Claim CLM-2024-001000

Claim CLM-2024-001000
16/60

Key Facts

LOB:HOME
Loss Type:Flood
Outcome:Cash Settlement
Amount:GBP 17,902
Risk Score:16 (low)
Date of Loss:2024-11-05
Settlement:GBP 17,902

Timeline

2024-11-05Incident occurred
2024-11-06Claim reported
2024-11-11Assessment completed
2024-12-08Decision made
2024-12-11Claim closed

Analysis

NEEDS REVIEW
4 FAIL6 WARN23 PASS
FAILS1Subsidence Expert Evidence + Monitoring Present
FAILS2First Contact Timeliness
FAILS2Payment Without Supporting Document

Inspections

33 inspections
Summary
InvestSubsidence Expert Evidence + Monitoring PresentFAILS189%No crack monitoring evidence2
CommsFirst Contact TimelinessFAILS275%5 days to first contact2
FinancePayment Without Supporting DocumentFAILS280%8k payment without invoice2
FinanceClosed Claim with Open Reserves / Open TasksFAILS288%Claim closed with 5k open reserve3
FileClaim Timeline CoherenceWARNS283%Timeline gap needs clarification2
CoverageStorm Claim Definition/Conditions AppliedWARNS186%Storm evidence borderline2
RepairRepair Route Scope/Completion EvidenceWARNS295%Scope documented but completion unclear2
RepairRepair Quality Risk (Rework Loop)WARNS286%One repeat visit, may be acceptable2
CashCash Settlement Oversight & Monitoring PresentWARNS278%Needs attention2
AltAccAA Timeline Aligns with Repair TimelineWARNS292%Needs attention1
FileRequired Evidence Present (by Peril/Archetype)PASSS274%Evidence pack complete1
FileDocument Quality / OCR RiskPASSS374%No OCR issues detected2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS290%No field/notes conflict1
FileContents Itemisation CompletenessPASSS293%Contents itemisation complete2
CoverageSettlement Method Consistent with IndemnityPASSS273%Indemnity properly applied1
CoverageExclusion Invoked Without Evidence PackPASSS175%Expert report confirms1
CoverageUnoccupied Condition Breach MaterialityPASSS276%Breach relevant to loss2
CoverageSubsidence/Ground Movement Classification SupportedPASSS186%Subsidence classification supported1
InvestInvestigation Thoroughness RecordedPASSS276%All steps recorded2
InvestGradual Damage Decisions Supported by ProofPASSS289%Gradual damage proof documented1
InvestMajor Water Damage: Source and Mitigation EvidencePASSS273%Mitigation actions documented2
CommsNo-Update Gaps (Silence Periods)PASSS277%No communication gaps2
CommsTimely and Reasonable InvestigationPASSS295%Investigation completed timely1
CommsDecline/Partial Settlement Explanation QualityPASSS281%Decision explanation clear1
CashCash Settlement Offered with Documented RationalePASSS282%Cash settlement rationale documented2
CashVulnerability ConsideredPASSS290%Vulnerability considered1
AltAccAA Need Assessed and DocumentedPASSS275%AA need assessed and documented2
FinanceReserve/Exposure Structure PresentPASSS291%All cost areas covered2
FinanceLarge Reserves/Payments Have Approval TrailPASSS286%Large payments have approval trail2
FinanceDuplicate Payments / Near-DuplicatesPASSS188%No duplicate payments detected1
RecoveryThird Party Involvement but No Recovery ReservePASSS184%Subrogation setup1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS286%Progress evidenced2
RecoveryRecovery Received Without Matching ExpectationPASSS274%Recovery reconciled1
Evidence

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