What does a sufficiency decision look like on a real insurance claim file?

A home insurer's claims assessor opens CLAIM-3305, a storm damage claim for a roof and ceiling. The file holds a claim form, four photographs and a roofing contractor's quote for the full amount. Policy rule CLM-DOC-07 requires, for any roof claim above the quote threshold, a second quote or a licensed assessor's report, plus evidence of the date of loss.

The assessor compares the file against the rule. The quote and photographs are present. The claim form gives a loss date, but the photograph metadata is two weeks earlier, and no weather evidence is attached. There is no second quote.

The assessor neither approves nor denies. They move the case from LODGED to AWAITING_INFO and send one request to the policyholder asking for a second quote or an assessor's report, and for an explanation of the date discrepancy. They also record that the contractor's quote is accepted as valid, so it is not requested again.

Two days later the policyholder uploads an assessor's report that confirms the date. The status moves to READY_FOR_ASSESSMENT.

The consequence of an error is concrete. Approving on the first file risks paying on an unverified loss date. Asking for the photographs again repeats a request already satisfied and delays a valid claim.

**What it teaches:** a good test records the requirement, the evidence found, the specific gaps and what was already satisfied. An agent should be scored on the precision of its request, not only on whether it stopped.