Unit of competency Outline
Date retreived
22/07/2026 10:40 PM AWST
22/07/2026 10:40 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.
Work with legal teams to resolve complex claims
Work with legal teams to resolve complex claims
Unit of competency
National Code
FNSISV512A
FNSISV512A
State Code
D4250
D4250
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
80
Description
This unit describes the performance outcomes, skills and knowledge required to support legal proceedings to resolve a non-routine, complex claim. It encompasses establishment of terms of reference for working with a legal team, the provision of timely, accurate information to support the legal proceedings for the claim, and participation in the settlement of a non-routine, complex claim that involves legal resolution.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. Establish the requirements of legal proceedings for an insurance claim
- 1.1. Comprehensive terms of reference or instructions relevant to the legal proceedings for the non-routine and complex claim are established
- 1.2. Terms of reference are checked to ensure they are within organisation and legislative guidelines, codes of practice and personal authorities and are clearly documented
- 1.3. Roles and responsibilities of all parties involved in the legal proceedings for the claim are negotiated, confirmed and documented
- 1.4. Requirements and procedures of legal systems involved in the claim proceedings, including domestic and/or other relevant countries, are clarified
2. Provide relevant claims information to the legal team
- 2.1. Legal team representatives are identified and information requirements confirmed
- 2.2. Options for obtaining the legal data/information are discussed and sources of legal data/information are identified
- 2.3. Facts, evidence and information relevant to claims proceedings, is collected thoroughly, systematically and accurately
- 2.4. Historical data is researched, as required
- 2.5. Legal data/information is analysed for relevance
- 2.6. Information deficiencies are identified and additional information is sought from appropriate sources
- 2.7. Legal data and information is provided to legal team in compliance with organisation policies and procedures, compliance, ethical and legal requirements and within required timeframes and authorities
3. Support the legal process from a claims/underwriting perspective
- 3.1. Instructions for and receipt of legal advice pertaining to the claim occurs as required
- 3.2. Liaison with legal team, doctors or other relevant parties occurs as required to expedite insurance claim resolution
- 3.3. Documents passed as part of the legal proceedings comply with organisation, regulatory and legislative considerations
- 3.4. Timelines are negotiated for provision of relevant documents to the legal team and adhered to
- 3.5. Insurers manage matter before the court in a matter that achieves the best and most expeditious resolution at minimum cost
- 3.6. All appropriate methods within organisation, legislative, codes of practice or other guidelines are employed to clarify conflicting evidence or information
- 3.7. All actions, procedures and outcomes in supporting the legal team are documented and recorded promptly
4. Participate in settlement arrangements
- 4.1. Participation in mediation and negotiation activities occurs, as required
- 4.2. Meeting is arranged with instructing legal practitioner to discuss settlement meeting and to review settlement documents
- 4.3. Settlement meeting is attended at prescribed venue
- 4.4. Documentation is checked to ensure it is correct
- 4.5. Documentation is exchanged with the appropriate parties
- 4.6. Letter of confirmation of settlement is drafted, forwarded to instructing legal practitioner for review and despatched to relevant parties
- 4.7. Relevant documents are registered/lodged/recorded as appropriate
- 4.8. Stakeholders are informed of outcome
5. Report outcomes and update records
- 5.1. Actions, procedures and outcomes are documented and recorded promptly and accurately according to organisation policy and legislative requirements and codes of practice, as applicable
- 5.2. Stakeholders are provided with accurate and timely advice regarding the claim settlement
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.
Terms of reference or instructions may include:
date and location of loss, damage or injury
estimate of loss, damage or injury
instructions for scope of information required
insurers reference
legal procedures and timelines associated with the claim
name of insured and initial contact
other parties involved
period of insurance
policy cover
policy number
proposed documents to be passed
type.
Non-routine and 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/bodily injury losses
complex technical determinations
high monetary impact
important client base.
Non-routine aspects may include:
disputes in other jurisdictions
special inclusions and exclusions.
Legal data and information may include:
claimant medical history
claimant medical records and reports
claimant test results
correspondence to a range of medical/hospital professionals on claimant related matters
forms
interview records
legal case reports
legal, government, professional and other documents
letters
meeting notes
minutes
official, general, other correspondence
policy documents (including current and archival policies relevant to the claim)
records of telephone conversations
reports from others such as loss adjusters, assessors, insurers, medical providers, rehabilitation providers and others as applicable
time sheets.
Sources of legal data/information may include:
employer and industry associations
employers
insurance brokers
legal team members
loss adjusters, specialist and other claims staff
medical and like providers
rehabilitation providers
relevant data bases and documentation:
legal
insurance
organisation
risk managers
the community
underwriters
union
work team members.
Historical data may include:
archival policies.
Documentation may include:
legal team reports, correspondence and records
legal, government, professional and other documents
meeting notes
minutes
official, general and other correspondence
reasons for recommending certain actions and 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
others
the basis on which the decision was determined.
Stakeholders may include:
broker or agent
claims managers and specialists
client
government or statutory authorities
insurance broker
insured
principal
reinsurers
third party
trustee
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.
Terms of reference or instructions may include:
date and location of loss, damage or injury
estimate of loss, damage or injury
instructions for scope of information required
insurers reference
legal procedures and timelines associated with the claim
name of insured and initial contact
other parties involved
period of insurance
policy cover
policy number
proposed documents to be passed
type.
Non-routine and 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/bodily injury losses
complex technical determinations
high monetary impact
important client base.
Non-routine aspects may include:
disputes in other jurisdictions
special inclusions and exclusions.
Legal data and information may include:
claimant medical history
claimant medical records and reports
claimant test results
correspondence to a range of medical/hospital professionals on claimant related matters
forms
interview records
legal case reports
legal, government, professional and other documents
letters
meeting notes
minutes
official, general, other correspondence
policy documents (including current and archival policies relevant to the claim)
records of telephone conversations
reports from others such as loss adjusters, assessors, insurers, medical providers, rehabilitation providers and others as applicable
time sheets.
Sources of legal data/information may include:
employer and industry associations
employers
insurance brokers
legal team members
loss adjusters, specialist and other claims staff
medical and like providers
rehabilitation providers
relevant data bases and documentation:
legal
insurance
organisation
risk managers
the community
underwriters
union
work team members.
Historical data may include:
archival policies.
Documentation may include:
legal team reports, correspondence and records
legal, government, professional and other documents
meeting notes
minutes
official, general and other correspondence
reasons for recommending certain actions and 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
others
the basis on which the decision was determined.
Stakeholders may include:
broker or agent
claims managers and specialists
client
government or statutory authorities
insurance broker
insured
principal
reinsurers
third party
trustee
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 working with legal teams in all aspects of the managing the legal process associated with a claim and resolving the legal aspects of a claim.
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 working with legal teams in all aspects of the managing the legal process associated with a claim and resolving the legal aspects of a claim.
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 |
|---|---|---|---|
| AUS36 | FNSISV512 | Work with legal teams to resolve complex claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| S727 | FNS51110 | Diploma of General Insurance | Qualification |
| D776 | FNS51312 | Diploma of Life Insurance | Qualification |