/2021
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
22/04/2021
Nominal Hours
55
Description
This unit describes the skills and knowledge required to assess an initial personal injury claim, including determining claim liability and identifying potential fraud indicators, and determine the outcome of a claim.The unit applies to those who use specialised personal injury management knowledge and follow structured approaches using discretion and judgement within the limits of their authority and relevant to the claims management function. Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Users are advised to check with the relevant state and territory regulatory authorities to confirm those requirements.
Notes
Elements and Performance Criteria
1. Determine validity of claim
  • 1.1 Gather information and review validity of claim according to organisational policies and procedures, and legislative and regulatory requirements
  • 1.2 Return invalid claims and information to claimant for correction as required
  • 1.3 Enter claim information into claims management system according to organisational policies and procedures and codes of practice
  • 1.4 Refer claim to appropriate risk assessment area according to organisation delegation of authority procedures
2. Assess and manage risks
  • 2.1 Identify and assess risks of the claim based on information collected during the claim registration process
  • 2.2 Manage identified risks according to organisational policies and procedures
  • 2.3 Escalate claim as required according to organisational policies and procedures
3. Assess claim for acceptance or rejection based on organisational policies and legislative requirements
  • 3.1 Conduct investigations to determine initial liability and obtain appropriate medical and factual evidence
  • 3.2 Assess evidence and information provided by the client and other required parties
  • 3.3 Identify fraud indicators and escalate according to organisational policies or procedures, or legal requirements
  • 3.4 Accept, deny or hold pending appropriate legal action according to legislative requirements, organisational policies or procedures
4. Determine entitlements and conduct claim management actions
  • 4.1 Determine compensation entitlement amounts according to legislative and organisational policies and procedures
  • 4.2 Plan and implement claim management strategies in consultation with stakeholders
  • 4.3 Document referral process and seek stakeholder confirmation as required
  • 4.4 Record stakeholder interaction and agree on actions according to organisational policies and procedures, and legislative and regulatory requirements
  • 4.5 Identify and document contingency and corrective action plans
  • 4.6 Determine medical liability in consultation with required stakeholders
  • 4.7 Prepare case for conference according to organisational policies and procedures
  • 4.8 Conduct conference and undertake agreed actions
No information
No information
Replaces
State Code National Code Title Type
AUS49 FNSPIM304 Assess and determine ongoing entitlements Unit of competency