AIC Adjuster Level 3 Senior Claims Scenario Guide
Use a repeatable method for Finance Prep Level 3 scenarios involving file oversight, complex losses, settlement, recovery, supervision, and regulatory escalation.
Scope
Finance Prep Level 3 scenarios test independent senior-claims reasoning. They are not official AIC questions and do not reproduce a separate Level 3 examination.
At Level 3, a scenario may contain two decisions at once:
- the claim decision, such as what evidence, coverage analysis, valuation, settlement, or recovery step is supportable; and
- the oversight decision, such as what should be approved, corrected, documented, delegated, or escalated.
Missing the second decision is a common reason a technically plausible answer remains weak.
Seven-step scenario method
| Step | Ask | Output |
|---|---|---|
| 1. Fix the role | Am I acting as file adjuster, Level 3 reviewer, supervisor, DR, insurer representative, or another decision-maker? | A clear responsibility boundary |
| 2. State the decision | What must be decided now, and what can wait for more evidence? | One sentence defining the decision point |
| 3. Separate the issues | Which coverage, liability, causation, quantum, conduct, authority, or process issues are distinct? | An issue list without premature conclusions |
| 4. Test the evidence | What supports each conclusion, what conflicts, and what is missing? | A targeted evidence plan |
| 5. Check authority and control | Who may instruct, approve, communicate, pay, settle, deny, release, or report? | Approval and escalation path |
| 6. Protect rights and people | What privacy, limitation, litigation, salvage, recovery, safety, complaint, or fairness risk could be prejudiced? | Immediate preservation action |
| 7. Make the record | What reasoning, instruction, approval, owner, communication, and follow-up must appear in the file? | Review-ready file note |
Read the stem in two layers
On the first pass, mark the technical facts: policy, loss, parties, cause, damage, treatment, contract, valuation, or allegation.
On the second pass, mark the control facts: role, authority, missing approval, deadline, complaint, conflict, privacy concern, payment change, represented party, expert disagreement, subordinate error, or incomplete file.
The strongest answer normally addresses the decisive technical fact and the control needed to act safely.
Scenario cues by practice area
| Cue | Questions to ask before choosing an answer |
|---|---|
| Licence or DR issue | Is this eligibility, personal licence authority, delegated claim authority, supervision, business management, or an AIC application question? |
| Incomplete coverage file | Do we have the full policy and endorsements? Which material fact changes the analysis? Who may direct or communicate the position? |
| Complex property loss | Are cause, emergency mitigation, scope, valuation, business interruption, expert roles, salvage, and recovery separately controlled? |
| Bodily injury | Is information obtained with proper purpose and authority? Are causation, treatment, prognosis, income loss, liability, limits, and damages supported? |
| Litigation or represented party | What communications must change? What evidence, limitation, privilege, legal instruction, and settlement controls apply? |
| Settlement pressure | Are coverage, liability, damages, authority, liens, release, payment destination, contribution, and recovery sufficiently resolved? |
| Subordinate error | Can the file be safely corrected? Must the client, insurer, management, DR, privacy lead, legal counsel, or regulator be involved? |
| Complaint or conflict | Is the concern documented, acknowledged, investigated objectively, separated from the underlying claim, and escalated under the proper process? |
Weaker answer patterns
| Pattern | Why it is weak | Better direction |
|---|---|---|
| Approve because the outcome seems commercially reasonable | Commercial convenience does not replace evidence, policy reasoning, or authority. | Identify the missing support and set a controlled next step. |
| Take over every difficult file | It hides capacity and competence problems and weakens accountable delegation. | Define review points, instructions, authority, and follow-up. |
| Correct the note without recording the change | It damages chronology and auditability. | Preserve the original record and document the correction and reason. |
| Deny or settle to resolve a complaint quickly | It combines service recovery with an unsupported claim outcome. | Handle the complaint and claim decision through their respective controls. |
| Treat a DR question as an ordinary claim-authority question | DR responsibility concerns management and supervision of the licensed business. | Identify whether the issue belongs to the claim file, firm controls, or AIC. |
| Wait for perfect evidence while rights expire | Inaction can prejudice limitation, recovery, safety, or mitigation. | Take permitted preservation steps while escalating unresolved decisions. |
Explanation review
After each scenario, write:
- the role you should have adopted;
- the decisive technical fact;
- the decisive control fact;
- the evidence still required;
- the person or function owning approval; and
- the file record and follow-up the preferred answer requires.
Retest with a different scenario. If you can only recognize the original wording, return to the focused topic drill before continuing with varied mixed practice.