Unit of competency Outline

Date retreived
22/07/2026 3:17 PM AWST

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Assess and determine ongoing entitlements

Assess and determine ongoing entitlements

Unit of competency
National Code
FNSPIM304
State Code
AUS49
TGA Status
Replaced
DTWD Status
Replaced
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
60
Description
This unit describes the skills and knowledge required to assess personal injury claims including assessing and determining claim liability, identifying potential fraud indicators and facilitating interaction with stakeholders to determine the outcome of a claim.It applies to individuals who use specialised knowledge and follow structured approaches using discretion and judgement within the limits of their authority and relevant to 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. Assess claim and determine liability
  • 1.1 Gather claim information from a range of sources in accordance with organisation guidelines and legislative requirements
  • 1.2 Review validity of claim in accordance with organisation and legislative requirements
  • 1.3 Return invalid claims or information to claimant for correction
  • 1.4 Enter claims into organisation claims management system in accordance with organisation guidelines, codes of practice and time requirements
  • 1.5 Refer claim to appropriate risk assessment area in accordance with organisation delegation authorities
2. Identify potential risk indicators
  • 2.1 Identify areas of risk within claim from the injured person or the service provider
  • 2.2 Use information collected during the claims registration process to assess the risk of the claim
  • 2.3 Follow organisational procedures and use appropriate tools to identify and manage risks factors that may escalate
  • 2.4 Follow organisation procedures for escalation
3. Facilitate interaction and consult with stakeholders
  • 3.1 Plan and implement strategies in consultation with stakeholders
  • 3.2 Document referral process with stakeholders’ involvement
  • 3.3 Record stakeholder interaction in accordance with legislative and organisation standards
  • 3.4 Record agreed actions and undertakings as outlined by stakeholders
  • 3.5 Identify and document contingency and corrective action plans
  • 3.6 Determine medical liability in consultation with stakeholders and related parties
  • 3.7 Prepare case for conference in accordance with organisation guidelines
  • 3.8 Undertake agreed actions as a result of conferencing
No information
No information
Replaces
State Code National Code Title Type
D4277 FNSPIM304A Manage claims Unit of competency
Replaced By
State Code National Code Title Type
OCZ57 FNSPIM314 Assess and determine initial entitlements for personal injury claims Unit of competency