Unit of competency Outline

Date retreived
22/07/2026 8:10 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.

Work with legal teams to resolve non-routine and complex insurance claims

Work with legal teams to resolve non-routine and complex insurance claims

Unit of competency
National Code
FNSISV522
State Code
OCI39
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
80
Description
This unit describes the skills and knowledge required to support legal proceedings to resolve non-routine and complex insurance claims. It involves establishing terms of reference for working with a legal team, providing timely and accurate information to support the legal proceedings for the claim, and participating in the settlement of a non-routine, complex claim that involves legal resolution.The unit applies to those who work with legal teams to resolve 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. Users are advised to check with the relevant state and territory regulatory authorities to confirm those requirements.
Notes
Elements and Performance Criteria
1. Establish requirements of legal proceedings for non-routine and complex insurance claim
  • 1.1 Establish comprehensive terms of reference and instructions applicable to legal proceedings for claim
  • 1.2 Identify terms of reference and confirm they are within organisational and legislative guidelines, codes of practice and personal authorities, and are documented accordingly
  • 1.3 Negotiate, confirm and document roles and responsibilities of parties involved in legal proceedings for claim
  • 1.4 Identify requirements and procedures of legal system involved in claim proceedings
2. Obtain and assess required claims information, and provide to legal team
  • 2.1 Identify legal team representatives and obtain information requirements
  • 2.2 Engage with legal team to identify legal data and information sources and discuss applicable options for obtaining requested legal data and information
  • 2.3 Obtain facts, evidence and information applicable to claims proceedings
  • 2.4 Research and analyse additional historical and legal data, as required
  • 2.5 Identify information deficiencies and seek additional information
  • 2.6 Provide legal data and information to legal team in compliance with organisational policies and procedures, and compliance, ethical and legal requirements
3. Support legal process to manage claim
  • 3.1 Obtain instructions and receipt of legal advice pertaining to claim
  • 3.2 Communicate with legal teams and other applicable parties as required and expedite insurance claim resolution
  • 3.3 Negotiate timelines for provision of required documents to legal team within agreed timeframes
  • 3.4 Clarify conflicting evidence and information according to organisational and legislative requirements, codes of practice, and other relevant guidelines and ensure settlement payments comply with relevant policies
  • 3.5 Document all actions, procedures and outcomes in supporting legal team within required timeframes
4. Support legal team with settlement arrangements
  • 4.1 Participate in mediation and negotiation activities, as required
  • 4.2 Initiate meeting with instructing legal practitioner to discuss settlement meeting and review settlement documents
  • 4.3 Check and exchange documentation with required parties
  • 4.4 Draft letter of confirmation of settlement, and forward to instructing legal practitioner for review and despatch to required parties
5. Report claim outcomes and update records
  • 5.1 Inform stakeholders of claim outcome according to organisational policies and procedures
  • 5.2 Document and record actions, procedures and outcomes according to organisational policies and procedures, legislative requirements, and codes of practice
  • 5.3 Provide stakeholders with advice regarding claim settlement
No information
No information
Replaces
State Code National Code Title Type
AUS36 FNSISV512 Work with legal teams to resolve complex claims Unit of competency