Claim CLM-2024-001036

Claim CLM-2024-001036
37/60

Key Facts

LOB:HOME
Loss Type:Impact Damage
Outcome:Settled
Amount:GBP 29,758
Risk Score:4 (low)
Date of Loss:2024-11-12
Settlement:GBP 29,758

Timeline

2024-11-12Incident occurred
2024-11-13Claim reported
2024-11-15Assessment completed
2024-12-08Decision made
2024-12-11Claim closed

Analysis

NEEDS REVIEW
2 FAIL4 WARN17 PASS
FAILS2Investigation Thoroughness Recorded
FAILS2Recovery Received Without Matching Expectation
WARNS2Contents Itemisation Completeness

Inspections

28 inspections
Summary
InvestInvestigation Thoroughness RecordedFAILS283%Steps unclear2
RecoveryRecovery Received Without Matching ExpectationFAILS270%Expected 3k, received 1k3
FileContents Itemisation CompletenessWARNS279%Needs attention1
CoverageSettlement Method Consistent with IndemnityWARNS274%Settlement rationale brief1
RepairOutsourced Handling Oversight PresentWARNS277%Needs attention1
FinanceClosed Claim with Open Reserves / Open TasksWARNS284%May be intentional1
FileRequired Evidence Present (by Peril/Archetype)INCS247%Insufficient evidence to determine1
FileClaim Timeline CoherenceINCS242%Insufficient evidence to determine1
CommsNo-Update Gaps (Silence Periods)INCS247%Insufficient evidence to determine2
AltAccAA Need Assessed and DocumentedINCS237%Insufficient evidence to determine1
FinanceReserve/Exposure Structure PresentINCS242%Insufficient evidence to determine2
FileDocument Quality / OCR RiskPASSS375%No OCR issues detected2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS274%No field/notes conflict2
CoverageExclusion Invoked Without Evidence PackPASSS192%Exclusion supported by evidence pack2
CoverageSubsidence/Ground Movement Classification SupportedPASSS188%Technical evidence present1
InvestGradual Damage Decisions Supported by ProofPASSS271%Expert evidence supports2
CommsFirst Contact TimelinessPASSS278%Timely customer engagement2
CommsTimely and Reasonable InvestigationPASSS294%No unexplained delays2
CommsDecline/Partial Settlement Explanation QualityPASSS289%Decision explanation clear1
RepairRepair Route Scope/Completion EvidencePASSS275%Scope and completion documented2
RepairRepair Quality Risk (Rework Loop)PASSS294%No rework detected2
CashCash Settlement Offered with Documented RationalePASSS284%Choice justified2
CashCash Settlement Oversight & Monitoring PresentPASSS283%Cash settlement controls present1
CashVulnerability ConsideredPASSS287%Tailored support offered2
FinanceLarge Reserves/Payments Have Approval TrailPASSS275%Authority verified2
FinancePayment Without Supporting DocumentPASSS273%All payments have supporting docs1
FinanceDuplicate Payments / Near-DuplicatesPASSS181%No duplicate payments detected2
RecoveryRecovery Reserve Exists but No Action EvidencePASSS282%Recovery actions documented1
Evidence

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