Unit of competency Outline
Date retreived
22/07/2026 3:05 PM AWST
22/07/2026 3:05 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.
Manage non-routine and complex claims
Manage non-routine and complex claims
Unit of competency
National Code
FNSISV510A
FNSISV510A
State Code
D4248
D4248
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
50
Description
This unit describes the performance outcomes, skills and knowledge required to manage non-routine and complex insurance claims including non-standard issues, determination of the business impact and managing all aspects of the claims resolution process.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. Analyse claim to determine validity
- 1.1. Validity of claim is assessed against organisation and policy acceptance criteria for relevant type and category of policy
- 1.2. Information is confirmed as accurate, comprehensive and authentic
- 1.3. Inclusive validity is sought from specialists for advice where required
- 1.4. Reinsurer is notified of any claim immediately
2. Evaluate the impact of a claim
- 2.1. Data relating to the extent of the loss, damage or injury situation is analysed and claim estimates sought and reviewed
- 2.2. Claim is compared to expected payment projections for the product type, and business impact is determined
- 2.3. Strategies to minimise negative impact of any non-routine/complex claim are determined within requirements to meet policy obligations
- 2.4. Necessity for urgent action to protect organisation interests is determined
3. Determine settlement options
- 3.1. Settlement options are identified within policy obligations, organisation, legislative and legal requirements
4. Manage support arrangements to resolve the claim
- 4.1. Liaise with relevant parties to identify and meet support requirements such as partnering with external experts to ensure clients' needs are met
- 4.2. Manage any legal processes from a non-routine/complex claims perspective, including international legal system requirements, if applicable
- 4.3. Employ mediation skills to resolve issues or disputes associated with a significant claim, as required
5. Identify any required changes to policy or procedures
- 5.1. Circumstances of claim are documented for consideration in portfolio review
- 5.2. Changes to policy and procedures are instigated to minimise further loss in similar circumstances, if appropriate
6. Report findings and update records
- 6.1. Actions, procedures and outcomes are documented and recorded promptly and accurately
- 6.2. Stakeholders are provided with accurate and timely advice regarding claim proceedings
- 6.3. Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable
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.
Types and categories of policies include:
accidental damage
additional benefits
burglary/theft
business interruption
business special risks
commercial
commercial motor
construction risks
crop
defined events
directors and officers
domestic
electronic equipment
employee fraud
engineering plant
environment and pollution
fire and perils
general and products liability
glass
Industrial Special Risks (ISR)
livestock
machinery breakdown
money
multi-risk
package contracts
personal accident and illness
professional indemnity
public liability
sprinkler leakage
transit
travel.
Specialists may include:
agents
investigators
medical practitioners
solicitors.
Non-routine/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, etc.
complex technical determinations
high monetary impact
important client base.
Relevant parties may include:
broker or agent
claimant
client
consultants
government or statutory authorities
insured
legal or other practitioners
manufacturers
medical
mortgagee
principal
reinsurer
subcontractor
suppliers
third party
trustee.
External experts may include:
accountants
architects
building consultants
engineers
legal
medical
quantity and other surveyors
repairers
state/local governments
valuers
other relevant experts as required.
Mediation may be:
simple or complex and involve highly developed interpersonal and analytical skills and the application of mediation and dispute resolution techniques.
Documentation may include:
legal, government, professional and other documents
meeting notes
minutes
official, general and other correspondence
reasons for recommending certain actions and settlement options over others
records of telephone conversations
reference to all data and information considered
reports from others such as loss adjusters, assessors, insurers, medical providers and others
the basis on which the decision was determined.
Stakeholders may include:
claimants
claims managers/specialists
insurance broker
reinsurers
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.
Types and categories of policies include:
accidental damage
additional benefits
burglary/theft
business interruption
business special risks
commercial
commercial motor
construction risks
crop
defined events
directors and officers
domestic
electronic equipment
employee fraud
engineering plant
environment and pollution
fire and perils
general and products liability
glass
Industrial Special Risks (ISR)
livestock
machinery breakdown
money
multi-risk
package contracts
personal accident and illness
professional indemnity
public liability
sprinkler leakage
transit
travel.
Specialists may include:
agents
investigators
medical practitioners
solicitors.
Non-routine/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, etc.
complex technical determinations
high monetary impact
important client base.
Relevant parties may include:
broker or agent
claimant
client
consultants
government or statutory authorities
insured
legal or other practitioners
manufacturers
medical
mortgagee
principal
reinsurer
subcontractor
suppliers
third party
trustee.
External experts may include:
accountants
architects
building consultants
engineers
legal
medical
quantity and other surveyors
repairers
state/local governments
valuers
other relevant experts as required.
Mediation may be:
simple or complex and involve highly developed interpersonal and analytical skills and the application of mediation and dispute resolution techniques.
Documentation may include:
legal, government, professional and other documents
meeting notes
minutes
official, general and other correspondence
reasons for recommending certain actions and settlement options over others
records of telephone conversations
reference to all data and information considered
reports from others such as loss adjusters, assessors, insurers, medical providers and others
the basis on which the decision was determined.
Stakeholders may include:
claimants
claims managers/specialists
insurance broker
reinsurers
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 data and apply concepts within organisation business objectives
negotiate an acceptable outcome to ensure mutual benefit.
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 data and apply concepts within organisation business objectives
negotiate an acceptable outcome to ensure mutual benefit.
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 |
|---|---|---|---|
| AUS21 | FNSISV510 | Manage non-routine and complex claims | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| S727 | FNS51110 | Diploma of General Insurance | Qualification |