Claim CLM-2024-001034

Claim CLM-2024-001034
54/60

Key Facts

LOB:HOME
Loss Type:Fire Damage
Outcome:Settled
Amount:GBP 9,666
Risk Score:0 (low)
Date of Loss:2024-11-02
Settlement:GBP 9,666

Timeline

2024-11-02Incident occurred
2024-11-03Claim reported
2024-11-06Assessment completed
2024-11-28Decision made
2024-12-03Claim closed

Analysis

NEEDS REVIEW
4 FAIL3 WARN21 PASS
FAILS2Required Evidence Present (by Peril/Archetype)
FAILS2Structured vs Narrative Mismatch (Loss Type/Cause/Pathway)
FAILS2Contents Itemisation Completeness

Inspections

29 inspections
Summary
FileRequired Evidence Present (by Peril/Archetype)FAILS291%Assessment absent2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)FAILS272%Peril mismatch3
FileContents Itemisation CompletenessFAILS276%Contents items not itemised2
CommsNo-Update Gaps (Silence Periods)FAILS274%21 day gap with no update3
InvestInvestigation Thoroughness RecordedWARNS286%Investigation documented but brief1
FinanceDuplicate Payments / Near-DuplicatesWARNS189%Needs attention2
FinanceClosed Claim with Open Reserves / Open TasksWARNS290%May be intentional1
AltAccAA Timeline Aligns with Repair TimelineINCS242%Insufficient evidence to determine2
FileDocument Quality / OCR RiskPASSS383%No OCR issues detected2
FileClaim Timeline CoherencePASSS277%Timeline events are coherent1
CoverageSettlement Method Consistent with IndemnityPASSS283%Settlement method documented with rationale2
CoverageExclusion Invoked Without Evidence PackPASSS189%Expert report confirms1
CoverageStorm Claim Definition/Conditions AppliedPASSS174%Storm definition clearly applied2
CoverageUnderground Services Responsibility CheckPASSS286%Pipe responsibility correctly assessed2
InvestGradual Damage Decisions Supported by ProofPASSS287%Gradual damage proof documented1
CommsFirst Contact TimelinessPASSS290%Timely customer engagement2
CommsTimely and Reasonable InvestigationPASSS289%Investigation completed timely1
CommsDecline/Partial Settlement Explanation QualityPASSS277%Decision explanation clear2
RepairRepair Route Scope/Completion EvidencePASSS295%Evidence captured1
RepairRepair Quality Risk (Rework Loop)PASSS275%No rework detected1
RepairOutsourced Handling Oversight PresentPASSS290%Supplier oversight documented1
CashCash Settlement Offered with Documented RationalePASSS294%Cash settlement rationale documented2
CashCash Settlement Oversight & Monitoring PresentPASSS291%Monitoring active2
CashVulnerability ConsideredPASSS276%Tailored support offered1
FinanceReserve/Exposure Structure PresentPASSS284%All cost areas covered1
FinanceLarge Reserves/Payments Have Approval TrailPASSS274%Authority verified2
FinancePayment Without Supporting DocumentPASSS293%Invoices linked1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS287%Recovery actions documented1
RecoveryRecovery Received Without Matching ExpectationPASSS280%Expected vs received matched2
Evidence

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