Unit of competency Outline

Date retreived
22/07/2026 8:14 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.

Make claim determinations

Make claim determinations

Unit of competency
National Code
PSPIM403A
State Code
C8168
TGA Status
Replaced
DTWD Status
Replaced
Current Release Number
3.00
Current Release Date
01/11/2012
State Implementation and Classification
Approved Date
Field of Education
061703 - Occupational Therapy
Original Release Date
Nominal Hours
30
Description
This unit covers assessment of compensation claims for employment-related injuries in order to make a determination. It includes assessing the claim and making a determination.In practice, making claim determinations may overlap with other generalist or specialist public sector work activities such as acting ethically, complying with legislation, applying government processes, delivering client services, gathering and analysing information.No licensing, legislative, regulatory or certification requirements apply to this unit at the time of publication
Notes
Elements and Performance Criteria
1. Assess claim
  • 1.1 Available information is assessed in accordance with legislation, policy and procedures to establish if it is sufficient for a determination to be made.
  • 1.2 Additional information required to make the determination is identified, where necessary.
  • 1.3 Additional information is obtained in accordance with legislation, policy and procedures.
  • 1.4 Information is re-assessed to lead to further investigation or is judged sufficient to proceed in making a determination.
  • 1.5 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.
2. Make a determination
  • 2.1 Claimant's eligibility to claim under the legislation is confirmed and the reported condition is confirmed as compensable under the legislation.
  • 2.2 Details of the claim are assessed to ensure they qualify for payment.
  • 2.3 The claim is accepted or rejected based on all available evidence in accordance with legislation, policy and procedures.
  • 2.4 Notional weekly earnings are calculated where required.
  • 2.5 The claimant and other relevant parties are advised in writing of the decision, and advice contains all information required by the legislation.
  • 2.6 Case files/records are completed and contain comprehensive details of the claim and justification for the decision in accordance with legislation, policy and procedures.
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
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
Replaced By
State Code National Code Title Type
AWU91 PSPINM004 Make claim determinations Unit of competency
State Code National Code Title Type
J283 PSP40112 Certificate IV in Government Qualification