Claim CLM-2024-001022

Claim CLM-2024-001022
32/60

Key Facts

LOB:HOME
Loss Type:Fire Damage
Outcome:Denied
Amount:GBP 22,894
Risk Score:4 (low)
Date of Loss:2024-10-17
Settlement:GBP 22,894

Timeline

2024-10-17Incident occurred
2024-10-18Claim reported
2024-10-22Assessment completed
2024-11-19Decision made
2024-11-22Claim closed

Analysis

NEEDS REVIEW
2 FAIL3 WARN21 PASS
FAILS2Settlement Method Consistent with Indemnity
FAILS2Payment Without Supporting Document
WARNS2Claim Timeline Coherence

Inspections

28 inspections
Summary
CoverageSettlement Method Consistent with IndemnityFAILS276%Settlement method not documented3
FinancePayment Without Supporting DocumentFAILS272%8k payment without invoice2
FileClaim Timeline CoherenceWARNS290%Timeline gap needs clarification1
RepairRepair Route Scope/Completion EvidenceWARNS286%Verify2
CashVulnerability ConsideredWARNS285%Vulnerability noted but support minimal1
FileContents Itemisation CompletenessINCS248%Insufficient evidence to determine2
CoverageUnderground Services Responsibility CheckINCS248%Insufficient evidence to determine1
FileRequired Evidence Present (by Peril/Archetype)PASSS295%Evidence pack complete2
FileDocument Quality / OCR RiskPASSS390%No OCR issues detected1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS289%Loss type coding matches narrative2
CoverageExclusion Invoked Without Evidence PackPASSS170%Expert report confirms1
InvestInvestigation Thoroughness RecordedPASSS292%Investigation thoroughly documented2
InvestSubsidence Expert Evidence + Monitoring PresentPASSS192%Subsidence evidence pack complete1
InvestGradual Damage Decisions Supported by ProofPASSS278%Expert evidence supports1
CommsFirst Contact TimelinessPASSS291%Timely customer engagement2
CommsNo-Update Gaps (Silence Periods)PASSS284%Regular updates provided2
CommsTimely and Reasonable InvestigationPASSS279%Investigation completed timely1
CommsDecline/Partial Settlement Explanation QualityPASSS274%Policy terms linked to outcome1
RepairRepair Quality Risk (Rework Loop)PASSS286%Single repair cycle2
RepairOutsourced Handling Oversight PresentPASSS287%QA checks recorded2
CashCash Settlement Offered with Documented RationalePASSS278%Cash settlement rationale documented1
CashCash Settlement Oversight & Monitoring PresentPASSS278%Cash settlement controls present1
FinanceReserve/Exposure Structure PresentPASSS286%Reserve structure present2
FinanceLarge Reserves/Payments Have Approval TrailPASSS271%Large payments have approval trail2
FinanceDuplicate Payments / Near-DuplicatesPASSS188%No duplicate payments detected1
FinanceClosed Claim with Open Reserves / Open TasksPASSS273%No open reserves or tasks1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS286%Recovery actions documented1
RecoveryRecovery Received Without Matching ExpectationPASSS270%Expected vs received matched1
Evidence

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