Claim CLM-2024-001037

Claim CLM-2024-001037
55/60

Key Facts

LOB:HOME
Loss Type:Storm Damage - Roof
Outcome:Denied
Amount:GBP 18,372
Risk Score:0 (low)
Date of Loss:2024-12-03
Settlement:GBP 18,372

Timeline

2024-12-03Incident occurred
2024-12-04Claim reported
2024-12-06Assessment completed
2024-12-10Decision made
2024-12-15Claim closed

Analysis

NEEDS REVIEW
6 FAIL7 WARN17 PASS
FAILS1Subsidence Expert Evidence + Monitoring Present
FAILS1Duplicate Payments / Near-Duplicates
FAILS2Unoccupied Condition Breach Materiality

Inspections

30 inspections
Summary
FileDocument Quality / OCR RiskFAILS385%Scanned PDF unreadable3
CoverageUnoccupied Condition Breach MaterialityFAILS284%Breach cited but not material to loss2
InvestInvestigation Thoroughness RecordedFAILS291%Steps unclear2
InvestSubsidence Expert Evidence + Monitoring PresentFAILS191%Subsidence lacks borehole data2
CashCash Settlement Offered with Documented RationaleFAILS288%No documented reason2
FinanceDuplicate Payments / Near-DuplicatesFAILS178%Duplicate detected3
FileRequired Evidence Present (by Peril/Archetype)WARNS271%Partial evidence only2
CoverageSettlement Method Consistent with IndemnityWARNS286%Settlement rationale brief1
CoverageExclusion Invoked Without Evidence PackWARNS177%May need review1
CoverageStorm Claim Definition/Conditions AppliedWARNS186%Definition applied loosely2
CommsNo-Update Gaps (Silence Periods)WARNS276%Close to breach1
RepairRepair Route Scope/Completion EvidenceWARNS272%Scope documented but completion unclear2
CashVulnerability ConsideredWARNS294%Review approach1
FileClaim Timeline CoherencePASSS277%Timeline events are coherent1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS291%Loss type coding matches narrative1
FileContents Itemisation CompletenessPASSS275%All items captured1
InvestGradual Damage Decisions Supported by ProofPASSS278%Gradual damage proof documented2
CommsFirst Contact TimelinessPASSS277%First contact within SLA1
CommsTimely and Reasonable InvestigationPASSS270%Investigation completed timely1
CommsDecline/Partial Settlement Explanation QualityPASSS270%Policy terms linked to outcome2
RepairRepair Quality Risk (Rework Loop)PASSS292%Single repair cycle1
CashCash Settlement Oversight & Monitoring PresentPASSS291%Monitoring active1
AltAccAA Timeline Aligns with Repair TimelinePASSS292%No gaps2
FinanceReserve/Exposure Structure PresentPASSS272%Reserve structure present2
FinanceLarge Reserves/Payments Have Approval TrailPASSS289%Large payments have approval trail1
FinancePayment Without Supporting DocumentPASSS281%All payments have supporting docs1
FinanceClosed Claim with Open Reserves / Open TasksPASSS281%Clean closure2
RecoveryThird Party Involvement but No Recovery ReservePASSS191%Recovery reserve created for TP1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS271%Progress evidenced1
RecoveryRecovery Received Without Matching ExpectationPASSS294%Expected vs received matched2
Evidence

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