Unit of competency Outline

Date retreived
23/07/2026 12:31 AM AWST

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Determine claim liability

Determine claim liability

Unit of competency
National Code
FNSPIM302
State Code
AUS57
TGA Status
Current
DTWD Status
Approved
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
20
Description
This unit describes the skills and knowledge required to process a personal injury claim in accordance with organisational guidelines and procedures. It encompasses all aspects of processing a claim, including possible claim rejection.It applies to individuals who use specialised knowledge and follow structured approaches using limited discretion and judgement within the claims management function.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. Receive and clarify claim information
  • 1.1 Enter claim information into relevant organisational systems
  • 1.2 Process claim in accordance with required timeframes and according to relevant Acts, regulations and organisational procedures
  • 1.3 Complete correspondence in accordance with organisational policy and procedures, and allocate to relevant claims personnel
  • 1.4 Advise clients of organisational claims procedures and respond to queries in an appropriate manner
  • 1.5 Check claim information for accuracy and validity in accordance with organisational policy and procedures
2. Determine status of claim
  • 2.1 Analyse all information against regulatory requirements and organisational guidelines to determine liability
  • 2.2 Refer claims to internal or external specialists where required and in accordance with organisational guidelines
3. Accept or reject claim
  • 3.1 Determine liability decision in accordance with organisational guidelines, regulatory requirements, industry codes of practice and defined timeframes
  • 3.2 Adhere to referral procedures where claim amounts are outside settlement and/or claims management authority
  • 3.3 Determine decision on liability, considering review and feedback from external stakeholders
4. Document liability decision
  • 4.1 Communicate liability decisions to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice
  • 4.2 Communicate reasons for decisions promptly to clients and other relevant stakeholders
  • 4.3 Document decisions and file to demonstrate basis on which claim decision was determined, including all evidence and information that was considered, where appropriate
No information
No information
Replaces
State Code National Code Title Type
D4275 FNSPIM302A Determine claim liability Unit of competency