Claim CLM-2024-001018

Claim CLM-2024-001018
51/60

Key Facts

LOB:HOME
Loss Type:Accidental Damage - Building
Outcome:Cash Settlement
Amount:GBP 15,512
Risk Score:0 (low)
Date of Loss:2024-11-18
Settlement:GBP 15,512

Timeline

2024-11-18Incident occurred
2024-11-19Claim reported
2024-11-24Assessment completed
2024-12-08Decision made
2024-12-13Claim closed

Analysis

NEEDS REVIEW
3 FAIL5 WARN18 PASS
FAILS2Repair Route Scope/Completion Evidence
FAILS2Vulnerability Considered
FAILS3Document Quality / OCR Risk

Inspections

27 inspections
Summary
FileDocument Quality / OCR RiskFAILS394%Scanned PDF unreadable3
RepairRepair Route Scope/Completion EvidenceFAILS270%Completion not evidenced3
CashVulnerability ConsideredFAILS280%No tailored support3
FileClaim Timeline CoherenceWARNS291%Timeline gap needs clarification2
CoverageSettlement Method Consistent with IndemnityWARNS271%Could be clearer2
CoverageExclusion Invoked Without Evidence PackWARNS182%Exclusion evidence partial1
CommsFirst Contact TimelinessWARNS275%Needs attention2
AltAccAA Need Assessed and DocumentedWARNS292%AA assessed but rationale brief2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)INCS238%Insufficient evidence to determine2
FileRequired Evidence Present (by Peril/Archetype)PASSS278%Evidence pack complete2
FileContents Itemisation CompletenessPASSS284%Contents itemisation complete2
CoverageSubsidence/Ground Movement Classification SupportedPASSS177%Technical evidence present1
InvestInvestigation Thoroughness RecordedPASSS285%Investigation thoroughly documented2
InvestGradual Damage Decisions Supported by ProofPASSS279%Expert evidence supports1
CommsNo-Update Gaps (Silence Periods)PASSS272%No communication gaps1
CommsDecline/Partial Settlement Explanation QualityPASSS279%Policy terms linked to outcome2
RepairRepair Quality Risk (Rework Loop)PASSS271%Single repair cycle1
RepairOutsourced Handling Oversight PresentPASSS283%QA checks recorded2
CashCash Settlement Offered with Documented RationalePASSS289%Cash settlement rationale documented1
CashCash Settlement Oversight & Monitoring PresentPASSS274%Monitoring active1
FinanceReserve/Exposure Structure PresentPASSS282%All cost areas covered2
FinanceLarge Reserves/Payments Have Approval TrailPASSS294%Large payments have approval trail1
FinancePayment Without Supporting DocumentPASSS289%Invoices linked2
FinanceDuplicate Payments / Near-DuplicatesPASSS175%Ledger clean1
FinanceClosed Claim with Open Reserves / Open TasksPASSS275%No open reserves or tasks2
RecoveryRecovery Reserve Exists but No Action EvidencePASSS277%Progress evidenced1
RecoveryRecovery Received Without Matching ExpectationPASSS280%Expected vs received matched1
Evidence

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