Claim CLM-2024-001031

Claim CLM-2024-001031
46/60

Key Facts

LOB:HOME
Loss Type:Flood
Outcome:Settled
Amount:GBP 31,853
Risk Score:2 (low)
Date of Loss:2024-11-17
Settlement:GBP 31,853

Timeline

2024-11-17Incident occurred
2024-11-18Claim reported
2024-11-22Assessment completed
2024-11-24Decision made
2024-11-28Claim closed

Analysis

NEEDS REVIEW
2 FAIL4 WARN25 PASS
FAILS2Unoccupied Condition Breach Materiality
FAILS2AA Timeline Aligns with Repair Timeline
WARNS2Structured vs Narrative Mismatch (Loss Type/Cause/Pathway)

Inspections

33 inspections
Summary
CoverageUnoccupied Condition Breach MaterialityFAILS283%Occupancy not relevant2
AltAccAA Timeline Aligns with Repair TimelineFAILS274%Gap unexplained2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)WARNS278%Review recommended1
CommsNo-Update Gaps (Silence Periods)WARNS293%10 day gap, borderline SLA1
FinanceReserve/Exposure Structure PresentWARNS270%Needs attention2
FinancePayment Without Supporting DocumentWARNS275%Needs attention1
CommsTimely and Reasonable InvestigationINCS240%Insufficient evidence to determine2
CommsDecline/Partial Settlement Explanation QualityINCS245%Insufficient evidence to determine1
FileRequired Evidence Present (by Peril/Archetype)PASSS281%All required documents present for peril type2
FileDocument Quality / OCR RiskPASSS372%Documents are text-extractable2
FileClaim Timeline CoherencePASSS281%Timeline events are coherent2
FileContents Itemisation CompletenessPASSS290%Contents itemisation complete1
CoverageSettlement Method Consistent with IndemnityPASSS294%Settlement method documented with rationale1
CoverageExclusion Invoked Without Evidence PackPASSS191%Expert report confirms2
InvestInvestigation Thoroughness RecordedPASSS284%Investigation thoroughly documented2
InvestSubsidence Expert Evidence + Monitoring PresentPASSS179%Monitoring data present1
InvestGradual Damage Decisions Supported by ProofPASSS278%Gradual damage proof documented1
InvestMajor Water Damage: Source and Mitigation EvidencePASSS272%Leak source identified2
CommsFirst Contact TimelinessPASSS288%First contact within SLA1
RepairRepair Route Scope/Completion EvidencePASSS279%Evidence captured2
RepairRepair Quality Risk (Rework Loop)PASSS292%Single repair cycle1
RepairRepairs Must Be Effective and LastingPASSS180%Repairs effective and lasting1
RepairOutsourced Handling Oversight PresentPASSS288%Supplier oversight documented2
CashCash Settlement Offered with Documented RationalePASSS271%Cash settlement rationale documented1
CashCash Settlement Oversight & Monitoring PresentPASSS284%Cash settlement controls present1
CashVulnerability ConsideredPASSS271%Vulnerability considered1
AltAccAA Need Assessed and DocumentedPASSS279%Habitability checked1
FinanceLarge Reserves/Payments Have Approval TrailPASSS275%Authority verified1
FinanceDuplicate Payments / Near-DuplicatesPASSS194%Ledger clean1
FinanceClosed Claim with Open Reserves / Open TasksPASSS276%No open reserves or tasks1
RecoveryThird Party Involvement but No Recovery ReservePASSS180%Subrogation setup1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS293%Recovery actions documented1
RecoveryRecovery Received Without Matching ExpectationPASSS287%Recovery reconciled1
Evidence

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