Claim CLM-2024-001015

Claim CLM-2024-001015
44/60

Key Facts

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Loss Type:Accidental Damage - Contents
Outcome:Total Loss
Amount:GBP 32,679
Risk Score:2 (low)
Date of Loss:2024-11-05
Settlement:GBP 32,679

Timeline

2024-11-05Incident occurred
2024-11-06Claim reported
2024-11-11Assessment completed
2024-11-27Decision made
2024-12-01Claim closed

Analysis

NEEDS REVIEW
4 FAIL3 WARN16 PASS
FAILS1Repairs Must Be Effective and Lasting
FAILS2Settlement Method Consistent with Indemnity
FAILS2Unoccupied Condition Breach Materiality

Inspections

28 inspections
Summary
CoverageSettlement Method Consistent with IndemnityFAILS294%Settlement method not documented3
CoverageUnoccupied Condition Breach MaterialityFAILS289%Occupancy not relevant3
RepairRepairs Must Be Effective and LastingFAILS193%Repairs not lasting2
RecoveryRecovery Reserve Exists but No Action EvidenceFAILS279%Recovery reserve but no action2
FileDocument Quality / OCR RiskWARNS377%Needs attention1
RepairRepair Route Scope/Completion EvidenceWARNS285%Verify2
CashCash Settlement Oversight & Monitoring PresentWARNS273%Needs attention2
CommsDecline/Partial Settlement Explanation QualityINCS245%Insufficient evidence to determine1
CashCash Settlement Offered with Documented RationaleINCS236%Insufficient evidence to determine1
CashVulnerability ConsideredINCS230%Insufficient evidence to determine1
AltAccAA Timeline Aligns with Repair TimelineINCS241%Insufficient evidence to determine1
FinanceClosed Claim with Open Reserves / Open TasksINCS232%Insufficient evidence to determine1
FileRequired Evidence Present (by Peril/Archetype)PASSS272%All required documents present for peril type1
FileClaim Timeline CoherencePASSS281%No sequence anomalies1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS292%Loss type coding matches narrative1
FileContents Itemisation CompletenessPASSS279%All items captured1
CoverageExclusion Invoked Without Evidence PackPASSS182%Exclusion supported by evidence pack2
InvestInvestigation Thoroughness RecordedPASSS277%All steps recorded2
InvestGradual Damage Decisions Supported by ProofPASSS290%Gradual damage proof documented1
CommsFirst Contact TimelinessPASSS285%Timely customer engagement2
CommsNo-Update Gaps (Silence Periods)PASSS277%No communication gaps2
RepairRepair Quality Risk (Rework Loop)PASSS290%Single repair cycle2
RepairOutsourced Handling Oversight PresentPASSS294%QA checks recorded1
FinanceReserve/Exposure Structure PresentPASSS293%All cost areas covered1
FinanceLarge Reserves/Payments Have Approval TrailPASSS278%Large payments have approval trail1
FinancePayment Without Supporting DocumentPASSS277%All payments have supporting docs2
FinanceDuplicate Payments / Near-DuplicatesPASSS192%No duplicate payments detected2
RecoveryRecovery Received Without Matching ExpectationPASSS275%Expected vs received matched1
Evidence

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