Claim CLM-2024-001028

Claim CLM-2024-001028
25/60

Key Facts

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Loss Type:Storm Damage - Structure
Outcome:Settled
Amount:GBP 5,363
Risk Score:12 (low)
Date of Loss:2024-11-11
Settlement:GBP 5,363

Timeline

2024-11-11Incident occurred
2024-11-12Claim reported
2024-11-14Assessment completed
2024-11-21Decision made
2024-11-26Claim closed

Analysis

NEEDS REVIEW
8 FAIL2 WARN15 PASS
FAILS1Storm Claim Definition/Conditions Applied
FAILS1Repairs Must Be Effective and Lasting
FAILS2Contents Itemisation Completeness

Inspections

27 inspections
Summary
FileContents Itemisation CompletenessFAILS275%Contents items not itemised2
CoverageStorm Claim Definition/Conditions AppliedFAILS173%Storm rejection without weather data2
CommsFirst Contact TimelinessFAILS278%SLA breached3
RepairRepairs Must Be Effective and LastingFAILS179%Subsidence cracks returned3
FinancePayment Without Supporting DocumentFAILS287%8k payment without invoice2
FinanceClosed Claim with Open Reserves / Open TasksFAILS277%Unclean closure3
RecoveryRecovery Reserve Exists but No Action EvidenceFAILS285%Recovery reserve but no action3
RecoveryRecovery Received Without Matching ExpectationFAILS293%No reconciliation3
CashCash Settlement Offered with Documented RationaleWARNS293%Cash rationale brief but present2
FinanceDuplicate Payments / Near-DuplicatesWARNS183%Needs attention2
FileDocument Quality / OCR RiskINCS330%Insufficient evidence to determine1
CashVulnerability ConsideredINCS237%Insufficient evidence to determine1
FileRequired Evidence Present (by Peril/Archetype)PASSS289%Evidence pack complete2
FileClaim Timeline CoherencePASSS272%Timeline events are coherent1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS273%No field/notes conflict2
CoverageSettlement Method Consistent with IndemnityPASSS278%Settlement method documented with rationale1
CoverageExclusion Invoked Without Evidence PackPASSS183%Exclusion supported by evidence pack1
InvestInvestigation Thoroughness RecordedPASSS272%All steps recorded1
InvestGradual Damage Decisions Supported by ProofPASSS281%Expert evidence supports2
CommsNo-Update Gaps (Silence Periods)PASSS271%Regular updates provided2
CommsTimely and Reasonable InvestigationPASSS273%Investigation completed timely2
CommsDecline/Partial Settlement Explanation QualityPASSS280%Decision explanation clear1
RepairRepair Route Scope/Completion EvidencePASSS286%Scope and completion documented2
RepairRepair Quality Risk (Rework Loop)PASSS291%No rework detected2
CashCash Settlement Oversight & Monitoring PresentPASSS289%Monitoring active1
FinanceReserve/Exposure Structure PresentPASSS294%Reserve structure present2
FinanceLarge Reserves/Payments Have Approval TrailPASSS271%Large payments have approval trail1
Evidence

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