Unit of competency Outline

Date retreived
23/07/2026 2:20 AM AWST

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Settle non-routine and complex insurance claims

Settle non-routine and complex insurance claims

Unit of competency
National Code
FNSISV521
State Code
OCI52
TGA Status
Current
DTWD Status
Approved
Current Release Number
1.00
Current Release Date
04/11/2020
View on TGA
State Implementation and Classification
Approved Date
11/03/2021
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
11/03/2021
Nominal Hours
25
Description
This unit describes the skills and knowledge required to settle non-routine and complex insurance claims. It includes identifying non-standard issues, accessing required information to allow a decision to be made, and negotiating and finalising the claims.The unit applies to those who apply specialist knowledge and functions in a range of insurance sectors in organisations of various sizes and across a range of client bases.Work functions in the occupational areas where this unit may be used are subject to regulatory requirements. Users are advised to check with the relevant state and territory regulatory authorities to confirm those requirements.
Notes
Elements and Performance Criteria
1. Determine terms and conditions of settlement
  • 1.1 Determine and evaluate non-routine aspects of claim and parties involved according to organisational policies and procedures
  • 1.2 Determine settlement terms according to policy wording, legislation, organisational policies and procedures, codes of practice, and any relevant transfer of monies procedures
  • 1.3 Identify type and level of variation to standard claims settlement and determine type of required negotiation and mediation
  • 1.4 Perform reconciliations as required
2. Negotiate and communicate settlement terms
  • 2.1 Communicate terms and conditions of settlement offer to client and associated parties according to claims procedures and within required timeframes
  • 2.2 Assess need for adjustment based on response by client and associated parties on terms of settlement offer
  • 2.3 Negotiate settlement terms, where required, and reach mutual agreement
  • 2.4 Meet obligations and determine settlement for minimal loss to organisation
  • 2.5 Document negotiated settlement and agreements
  • 2.6 Update terms of settlement offer as required and advise client and associated parties within required timeframes
3. Document and communicate liability decisions
  • 3.1 Review liability decision and confirm compliance with legislative and regulatory requirements and codes of practice
  • 3.2 Provide statement of claims and disclaimer as required
  • 3.3 Document liability decisions, evidence, and information considered
  • 3.4 Communicate decision to required stakeholders
  • 3.5 Determine if payment falls within individual authority limits, and if not refer claim to required stakeholders
4. Finalise settlement
  • 4.1 Verify and recommend final payment and breakdown of costs to be paid to relevant stakeholders within required timeframes once settlement is reached
  • 4.2 Obtain settlement release from client and third party, as required
  • 4.3 Obtain discharge and determine potential for further liability
5. Finalise claim documentation and identify required changes to policies or procedures
  • 5.1 Document claim circumstances for consideration in portfolio review and make recommendation to underwriter
  • 5.2 Review policies and procedures to minimise further loss in similar circumstances, as required
  • 5.3 Recommend changes to policies and procedures and monitor effectiveness of the review process
  • 5.4 Record actions, procedures and outcomes according to organisational policies and procedures
  • 5.5 Communicate advice regarding claims settlement to required stakeholders according to organisational policies and procedures
  • 5.6 Maintain finalised claims files according to required organisational policy, legislative requirements, and codes of practice
No information
No information
Replaces
State Code National Code Title Type
AUS16 FNSISV511 Settle non-routine and complex claims Unit of competency
State Code National Code Title Type
BFX4 FNS51120 Diploma of General Insurance Qualification