Claim CLM-2024-001044

Claim CLM-2024-001044
58/60

Key Facts

LOB:HOME
Loss Type:Impact Damage
Outcome:Repaired
Amount:GBP 29,318
Risk Score:0 (low)
Date of Loss:2024-11-09
Settlement:GBP 29,318

Timeline

2024-11-09Incident occurred
2024-11-10Claim reported
2024-11-12Assessment completed
2024-11-25Decision made
2024-11-28Claim closed

Analysis

NEEDS REVIEW
2 FAIL1 WARN24 PASS
FAILS2Timely and Reasonable Investigation
FAILS2Repair Route Scope/Completion Evidence
WARNS3Document Quality / OCR Risk

Inspections

30 inspections
Summary
CommsTimely and Reasonable InvestigationFAILS287%Investigation delayed 6 weeks3
RepairRepair Route Scope/Completion EvidenceFAILS275%Completion not evidenced2
FileDocument Quality / OCR RiskWARNS385%Needs attention1
RepairOutsourced Handling Oversight PresentINCS237%Insufficient evidence to determine2
FinanceDuplicate Payments / Near-DuplicatesINCS145%Insufficient evidence to determine1
RecoveryRecovery Reserve Exists but No Action EvidenceINCS244%Insufficient evidence to determine1
FileRequired Evidence Present (by Peril/Archetype)PASSS284%Evidence pack complete2
FileClaim Timeline CoherencePASSS275%Timeline events are coherent2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS292%Loss type coding matches narrative1
FileContents Itemisation CompletenessPASSS281%All items captured1
CoverageSettlement Method Consistent with IndemnityPASSS293%Settlement method documented with rationale2
CoverageExclusion Invoked Without Evidence PackPASSS187%Expert report confirms2
CoverageStorm Claim Definition/Conditions AppliedPASSS175%Storm definition clearly applied2
CoverageUnoccupied Condition Breach MaterialityPASSS270%Unoccupied breach materiality checked1
InvestInvestigation Thoroughness RecordedPASSS276%Investigation thoroughly documented1
InvestGradual Damage Decisions Supported by ProofPASSS277%Expert evidence supports1
CommsFirst Contact TimelinessPASSS292%First contact within SLA2
CommsNo-Update Gaps (Silence Periods)PASSS281%No communication gaps1
CommsDecline/Partial Settlement Explanation QualityPASSS284%Policy terms linked to outcome1
RepairRepair Quality Risk (Rework Loop)PASSS272%No rework detected1
CashCash Settlement Offered with Documented RationalePASSS284%Cash settlement rationale documented2
CashCash Settlement Oversight & Monitoring PresentPASSS277%Cash settlement controls present1
CashVulnerability ConsideredPASSS294%Tailored support offered2
AltAccAA Need Assessed and DocumentedPASSS275%Habitability checked1
FinanceReserve/Exposure Structure PresentPASSS272%All cost areas covered2
FinanceLarge Reserves/Payments Have Approval TrailPASSS292%Large payments have approval trail1
FinancePayment Without Supporting DocumentPASSS279%Invoices linked1
FinanceClosed Claim with Open Reserves / Open TasksPASSS277%Clean closure1
RecoveryThird Party Involvement but No Recovery ReservePASSS184%Recovery reserve created for TP1
RecoveryRecovery Received Without Matching ExpectationPASSS281%Recovery reconciled2
Evidence

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