Claim CLM-2024-001026

Claim CLM-2024-001026
20/60

Key Facts

LOB:HOME
Loss Type:Accidental Damage - Building
Outcome:Cash Settlement
Amount:GBP 5,764
Risk Score:16 (low)
Date of Loss:2024-10-25
Settlement:GBP 5,764

Timeline

2024-10-25Incident occurred
2024-10-26Claim reported
2024-10-31Assessment completed
2024-11-19Decision made
2024-11-23Claim closed

Analysis

NEEDS REVIEW
5 FAIL4 WARN17 PASS
FAILS1Duplicate Payments / Near-Duplicates
FAILS2Investigation Thoroughness Recorded
FAILS2Repair Route Scope/Completion Evidence

Inspections

28 inspections
Summary
InvestInvestigation Thoroughness RecordedFAILS279%Investigation not documented3
RepairRepair Route Scope/Completion EvidenceFAILS276%Completion not evidenced3
FinancePayment Without Supporting DocumentFAILS274%8k payment without invoice3
FinanceDuplicate Payments / Near-DuplicatesFAILS192%Same 2400 paid twice to contractor3
RecoveryRecovery Received Without Matching ExpectationFAILS272%Expected 3k, received 1k2
CoverageSettlement Method Consistent with IndemnityWARNS275%Could be clearer2
InvestGradual Damage Decisions Supported by ProofWARNS286%Gradual damage evidence partial1
CommsFirst Contact TimelinessWARNS283%Needs attention1
CommsTimely and Reasonable InvestigationWARNS279%Investigation delayed but completed2
CommsDecline/Partial Settlement Explanation QualityINCS243%Insufficient evidence to determine2
RepairOutsourced Handling Oversight PresentINCS232%Insufficient evidence to determine2
FileRequired Evidence Present (by Peril/Archetype)PASSS292%Evidence pack complete1
FileDocument Quality / OCR RiskPASSS391%Documents are text-extractable1
FileClaim Timeline CoherencePASSS273%Timeline events are coherent2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS275%No field/notes conflict1
FileContents Itemisation CompletenessPASSS293%Contents itemisation complete1
CoverageExclusion Invoked Without Evidence PackPASSS177%Exclusion supported by evidence pack2
InvestMajor Water Damage: Source and Mitigation EvidencePASSS277%Leak source identified2
CommsNo-Update Gaps (Silence Periods)PASSS293%Regular updates provided1
RepairRepair Quality Risk (Rework Loop)PASSS286%No rework detected1
CashCash Settlement Offered with Documented RationalePASSS281%Cash settlement rationale documented2
CashCash Settlement Oversight & Monitoring PresentPASSS279%Monitoring active1
CashVulnerability ConsideredPASSS279%Vulnerability considered2
FinanceReserve/Exposure Structure PresentPASSS276%All cost areas covered2
FinanceLarge Reserves/Payments Have Approval TrailPASSS287%Authority verified1
FinanceClosed Claim with Open Reserves / Open TasksPASSS285%No open reserves or tasks2
RecoveryThird Party Involvement but No Recovery ReservePASSS178%Recovery reserve created for TP1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS282%Recovery actions documented1
Evidence

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