Insurance claim test cases, where the date decides the settlement

Almost every wrong claim decision comes from evaluating the policy at the wrong moment. Coverage, sum insured, riders, exclusions and the deductible all belong to the policy as it stood on the date of loss, not as it stands when the claim is keyed in. A system that reads current state will decline valid claims on lapsed policies and will apply a rider to a loss that predates it. This is testable in a single case and it is skipped in most published sets, because the happy path submits a claim on an active policy the same week.

The arithmetic is the second problem, and it is an ordering problem rather than a calculation one. A category sub limit, a co-payment percentage and an overall sum insured ceiling produce three different settlements depending on the sequence in which they are applied. The sequence is stated in the policy wording, and the test has to assert against the wording rather than against whatever the code happens to do. The same applies to the remaining balance: a sum insured is consumed across a term by earlier claims and resets at renewal, and getting that wrong overpays or underpays every subsequent claim.

Document handling is where claimants abandon the process. Attachments lost because an unrelated field failed validation, uploads accepted on file extension alone, and stored document URLs that stay accessible to anyone who learns them are all common and all avoidable. A claim document is medical or financial evidence, so authorisation belongs on every request for it rather than on the page that linked to it.

Finally, the regulatory clock. Acknowledgement and decision timers are audited, and they usually pause while further information is awaited. If the pause and resume rule is implemented loosely, the elapsed time reported to a regulator does not match the elapsed time that actually passed, and that is a compliance finding rather than a bug. Two handlers saving conflicting assessments at the same instant belongs in the same category: a silent last write wins quietly overwrites a decision that someone signed.