Claim CLM-2024-001004

Claim CLM-2024-001004
5/60

Key Facts

LOB:HOME
Loss Type:Impact Damage
Outcome:Denied
Amount:GBP 62,193
Risk Score:41 (medium)
Date of Loss:2024-11-23
Settlement:GBP 62,193

Timeline

2024-11-23Incident occurred
2024-11-24Claim reported
2024-11-26Assessment completed
2024-12-01Decision made
2024-12-05Claim closed

Analysis

NEEDS REVIEW
3 FAIL7 WARN18 PASS
FAILS1Duplicate Payments / Near-Duplicates
FAILS2Large Reserves/Payments Have Approval Trail
FAILS2Recovery Reserve Exists but No Action Evidence

Inspections

28 inspections
Summary
FinanceLarge Reserves/Payments Have Approval TrailFAILS294%Authority not recorded3
FinanceDuplicate Payments / Near-DuplicatesFAILS188%Duplicate detected3
RecoveryRecovery Reserve Exists but No Action EvidenceFAILS283%Recovery reserve but no action3
FileRequired Evidence Present (by Peril/Archetype)WARNS276%Some supporting docs unclear1
InvestInvestigation Thoroughness RecordedWARNS289%Investigation documented but brief2
CommsTimely and Reasonable InvestigationWARNS272%Timing concern1
RepairRepair Route Scope/Completion EvidenceWARNS279%Scope documented but completion unclear2
RepairRepair Quality Risk (Rework Loop)WARNS287%One repeat visit, may be acceptable2
CashVulnerability ConsideredWARNS285%Vulnerability noted but support minimal1
FinancePayment Without Supporting DocumentWARNS274%Needs attention1
FileDocument Quality / OCR RiskPASSS372%Documents are text-extractable1
FileClaim Timeline CoherencePASSS273%Timeline events are coherent1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS291%Loss type coding matches narrative2
FileContents Itemisation CompletenessPASSS289%All items captured2
CoverageSettlement Method Consistent with IndemnityPASSS276%Settlement method documented with rationale1
CoverageExclusion Invoked Without Evidence PackPASSS194%Exclusion supported by evidence pack1
CoverageStorm Claim Definition/Conditions AppliedPASSS183%Weather evidence present2
InvestSubsidence Expert Evidence + Monitoring PresentPASSS181%Monitoring data present1
InvestGradual Damage Decisions Supported by ProofPASSS283%Gradual damage proof documented1
CommsFirst Contact TimelinessPASSS273%Timely customer engagement2
CommsNo-Update Gaps (Silence Periods)PASSS275%No communication gaps2
CommsDecline/Partial Settlement Explanation QualityPASSS285%Decision explanation clear2
RepairOutsourced Handling Oversight PresentPASSS272%QA checks recorded2
CashCash Settlement Offered with Documented RationalePASSS295%Choice justified2
CashCash Settlement Oversight & Monitoring PresentPASSS290%Cash settlement controls present1
FinanceReserve/Exposure Structure PresentPASSS273%All cost areas covered1
FinanceClosed Claim with Open Reserves / Open TasksPASSS275%No open reserves or tasks1
RecoveryRecovery Received Without Matching ExpectationPASSS276%Recovery reconciled2
Evidence

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