Claim CLM-2024-001019

Claim CLM-2024-001019
24/60

Key Facts

LOB:HOME
Loss Type:Subsidence
Outcome:Denied
Amount:GBP 12,521
Risk Score:12 (low)
Date of Loss:2024-11-28
Settlement:GBP 12,521

Timeline

2024-11-28Incident occurred
2024-11-29Claim reported
2024-12-05Assessment completed
2024-12-06Decision made
2024-12-11Claim closed

Analysis

NEEDS REVIEW
1 FAIL4 WARN22 PASS
FAILS2Settlement Method Consistent with Indemnity
WARNS2Required Evidence Present (by Peril/Archetype)
WARNS2Decline/Partial Settlement Explanation Quality

Inspections

29 inspections
Summary
CoverageSettlement Method Consistent with IndemnityFAILS290%Settlement method not documented2
FileRequired Evidence Present (by Peril/Archetype)WARNS284%Some supporting docs unclear2
CommsDecline/Partial Settlement Explanation QualityWARNS278%Needs attention1
AltAccAA Timeline Aligns with Repair TimelineWARNS275%Needs attention1
RecoveryRecovery Received Without Matching ExpectationWARNS289%Minor variance in expected vs received2
CommsFirst Contact TimelinessINCS236%Insufficient evidence to determine2
CashCash Settlement Oversight & Monitoring PresentINCS250%Insufficient evidence to determine2
FileDocument Quality / OCR RiskPASSS387%No OCR issues detected1
FileClaim Timeline CoherencePASSS281%No sequence anomalies2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS273%Loss type coding matches narrative2
FileContents Itemisation CompletenessPASSS291%Contents itemisation complete2
CoverageExclusion Invoked Without Evidence PackPASSS187%Expert report confirms2
CoverageSubsidence/Ground Movement Classification SupportedPASSS182%Subsidence classification supported2
InvestInvestigation Thoroughness RecordedPASSS271%Investigation thoroughly documented2
InvestSubsidence Expert Evidence + Monitoring PresentPASSS173%Monitoring data present1
InvestGradual Damage Decisions Supported by ProofPASSS293%Gradual damage proof documented2
CommsNo-Update Gaps (Silence Periods)PASSS289%No communication gaps1
RepairRepair Route Scope/Completion EvidencePASSS271%Scope and completion documented2
RepairRepair Quality Risk (Rework Loop)PASSS282%Single repair cycle1
RepairRepairs Must Be Effective and LastingPASSS180%Repairs effective and lasting2
CashCash Settlement Offered with Documented RationalePASSS279%Cash settlement rationale documented2
CashVulnerability ConsideredPASSS285%Tailored support offered1
AltAccAA Need Assessed and DocumentedPASSS276%Habitability checked2
FinanceReserve/Exposure Structure PresentPASSS290%Reserve structure present2
FinanceLarge Reserves/Payments Have Approval TrailPASSS272%Authority verified1
FinancePayment Without Supporting DocumentPASSS294%Invoices linked1
FinanceDuplicate Payments / Near-DuplicatesPASSS193%No duplicate payments detected1
FinanceClosed Claim with Open Reserves / Open TasksPASSS271%No open reserves or tasks2
RecoveryRecovery Reserve Exists but No Action EvidencePASSS292%Recovery actions documented1
Evidence

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