Competencies evaluation tables Claims adjustment

The evaluation tables indicate the skills that candidates must acquire in order to master a competency that will be evaluated by an AMF exam. They set out the weighting of the components of the evaluated competency, which is reflected by the number of questions in the exam.

The evaluation tables are therefore a reference framework for AMF exams. They reflect the AMF's expectations with regard to each skill set out in the Regulation respecting the issuance and renewal of representatives' certificates This link will open in a new window.

These tables also guide candidates in preparing for the exams by helping them focus their readings on the AMF's expectations. The evaluation tables should consequently guide candidates in preparing to write AMF exams.

Claims adjustment

Law and Ethics

COMPETENCY: Integrate into practice the general principles of law applicable to damage insurance and the rules governing the activities of claims adjusters (05-115)

Duration of the exam: 60 minutes

Number of questions: 20

Competency components:

  1. Understand the legislative framework governing damage insurance (weighting: 20%)
    1. Understand the provisions of the Civil Code of Québec applicable to damage insurance
    2. Determine the scope of An Act respecting the protection of personal information in the private sector
    3. Identify the main features of the compensation schemes set up under the Automobile Insurance Act
  2. Integrate into practice the general principles of law applicable to damage insurance contracts (weighting: 40%)
    1. Interpret the scope of property insurance and liability insurance
    2. Define the roles of the stakeholders in a damage insurance contract
    3. Identify the main elements and characteristics of a damage insurance contract
    4. Identify the validity conditions of a damage insurance contract
    5. Compare the effects and rules of interpretation of a damage insurance contract
  3. Integrate into practice the rules governing the activities of claims adjusters (weighting: 40%)
    1. Compare the different organizations that protect damage insurance consumers
    2. Specify the obligations and responsibilities of damage insurance industry representatives and registrants
    3. Interpret the scope of the duties and obligations set out in the Code of ethics of claims adjusters

Personal property claims

COMPETENCY: Settle personal property insurance claims based on the client's coverage (05-511)

Duration of the exam: 60 minutes

Number of questions: 25  

Competency components:

  1. Determine the type of claim (weighting: 16%)
    1. Gather and analyze the information contained in the notice of loss
    2. Gather relevant information for the investigation
    3. Determine the causes of the loss, the insured's liability and the possibility of recovery
  2. Validate the eligibility of the loss (weighting: 36%)
    1. Evaluate the scope of applicable coverage and endorsements in order to determine loss eligibility
    2. Complete the investigation and analyze the information gathered to determine whether the claim is legitimate and eligible
    3. Identify information to be communicated to other stakeholders in the insurance contract
  3. Determine the value of the claim and propose a settlement (weighting: 32%)
    1. Adjust and add reserves according to the coverage affected
    2. Analyze the relevant documents in the claim file in order to control the loss, establish its value and validate the legitimacy of the claim
    3. Apply contract terms and conditions to calculate and justify the indemnity
    4. Determine the documents to be given to claimants for indemnification purposes and follow-up on the claim file
  4. Help the claimant through the claims settlement process (weighting: 16%)
    1. Inform the claimant of his rights as well as the protection and services to which he is entitled under the contract and applicable laws
    2. Inform the claimant of his contractual obligations
    3. Explain the claims settlement process and the role of specialists

Personal-lines and commercial-lines automobile claims

COMPETENCY: Settle personal-lines and commercial-lines automobile insurance claims based on the client's coverage (05-512)

Duration of the exam: 60 minutes

Number of questions: 25  

Competency components:

  1. Determine the nature of the claim (weighting: 20%)
    1. Gather and analyze the information contained in the notice of loss
    2. Gather relevant information for the investigation
    3. Determine the causes of the loss, the liability and the possibility of recovery
  2. Validate the eligibility of the loss (weighting: 40%)
    1. Evaluate the scope of applicable coverage and endorsement in order to determine loss eligibility
    2. Complete the investigation and analyze the information gathered to determine whether the claim is legitimate and eligible
    3. Identify information to be communicated to other stakeholders in the insurance contract
  3. Determine the value of the claim and propose a settlement (weighting: 20%)
    1. Adjust the reserve and control the loss
    2. Apply contract terms and conditions to calculate and justify the indemnity
    3. Determine the documents to be given to claimants for indemnification purposes and record information about the loss in the Automobile Claims Database
  4. Help the claimant through the claims settlement process (weighting: 20%)
    1. Inform the claimant of his rights as well as the protection and services he is entitled to under the contract and applicable laws
    2. Inform the claimant of his contractual obligations
    3. Explain the claims settlement process

Commercial-lines property claims

COMPETENCY: Settle commercial-lines property and civil liability insurance claims based on the client's coverage (05-513)

Duration of the exam: 120 minutes

Number of questions: 40  

Competency components:

  1. Determine the type of claim (weighting: 10%)
    1. Gather and analyze the information contained in the notice of loss
    2. Gather relevant information for the investigation
    3. Determine the causes of the loss and the type of damage
  2. Determine the liability of the parties involved (weighting: 20%)
    1. Determine the liability of the parties involved
    2. Identify possibilities of subrogation
  3. Validate the eligibility of the loss (weighting: 40%)
    1. Evaluate the scope of applicable coverage and endorsements in order to determine loss eligibility
    2. Complete the investigation and analyze the information gathered to determine whether the claim is legitimate and eligible
    3. Identify information to be communicated to other stakeholders in the insurance contract
  4. Determine the value of the claim and propose a settlement (weighting: 20%)
    1. Adjust and add reserves according to the coverage affected
    2. Analyze the relevant documents in the claim file in order to control the loss, establish its value and validate the legitimacy of the claim
    3. Apply contract terms and conditions and consider each party's liability to calculate and justify the indemnity
    4. Determine the documents to be given to claimants for indemnification purposes and follow-up on the claim file
  5. Help the insured and the claimant through the claims settlement process (weighting: 10%)
    1. Inform the insured and the claimant of their rights and inform the insured of the protection and services to which he is entitled under the contract and applicable laws
    2. Inform the insured of his contractual obligations and inform the claimant of his legal obligations
    3. Explain the claims settlement process and the role of specialists