Unit of competency Outline
Date retreived
23/07/2026 3:26 AM AWST
23/07/2026 3:26 AM 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.
Determine claim liability
Determine claim liability
Unit of competency
National Code
FNSPIM302A
FNSPIM302A
State Code
D4275
D4275
TGA Status
Replaced
Replaced
DTWD Status
Replaced
Replaced
State Implementation and Classification
Approved Date
28/07/2014
Field of Education
081103 - Insurance And Actuarial Studies
Original Release Date
28/07/2014
Nominal Hours
20
Description
This unit describes the performance outcomes, skills and knowledge required to process a personal injury claim in accordance with organisation guidelines and procedures. It encompasses all aspects of processing a claim including possible claim rejection.This unit may apply to job roles subject to licensing, legislative, regulatory or certification requirements so Commonwealth, State or Territory requirements should be confirmed with the relevant body.
Notes
Elements and Performance Criteria
1. Receive and clarify claim information
- 1.1. Claim information is received and entered into relevant organisation systems
- 1.2. Claim is processed in accordance with required timeframes and according to relevant Acts, regulations and organisation procedures
- 1.3. Correspondence is completed in accordance with organisation policies and procedures, and is allocated to relevant claims personnel
- 1.4. Clients are advised of organisation claims procedures and queries are responded to in an appropriate manner
- 1.5. Claim information is checked for accuracy and validity in accordance with organisation policies and procedures
2. Determine status of claim
- 2.1. All information is analysed against regulatory requirements and organisation guidelines to determine liability
- 2.2. Claims are referred to specialists where required and in accordance with organisation guidelines
3. Accept or reject claim
- 3.1. Liability decision is made in accordance with organisation guidelines, regulatory requirements, industry codes of practice and defined timeframes
- 3.2. Referral procedures are observed where claim amounts are outside settlement and/or claims management authority
- 3.3. Decision on liability is determined considering review and feedback from external stakeholders
4. Document liability decision
- 4.1. Liability decisions are communicated to relevant stakeholders in accordance with regulatory requirements, operating procedures and relevant codes of practice
- 4.2. Reasons for decisions are communicated promptly to clients and other relevant stakeholders
- 4.3. Decisions are documented and filed to demonstrate the basis on which the claim decision was determined, including all evidence and information that was considered, where appropriate
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.
Claim information may include identifying:
data
policy
previous history with the organisation
risk.
Organisation procedures may include:
initiation of new claims
processing of routine claims.
Specialists may include organisation specialists or outside service providers such as:
accountants
allied health practitioners
investigators
legal providers
loss assessors
medical practitioners.
Referral procedures may involve:
referral to the next level of authority.
Decisions may involve:
consultation
fact finding
research.
Filing may include:
electronic
paper documents.
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.
Claim information may include identifying:
data
policy
previous history with the organisation
risk.
Organisation procedures may include:
initiation of new claims
processing of routine claims.
Specialists may include organisation specialists or outside service providers such as:
accountants
allied health practitioners
investigators
legal providers
loss assessors
medical practitioners.
Referral procedures may involve:
referral to the next level of authority.
Decisions may involve:
consultation
fact finding
research.
Filing may include:
electronic
paper documents.
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:
receive and clarify information and determine the status of a claim using organisation guidelines and regulatory requirements
document liability decision using organisation guidelines, demonstrating knowledge of relevant Acts and regulations and organisation policies and procedures
analyse information to draw meaningful conclusions
read and interpret insurance policies, reports and related documents.
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.
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:
receive and clarify information and determine the status of a claim using organisation guidelines and regulatory requirements
document liability decision using organisation guidelines, demonstrating knowledge of relevant Acts and regulations and organisation policies and procedures
analyse information to draw meaningful conclusions
read and interpret insurance policies, reports and related documents.
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.
Guidance information for assessment
Replaced By
| State Code | National Code | Title | Type |
|---|---|---|---|
| AUS57 | FNSPIM302 | Determine claim liability | Unit of competency |
| State Code | National Code | Title | Type |
|---|---|---|---|
| S694 | FNS30210 | Certificate III in Personal Injury Management (ClaimsManagement) | Qualification |