Unit of competency Outline
Date retreived
22/07/2026 1:12 PM AWST
22/07/2026 1:12 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.
Investigate claims
Investigate claims
Unit of competency
National Code
FNSISV506A
FNSISV506A
State Code
D4244
D4244
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
60
Description
This unit describes the performance outcomes, skills and knowledge required to investigate a claim. Investigation may cover the degree of liability or a potential fraud and covers clarifying the brief, conducting the investigation and reporting.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. Clarify the brief and the instructions
- 1.1. The brief provided to the investigator is clarified including the facts of the claim, the insurer's instructions and outcomes required
- 1.2. The subject matter questions to be investigated are checked
2. Investigate claim
- 2.1. Method of investigation is determined
- 2.2. Required information is collected and organised to make a logical case
- 2.3. Investigations are carried out in accordance with legislation, regulations and organisation operating procedures and codes of practice, if applicable
- 2.4. All data and information is recorded progressively and accurately
- 2.5. All original documents, tapes, photographs and other material are filed and stored securely
- 2.6. Appropriate changes in the brief or instructions are prepared and communicated
- 2.7. Any changes in the brief or the instructions are complied with
3. Report on the investigation
- 3.1. Comprehensive reports are prepared and transmitted according to reporting guidelines
- 3.2. Copies of the documents, tapes, photographs and other materials are provided to the insurer's nominated person
- 3.3. Facts and justification for conclusions are given to the insurer's nominated person
- 3.4. Recommendations for action are made, with appropriate justifications, where required
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.
The brief may include:
claims history
information provided by the customer
witness statements.
Subject matter may include:
corporations
evidence
incidents
individuals
locations
objects
processes
statements.
Methods of investigation may include:
interviews
mechanical or chemical analysis
observation
phone calls
review of documents
other relevant information gathering activities.
Investigations may include:
corroboration or analysis of subject matter
determining causes or sequence of events
extent of liability
identification of subject matter
suspected or potential fraud
validation of evidence
other actual or potential problems.
Data and information collected may include:
audio and video tapes
documents
electronic records
photographs
subject matter and other relevant materials.
Comprehensive reports may include:
findings
photos
recommendations
witness statements.
Reporting guidelines may include:
areas to be excluded
attachments and evidence
frequency and number of reports
level of detail
limits and types of enclosures
methods of transmission
structure of reports and number copies
topics to be covered.
The nominated person may include:
the person monitoring the investigation on behalf of the organisation.
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.
The brief may include:
claims history
information provided by the customer
witness statements.
Subject matter may include:
corporations
evidence
incidents
individuals
locations
objects
processes
statements.
Methods of investigation may include:
interviews
mechanical or chemical analysis
observation
phone calls
review of documents
other relevant information gathering activities.
Investigations may include:
corroboration or analysis of subject matter
determining causes or sequence of events
extent of liability
identification of subject matter
suspected or potential fraud
validation of evidence
other actual or potential problems.
Data and information collected may include:
audio and video tapes
documents
electronic records
photographs
subject matter and other relevant materials.
Comprehensive reports may include:
findings
photos
recommendations
witness statements.
Reporting guidelines may include:
areas to be excluded
attachments and evidence
frequency and number of reports
level of detail
limits and types of enclosures
methods of transmission
structure of reports and number copies
topics to be covered.
The nominated person may include:
the person monitoring the investigation on behalf of the organisation.
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 comply with relevant legislation and regulatory requirements
implement investigation methodologies
apply comprehensive understanding of the industry sector and all legal obligations and organisation procedures in relation to investigating claims
produce complete and accurate investigation reports.
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 comply with relevant legislation and regulatory requirements
implement investigation methodologies
apply comprehensive understanding of the industry sector and all legal obligations and organisation procedures in relation to investigating claims
produce complete and accurate investigation reports.
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
Replaces
| State Code | National Code | Title | Type |
|---|---|---|---|
| C9849 | FNSINSV506B | Investigate claims | Unit of competency |
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUS29 | FNSISV506 | Investigate insurance claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| S727 | FNS51110 | Diploma of General Insurance | Qualification |
| D776 | FNS51312 | Diploma of Life Insurance | Qualification |
| S717 | FNS50110 | Diploma of Personal Injury Management | Qualification |