Claim CLM-2024-001012

Claim CLM-2024-001012
49/60

Key Facts

LOB:HOME
Loss Type:Subsidence
Outcome:Total Loss
Amount:GBP 14,193
Risk Score:0 (low)
Date of Loss:2024-12-06
Settlement:GBP 14,193

Timeline

2024-12-06Incident occurred
2024-12-07Claim reported
2024-12-13Assessment completed
2024-12-14Decision made
2024-12-17Claim closed

Analysis

NEEDS REVIEW
4 FAIL7 WARN19 PASS
FAILS1Subsidence Expert Evidence + Monitoring Present
FAILS2Outsourced Handling Oversight Present
FAILS2AA Need Assessed and Documented

Inspections

31 inspections
Summary
InvestSubsidence Expert Evidence + Monitoring PresentFAILS183%No crack monitoring evidence2
RepairOutsourced Handling Oversight PresentFAILS293%No oversight of third party3
AltAccAA Need Assessed and DocumentedFAILS291%Habitability not assessed2
FinanceReserve/Exposure Structure PresentFAILS290%No reserve structure2
FileRequired Evidence Present (by Peril/Archetype)WARNS294%Some supporting docs unclear2
FileClaim Timeline CoherenceWARNS281%Timeline gap needs clarification1
FileContents Itemisation CompletenessWARNS276%Needs attention2
CoverageSettlement Method Consistent with IndemnityWARNS292%Settlement rationale brief2
CoverageSubsidence/Ground Movement Classification SupportedWARNS184%Needs attention2
CommsTimely and Reasonable InvestigationWARNS284%Timing concern2
FinanceDuplicate Payments / Near-DuplicatesWARNS180%Needs attention2
CashCash Settlement Offered with Documented RationaleINCS235%Insufficient evidence to determine2
FileDocument Quality / OCR RiskPASSS380%No OCR issues detected2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS286%Loss type coding matches narrative1
CoverageExclusion Invoked Without Evidence PackPASSS174%Expert report confirms2
InvestInvestigation Thoroughness RecordedPASSS282%Investigation thoroughly documented1
InvestGradual Damage Decisions Supported by ProofPASSS295%Expert evidence supports1
CommsFirst Contact TimelinessPASSS277%Timely customer engagement2
CommsNo-Update Gaps (Silence Periods)PASSS271%No communication gaps1
CommsDecline/Partial Settlement Explanation QualityPASSS292%Decision explanation clear1
RepairRepair Route Scope/Completion EvidencePASSS286%Evidence captured2
RepairRepair Quality Risk (Rework Loop)PASSS283%No rework detected2
RepairRepairs Must Be Effective and LastingPASSS185%Repairs effective and lasting2
CashCash Settlement Oversight & Monitoring PresentPASSS287%Cash settlement controls present1
CashVulnerability ConsideredPASSS293%Vulnerability considered2
AltAccAA Timeline Aligns with Repair TimelinePASSS291%No gaps2
FinanceLarge Reserves/Payments Have Approval TrailPASSS287%Authority verified2
FinancePayment Without Supporting DocumentPASSS294%All payments have supporting docs2
FinanceClosed Claim with Open Reserves / Open TasksPASSS283%Clean closure1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS282%Progress evidenced1
RecoveryRecovery Received Without Matching ExpectationPASSS293%Expected vs received matched1
Evidence

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