Claim CLM-2024-001014

Claim CLM-2024-001014
30/60

Key Facts

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Loss Type:Accidental Damage - Contents
Outcome:Cash Settlement
Amount:GBP 19,001
Risk Score:4 (low)
Date of Loss:2024-11-07
Settlement:GBP 19,001

Timeline

2024-11-07Incident occurred
2024-11-08Claim reported
2024-11-13Assessment completed
2024-12-10Decision made
2024-12-14Claim closed

Analysis

NEEDS REVIEW
4 FAIL7 WARN17 PASS
FAILS2Contents Itemisation Completeness
FAILS2No-Update Gaps (Silence Periods)
FAILS2Timely and Reasonable Investigation

Inspections

30 inspections
Summary
FileContents Itemisation CompletenessFAILS287%Incomplete listing2
CommsNo-Update Gaps (Silence Periods)FAILS278%21 day gap with no update3
CommsTimely and Reasonable InvestigationFAILS289%Investigation delayed 6 weeks3
RepairRepair Route Scope/Completion EvidenceFAILS274%Completion not evidenced3
FileRequired Evidence Present (by Peril/Archetype)WARNS286%Partial evidence only2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)WARNS278%Review recommended2
CoverageStorm Claim Definition/Conditions AppliedWARNS185%Storm evidence borderline1
InvestGradual Damage Decisions Supported by ProofWARNS277%Gradual damage evidence partial1
RepairRepair Quality Risk (Rework Loop)WARNS290%Monitor pattern1
FinancePayment Without Supporting DocumentWARNS285%Needs attention2
FinanceDuplicate Payments / Near-DuplicatesWARNS191%Needs attention2
CoverageUnderground Services Responsibility CheckINCS240%Insufficient evidence to determine2
CommsFirst Contact TimelinessINCS235%Insufficient evidence to determine1
FileDocument Quality / OCR RiskPASSS383%Documents are text-extractable1
FileClaim Timeline CoherencePASSS271%No sequence anomalies2
CoverageSettlement Method Consistent with IndemnityPASSS284%Settlement method documented with rationale2
CoverageExclusion Invoked Without Evidence PackPASSS183%Exclusion supported by evidence pack1
CoverageUnoccupied Condition Breach MaterialityPASSS291%Unoccupied breach materiality checked1
InvestInvestigation Thoroughness RecordedPASSS282%All steps recorded1
CommsDecline/Partial Settlement Explanation QualityPASSS278%Decision explanation clear2
RepairRepairs Must Be Effective and LastingPASSS175%Quality verified2
RepairOutsourced Handling Oversight PresentPASSS277%Supplier oversight documented2
CashCash Settlement Offered with Documented RationalePASSS282%Choice justified1
CashCash Settlement Oversight & Monitoring PresentPASSS279%Cash settlement controls present2
CashVulnerability ConsideredPASSS285%Tailored support offered2
FinanceReserve/Exposure Structure PresentPASSS271%Reserve structure present1
FinanceLarge Reserves/Payments Have Approval TrailPASSS286%Large payments have approval trail1
FinanceClosed Claim with Open Reserves / Open TasksPASSS280%No open reserves or tasks1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS294%Recovery actions documented1
RecoveryRecovery Received Without Matching ExpectationPASSS286%Recovery reconciled1
Evidence

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