Claim CLM-2024-001021

Claim CLM-2024-001021
31/60

Key Facts

LOB:MOTOR
Loss Type:Weather Damage
Outcome:Denied
Amount:GBP 9,499
Risk Score:4 (low)
Date of Loss:2024-11-24
Settlement:GBP 9,499

Timeline

2024-11-24Incident occurred
2024-11-25Claim reported
2024-11-28Assessment completed
2024-12-09Decision made
2024-12-11Claim closed

Analysis

NEEDS REVIEW
4 FAIL1 WARN16 PASS
FAILS2First Contact Delay
FAILS2Repair Cycle Time Outlier
FAILS2Closed with Open Financial Items

Inspections

25 inspections
Summary
LiabilityTP Present but Liability Not SetFAILS387%Stance not set2
CommsFirst Contact DelayFAILS287%5 days to first contact2
RepairRepair Cycle Time OutlierFAILS284%Major delay3
FinanceClosed with Open Financial ItemsFAILS290%Unclean closure2
CommsNo-Update GapWARNS270%Close to breach2
RepairRework Loop DetectedINCS246%Insufficient evidence to determine1
RecoveryTP Insurer Details MissingINCS245%Insufficient evidence to determine2
RecoveryExcess Recovery MissingINCS231%Insufficient evidence to determine1
EvidenceDocument Quality Too LowINCS348%Insufficient evidence to determine2
FileRequired Evidence PresencePASSS290%Evidence pack complete2
FileDocument Extractability / OCR RiskPASSS387%Documents are text-extractable1
FileTimeline CoherencePASSS290%No sequence anomalies1
FileStructured vs Narrative MismatchPASSS279%Structured fields match narrative2
FileClaim Story ConfidencePASSS390%Claim story is complete1
LiabilitySplit Liability Settlement InconsistencyPASSS284%Split liability correctly reflected1
CommsPromised Follow-Up Not CompletedPASSS284%Commitments honored1
CommsFinal Decision Explanation MissingPASSS282%Decision explanation sent2
RepairInvoice vs Authorization MismatchPASSS294%Invoice matches authorization1
RepairSupplier Delay Attribution MissingPASSS388%Ownership clear2
FinancePayment Without Supporting ArtifactPASSS276%Payments have supporting docs1
FinanceReserve Category MismatchPASSS391%Reserve categories correct2
FinanceDuplicate or Near-Duplicate PaymentsPASSS179%Ledger clean1
RecoverySubrogation Expected but Not Set UpPASSS180%Subrogation properly set up2
EvidenceCritical Document MissingPASSS273%File complete1
EvidenceTranscript Not AvailablePASSS393%Transcript available2
Evidence

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