Claim CLM-2024-001042

Claim CLM-2024-001042
40/60

Key Facts

LOB:HOME
Loss Type:Flood
Outcome:Cash Settlement
Amount:GBP 27,451
Risk Score:4 (low)
Date of Loss:2024-10-21
Settlement:GBP 27,451

Timeline

2024-10-21Incident occurred
2024-10-22Claim reported
2024-10-24Assessment completed
2024-11-26Decision made
2024-11-30Claim closed

Analysis

NEEDS REVIEW
3 FAIL5 WARN19 PASS
FAILS1Exclusion Invoked Without Evidence Pack
FAILS1Third Party Involvement but No Recovery Reserve
FAILS2Major Water Damage: Source and Mitigation Evidence

Inspections

31 inspections
Summary
CoverageExclusion Invoked Without Evidence PackFAILS181%Exclusion cited without evidence3
InvestMajor Water Damage: Source and Mitigation EvidenceFAILS285%No mitigation documented3
RecoveryThird Party Involvement but No Recovery ReserveFAILS182%Subrogation missed2
FileContents Itemisation CompletenessWARNS290%Needs attention2
CoverageSettlement Method Consistent with IndemnityWARNS281%Settlement rationale brief2
RepairRepair Quality Risk (Rework Loop)WARNS290%Monitor pattern1
AltAccAA Need Assessed and DocumentedWARNS286%AA assessed but rationale brief1
FinanceReserve/Exposure Structure PresentWARNS286%Needs attention1
CommsNo-Update Gaps (Silence Periods)INCS239%Insufficient evidence to determine2
CashCash Settlement Oversight & Monitoring PresentINCS243%Insufficient evidence to determine2
FinanceClosed Claim with Open Reserves / Open TasksINCS241%Insufficient evidence to determine2
RecoveryRecovery Received Without Matching ExpectationINCS247%Insufficient evidence to determine2
FileRequired Evidence Present (by Peril/Archetype)PASSS280%Evidence pack complete1
FileDocument Quality / OCR RiskPASSS377%No OCR issues detected2
FileClaim Timeline CoherencePASSS280%No sequence anomalies1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS283%Loss type coding matches narrative1
CoverageUnoccupied Condition Breach MaterialityPASSS280%Unoccupied breach materiality checked2
InvestInvestigation Thoroughness RecordedPASSS283%All steps recorded2
InvestGradual Damage Decisions Supported by ProofPASSS282%Gradual damage proof documented1
CommsFirst Contact TimelinessPASSS275%Timely customer engagement1
CommsTimely and Reasonable InvestigationPASSS292%No unexplained delays1
CommsDecline/Partial Settlement Explanation QualityPASSS292%Decision explanation clear1
RepairRepair Route Scope/Completion EvidencePASSS285%Scope and completion documented1
RepairRepairs Must Be Effective and LastingPASSS175%Repairs effective and lasting2
CashCash Settlement Offered with Documented RationalePASSS282%Cash settlement rationale documented2
CashVulnerability ConsideredPASSS278%Tailored support offered2
AltAccAA Timeline Aligns with Repair TimelinePASSS282%No gaps2
FinanceLarge Reserves/Payments Have Approval TrailPASSS293%Large payments have approval trail1
FinancePayment Without Supporting DocumentPASSS281%All payments have supporting docs2
FinanceDuplicate Payments / Near-DuplicatesPASSS175%Ledger clean1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS279%Recovery actions documented1
Evidence

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