Claim CLM-2024-001023

Claim CLM-2024-001023
19/60

Key Facts

LOB:MOTOR
Loss Type:Collision - Own Fault
Outcome:Denied
Amount:GBP 5,581
Risk Score:16 (low)
Date of Loss:2024-11-02
Settlement:GBP 5,581

Timeline

2024-11-02Incident occurred
2024-11-03Claim reported
2024-11-08Assessment completed
2024-11-21Decision made
2024-11-23Claim closed

Analysis

NEEDS REVIEW
1 FAIL4 WARN20 PASS
FAILS2First Contact Delay
WARNS2Timeline Coherence
WARNS2Final Decision Explanation Missing

Inspections

26 inspections
Summary
CommsFirst Contact DelayFAILS271%SLA breached3
FileTimeline CoherenceWARNS273%Sequence unclear2
CommsFinal Decision Explanation MissingWARNS276%Needs attention1
RepairSupplier Delay Attribution MissingWARNS374%Needs attention1
FinanceClosed with Open Financial ItemsWARNS278%Small reserve open at closure2
FinanceReserve Category MismatchINCS349%Insufficient evidence to determine1
FileRequired Evidence PresencePASSS287%Evidence pack complete2
FileDocument Extractability / OCR RiskPASSS389%Documents are text-extractable2
FileStructured vs Narrative MismatchPASSS278%Structured fields match narrative1
FileClaim Story ConfidencePASSS392%Key facts documented2
LiabilitySplit Liability Settlement InconsistencyPASSS286%Split liability correctly reflected1
CommsNo-Update GapPASSS275%Regular updates provided1
CommsPromised Follow-Up Not CompletedPASSS286%Follow-ups completed as promised2
RepairRepair Cycle Time OutlierPASSS284%Repair cycle within expected range1
RepairRework Loop DetectedPASSS294%No rework detected2
RepairInvoice vs Authorization MismatchPASSS283%Invoice matches authorization1
TL/ValDeductions Without JustificationPASSS292%Evidence supports adjustments2
TL/ValSalvage Handling MissingPASSS273%Salvage handling documented1
FinancePayment Without Supporting ArtifactPASSS276%Payments have supporting docs2
FinanceDuplicate or Near-Duplicate PaymentsPASSS181%No duplicate payments detected2
RecoverySubrogation Expected but Not Set UpPASSS172%Recovery reserve created2
RecoveryTP Insurer Details MissingPASSS280%Contact info present1
RecoveryRecovery Reserve Without ActionPASSS290%Recovery actions documented2
EvidenceCritical Document MissingPASSS284%File complete1
EvidenceDocument Quality Too LowPASSS373%OCR confidence high1
EvidenceTranscript Not AvailablePASSS371%Transcript available2
Evidence

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