Unit of competency Outline

Date retreived
22/07/2026 10:12 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.

Work with legal teams to resolve complex claims

Work with legal teams to resolve complex claims

Unit of competency
National Code
FNSISV512
State Code
AUS36
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
80
Description
This unit describes the skills and knowledge required to support legal proceedings to resolve a non-routine, complex claim and encompasses establishment of terms of reference for working with a legal team, the provision of timely, accurate information to support the legal proceedings for the claim, and participation in the settlement of a non-routine, complex claim that involves legal resolution.It applies to individuals working in job roles involving specialist knowledge and functions where it may be necessary to work with legal teams in resolving non-routine, complex insurance claims such as major losses, bodily injury losses and long-term settlement.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. Establish requirements of legal proceedings for insurance claim
  • 1.1 Establish comprehensive terms of reference or instructions relevant to legal proceedings for non-routine and complex claim
  • 1.2 Check terms of reference to ensure they are within organisational and legislative guidelines, codes of practice and personal authorities, and are clearly documented
  • 1.3 Negotiate, confirm and document roles and responsibilities of all parties involved in legal proceedings for claim
  • 1.4 Clarify requirements and procedures of legal systems involved in claim proceedings, including domestic and/or other relevant countries
2. Provide relevant claims information to legal team
  • 2.1 Identify legal team representatives and confirm information requirements
  • 2.2 Discuss options for obtaining legal data and information, and identify sources of legal data and information
  • 2.3 Collect facts, evidence and information relevant to claims proceedings thoroughly, systematically and accurately
  • 2.4 Research historical data, as required
  • 2.5 Analyse legal data and information for relevance
  • 2.6 Identify information deficiencies and seek additional information from appropriate sources
  • 2.7 Provide legal data and information to legal team in compliance with organisational policy and procedures, compliance, ethical and legal requirements and within required timeframes and authorities
3. Support legal process from claims perspective
  • 3.1 Ensure instructions for and receipt of legal advice pertaining to claim occurs as required
  • 3.2 Liaise with legal team, doctors or other relevant parties as required to expedite insurance claim resolution
  • 3.3 Ensure documents passed as part of legal proceedings comply with organisational, regulatory and legislative considerations
  • 3.4 Negotiate timelines for provision of relevant documents to legal team and ensure they are adhered to
  • 3.5 Ensure insurers manage matters before court in a manner that achieves best and most expeditious resolution and at minimum cost
  • 3.6 Employ all appropriate methods within organisational, legislative, codes of practice or other guidelines to clarify conflicting evidence or information
  • 3.7 Document all actions, procedures and outcomes in supporting legal team and record promptly
4. Participate in settlement arrangements
  • 4.1 Participate in mediation and negotiation activities as required
  • 4.2 Arrange meeting with instructing legal practitioner to discuss settlement meeting and review settlement documents
  • 4.3 Attend settlement meeting at prescribed venue
  • 4.4 Check documentation to ensure it is correct
  • 4.5 Exchange documentation with appropriate parties
  • 4.6 Draft letter of confirmation of settlement, forward to instructing legal practitioner for review and despatch to relevant parties
  • 4.7 Register, lodge and record relevant documents as appropriate
  • 4.8 Inform stakeholders of outcome
5. Report outcomes and update records
  • 5.1 Document and record actions, procedures and outcomes promptly and accurately according to organisational policy, legislative requirements and codes of practice, as applicable
  • 5.2 Provide stakeholders with accurate and timely advice regarding the claim settlement
No information
No information
Replaces
State Code National Code Title Type
D4250 FNSISV512A Work with legal teams to resolve complex claims Unit of competency
Replaced By
State Code National Code Title Type
OCI39 FNSISV522 Work with legal teams to resolve non-routine and complex insurance claims Unit of competency