Unit of competency Outline

Date retreived
23/07/2026 8:03 AM AWST

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Settle insurance claims

Settle insurance claims

Unit of competency
National Code
FNSISV309
State Code
AUR95
TGA Status
Deleted
DTWD Status
Deleted
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
40
Description
This unit describes the skills and knowledge required to settle insurance claims, including the negotiation of terms, recording of detail, finalisation of payments and filing of documents.It applies to individuals employed in a range of insurance sectors and may be applied within organisations of various sizes and across a range of customer bases.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. Calculate claim entitlement
  • 1.1 Gather and evaluate information to determine amount of loss suffered by customer
  • 1.2 Determine settlement terms according to policy wording, legislation and codes of practice
2. Negotiate and communicate settlement terms
  • 2.1 Advise promptly terms and conditions of settlement to customer and/or third party according to organisational claims procedures, where appropriate
  • 2.2 Consider response by customer and/or third party to terms of settlement offer and assess whether adjustment is required to take into account value of lost or damaged goods
  • 2.3 Undertake negotiation in endeavour to reach mutual agreement on valuation
  • 2.4 Modify terms and conditions of settlement as necessary and advise customer and/or third party promptly
3. Document liability decisions
  • 3.1 Clearly communicate claim decisions to relevant parties in manner required by policy wording, legislation, organisational operating procedures and codes of practice
  • 3.2 Document decisions in such a way as to determine basis on which decision was reached and consider all evidence and information, where applicable
  • 3.3 Send claims documentation to reinsurers
4. Finalise settlement
  • 4.1 Make or give instructions for payments within the required timeframe once settlement is reached
  • 4.2 Obtain settlement release from customer and/or third party, as applicable
  • 4.3 Refer claim for recovery action if appropriate, and appoint loss recovery agent if applicable
  • 4.4 Initiate recovery action from reinsurers, if applicable
  • 4.5 Store and maintain finalised claims files according to organisational policy, legislative requirements and codes of practice, as applicable
No information
No information
Replaces
State Code National Code Title Type
D4231 FNSISV309A Settle claims Unit of competency
State Code National Code Title Type
AVZ8 FNS30515 Certificate III in General Insurance Qualification