Risk Assessment of Dispute Circumstances - Assignment Example

FNSICGEN404B Resolve disputes Assessment Booklet Cover Sheet Please ensure that a new assessment booklet cover sheet is completed with each submission to NIBA for assessment (you may also attach the markers previous comments if you wish). Assessors Comments: Andrew, I have marked your 2nd attempt and further information is still required for two of the competency tasks. Activity 1 – Question 4 – More detail for risk assessments required for each Property, liability & casualty (Volunteer work, Police check, Number of people working, etc…) – Resubmit Activity 2 – Task 4 – You need to explain how you would finalise the claim, things you need to cover off on include but not limited to e.g. communication, settlement, win-win   ASSESSMENT ACTIVITY I 1) D 2) A 3) True False True False True True True 4) In assessing the risks of the case at bar, the following should be identified: Activity 1 – Question 4 – More detail for risk assessments required for each Property, liability & casualty (Volunteer work, Police check, Number of people working, etc…) – Resubmit Property Liability Casualty Dam Proper fencing and installation of warning signs Regular police checks to ensure security and safety Possibility of drowning Underground water supply Regular monitoring of water quality as well as quantity of water available. Risk of contamination of water due to pollution at the facility. Generators Noise Monitoring of exhaust emissions Threats to animals in the creek Generator exhausts’ emissions may affect the people at the education centre. Dormitory Maintenance of risk facilities Monitoring fire equipment in the dormitory Large number of staff working in the dormitory as well as people using the dormitory. Risks: wet surfaces, fire. Kitchen and dining facilities Old age Fire Maintenance of gas facilities High risk of fire due to the gas infrastructure Possible collapse of wooden structures due to old age 5) A 6) C 7) B 8) False True False True ASSESSMENT ACTIVITY II Investigation into the Circumstances of a Dispute Reference No. JS-01-12-09 Name of Complainant: Jason Smith Date of Complaint: December 1, 2009 Description of Problem: Jason Smith, a 17-year old school boy has had an asthma attack previously but is under control under medication. However, during the school’s musical production he allegedly suffered a severe asthmatic attack as a result of exposure to chemicals following the operation of a ‘fog machine’ and exposure to other allergens. Personnel Involved in the Dispute: ABC Insurance Co. Ltd Possible Causes of Complaint/ Dispute: As the applicant had previously been diagnosed as an asthmatic, the issue arose as to whether he sustained an injury as covered by the policy. Effects of Complaint/ Dispute: The interpretation of the policy wordings was scrutinized. Location of Problem: Actions of Staff: Help the complainant lodged his complaint and determine for the existence of a dispute. Was the Complaint Referred? Yes To whom was the Complaint Referred? Internal Dispute Resolution Reason for Referral: The complainant and insurance company could not come to a settlement, both with arguments. Action that has been taken to date: Internal Dispute Resolution Why the Problem Occurred: The insurance company contended that the complainant has a pre-existing medical condition. Is further action required? Yes If so, what action is recommended? Refer the matter to external dispute resolution. Customer Service Officer investigating the complaint: Andrew Tan Date: December 2, 2009 Outline on How to Resolve the Dispute Client must lodge a complaint either verbally or in writing; however, it is preferred to be in writing for easy validation of the complaint either way the complaint must be dealt with. In all aspects of handling complaint fairness must be exercised and with no charge in lodging the complaint. Offer reasonable assistance to the complaint and let an officer who is not a party to the complaint handle the case. Also inform the client of other possible dispute resolution scheme should the complaint left unresolved internally. Listen to the client, be courteous and polite and make an assessment of the complaint taking into consideration the rights and obligations of the client and the broker. No admission should be made of any liability without the approval of the organisation’s senior management. Consideration of a remedy that is fair and reasonable and a good industry practice. Finalise the dispute. Record the outcome of the process and tell the parties why you have come to such conclusion. Weigh the facts of the case, company policy, good industry practice, and the benefits or disadvantages of such decision. As much as possible the complaint must be resolved internally within the firm in an expedient and speedy manner to satisfy not only the client but other parties in the dispute also. Should the dispute be not resolved internally, it must be referred to the external dispute resolution scheme of which the firm is a part of. Options for finalizing the dispute OPTIONS FOR RESOLUTION OF AN INJURY COMPLAINT/DISPUTE (REFERENCE NO. JS-01-12-09) Customer’s name: Jason Smith Contact details: Level 17, 109 Pacific Highway, North Sydney, New South Wales, 2060 Phone: (02) 9987 7577 Fax: (02) 9964 9682 Description of complaint: Jason Smith, a 17-year old school boy has had an asthma attack previously but is under control under medication. However, during the school’s musical production he allegedly suffered a severe asthmatic attack as a result of exposure to chemicals following the operation of a ‘fog machine’ and exposure to other allergens. Finalization of the dispute Dispute: Jason Smith suffered a severe asthmatic attack after an exposure to chemical arising from the use of a fog machine as well as other allergens. Since the applicant had previously been diagnosed with asthma, the insurance company contends that it is not known whether the applicant actually sustained an injury as covered under the insurance policy. According the insurance company, the sustained injury could have occurred because of the pre existing medical condition. As the applicant had previously been diagnosed as an asthmatic, the issue arose as to whether he sustained an injury as covered by the policy. The insurance company contended that the complainant has a pre-existing medical condition. The following is a table for steps to finalize the dispute in order to obtain a win-win resolution. Steps in the process Elements in the process Outcomes Step I Establishing that the dispute indeed exists Grounds for the dispute. The applicant sustained an injury and has made a claim from the insurance company. However, the insurance company contends that injury insured is not directly the injury sustained since the applicant had a pre existing medical condition. Is the dispute legitimate? Yes. Given that the terms of insurance and the conditions under which the sustained injury occurred do not agree. Were operating procedures followed? The fog machine allegedly malfunctioned and this led to the emission of allergen that caused the applicant to suffer an asthmatic attack. Prior to this, the complainant had been diagnosed to be asthmatic. This information will be supplied to the customer in order to agree on the elements of the dispute. Information will be gathered from relevant parties concerning the injury. The parties include the school attended by the complainant as well as the complainant’s doctor. Note: The insurance company like to inform the complainant (customer) that all obligations and procedures will be followed within an appreciate timeline for investigation of the dispute. The dispute is legitimate based on the different standpoints taken by the complainant and the insurer Step II Investigating the dispute Records show that the complainant was initially diagnosed with asthma and was put on medication which is still ongoing. The condition rather than the exposure to allergens from the fog machine could have caused the injury to the complainant, though it is not documented under the insurance policy. Action to taken: The medical doctor in charge will provide evidence of the sustained injury in order to determine whether the complainant is justified to make a claim. All concerned parties including the school and the doctor have been informed of the planned action Results of the doctor’s investigation regarding the complainant will reveal the appropriate steps to be taken regarding the dispute Step III Resolving the dispute The decision to investigate the dispute has been occasioned by the need to determine facts about the injury. The insurance company shall negotiate with the client and the clients’ doctor about the nature of the asthmatic condition in order to quickly arrive at a resolution. In order to time as well as resources, the insurance company wishes to treat this dispute as one that can be resolved under IDR (internal dispute resolution rather than EDR (external dispute resolution) the company thus wishes not to resort to conciliatory measures. Due respect is accorded to the customer in the whole process of investigation to resolve the dispute. Reference shall be made to EDR only if dire need arises. Most resolutions in the investigation have been based on IDR principles. Step IV Finalisation of the dispute Investigation from doctor’s records shows that the complainant’s asthmatic attach occurred due to the current illness and as a result of exposure to allergens from the from machine. There is evidence that no other student suffered the same condition even though they were equally exposed to the allergens as the client. It is therefore hereby stated that the complainant has no right to be paid under existing policy terms since the current agreement does not cover the scope of the injury that was sustained. In order to ensure that the current dispute does not recur, it is advised that the policy agreement between the complainant and the insurer be re-negotiated in order to take into account the complainant’s current health condition. Records reveal that the patient’s alleged injury occurred due to the pre existing medical conditions rather than current exposure to allergens; hence no payment shall be made. Reference: FNSICGEN404B Learning Guide, NIBA. Financial Ombudsman Service: General Insurance Case Studies. Retrieved on October 14, 2009 from http://www.fos.org.au/centric/home_page/cases/general_insurance_case_studies.jsp Read More