Claim CLM-2024-001038

Claim CLM-2024-001038
38/60

Key Facts

LOB:HOME
Loss Type:Impact Damage
Outcome:Total Loss
Amount:GBP 5,393
Risk Score:4 (low)
Date of Loss:2024-12-01
Settlement:GBP 5,393

Timeline

2024-12-01Incident occurred
2024-12-02Claim reported
2024-12-05Assessment completed
2024-12-09Decision made
2024-12-12Claim closed

Analysis

NEEDS REVIEW
2 FAIL5 WARN20 PASS
FAILS2Structured vs Narrative Mismatch (Loss Type/Cause/Pathway)
FAILS2Closed Claim with Open Reserves / Open Tasks
WARNS1Duplicate Payments / Near-Duplicates

Inspections

29 inspections
Summary
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)FAILS283%Peril mismatch2
FinanceClosed Claim with Open Reserves / Open TasksFAILS282%Claim closed with 5k open reserve3
InvestInvestigation Thoroughness RecordedWARNS271%Could be more thorough1
CashCash Settlement Offered with Documented RationaleWARNS288%Could be clearer1
FinanceLarge Reserves/Payments Have Approval TrailWARNS276%Verify authority1
FinancePayment Without Supporting DocumentWARNS283%Needs attention1
FinanceDuplicate Payments / Near-DuplicatesWARNS182%Needs attention2
CoverageUnoccupied Condition Breach MaterialityINCS235%Insufficient evidence to determine1
CoverageUnderground Services Responsibility CheckINCS238%Insufficient evidence to determine2
FileRequired Evidence Present (by Peril/Archetype)PASSS271%All required documents present for peril type1
FileDocument Quality / OCR RiskPASSS388%No OCR issues detected1
FileClaim Timeline CoherencePASSS292%Timeline events are coherent2
FileContents Itemisation CompletenessPASSS292%All items captured2
CoverageSettlement Method Consistent with IndemnityPASSS270%Indemnity properly applied2
CoverageExclusion Invoked Without Evidence PackPASSS186%Exclusion supported by evidence pack1
CoverageStorm Claim Definition/Conditions AppliedPASSS184%Weather evidence present2
InvestGradual Damage Decisions Supported by ProofPASSS275%Expert evidence supports1
CommsFirst Contact TimelinessPASSS276%Timely customer engagement2
CommsNo-Update Gaps (Silence Periods)PASSS276%Regular updates provided2
CommsDecline/Partial Settlement Explanation QualityPASSS293%Decision explanation clear1
RepairRepair Route Scope/Completion EvidencePASSS274%Scope and completion documented2
RepairRepair Quality Risk (Rework Loop)PASSS284%No rework detected2
RepairOutsourced Handling Oversight PresentPASSS272%Supplier oversight documented2
CashCash Settlement Oversight & Monitoring PresentPASSS289%Monitoring active2
CashVulnerability ConsideredPASSS285%Vulnerability considered2
AltAccAA Need Assessed and DocumentedPASSS277%Habitability checked2
FinanceReserve/Exposure Structure PresentPASSS292%Reserve structure present1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS273%Progress evidenced1
RecoveryRecovery Received Without Matching ExpectationPASSS295%Recovery reconciled1
Evidence

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