Claim CLM-2024-001047

Claim CLM-2024-001047
23/60

Key Facts

LOB:HOME
Loss Type:Storm Damage - Roof
Outcome:Denied
Amount:GBP 37,411
Risk Score:14 (low)
Date of Loss:2024-10-26
Settlement:GBP 37,411

Timeline

2024-10-26Incident occurred
2024-10-27Claim reported
2024-11-02Assessment completed
2024-12-03Decision made
2024-12-05Claim closed

Analysis

NEEDS REVIEW
8 FAIL4 WARN15 PASS
FAILS1Exclusion Invoked Without Evidence Pack
FAILS1Subsidence Expert Evidence + Monitoring Present
FAILS1Duplicate Payments / Near-Duplicates

Inspections

30 inspections
Summary
FileRequired Evidence Present (by Peril/Archetype)FAILS280%Assessment absent3
CoverageSettlement Method Consistent with IndemnityFAILS293%No rationale for cash vs repair3
CoverageExclusion Invoked Without Evidence PackFAILS190%Exclusion cited without evidence2
InvestSubsidence Expert Evidence + Monitoring PresentFAILS178%No crack monitoring evidence3
CommsTimely and Reasonable InvestigationFAILS277%Investigation delayed 6 weeks3
CommsDecline/Partial Settlement Explanation QualityFAILS295%Policy terms not linked3
CashVulnerability ConsideredFAILS273%No tailored support3
FinanceDuplicate Payments / Near-DuplicatesFAILS188%Same 2400 paid twice to contractor3
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)WARNS277%Review recommended1
CoverageUnderground Services Responsibility CheckWARNS279%Needs attention1
InvestInvestigation Thoroughness RecordedWARNS288%Could be more thorough1
FinanceLarge Reserves/Payments Have Approval TrailWARNS284%Approval trail present but informal1
FileDocument Quality / OCR RiskINCS340%Insufficient evidence to determine1
InvestGradual Damage Decisions Supported by ProofINCS245%Insufficient evidence to determine2
RepairRepair Route Scope/Completion EvidenceINCS243%Insufficient evidence to determine2
FileClaim Timeline CoherencePASSS293%No sequence anomalies1
FileContents Itemisation CompletenessPASSS277%Contents itemisation complete2
CoverageStorm Claim Definition/Conditions AppliedPASSS182%Storm definition clearly applied1
CoverageUnoccupied Condition Breach MaterialityPASSS278%Unoccupied breach materiality checked2
CoverageSubsidence/Ground Movement Classification SupportedPASSS189%Subsidence classification supported1
CommsFirst Contact TimelinessPASSS288%First contact within SLA2
CommsNo-Update Gaps (Silence Periods)PASSS271%Regular updates provided1
RepairRepair Quality Risk (Rework Loop)PASSS273%Single repair cycle1
CashCash Settlement Offered with Documented RationalePASSS284%Choice justified2
CashCash Settlement Oversight & Monitoring PresentPASSS291%Monitoring active2
FinanceReserve/Exposure Structure PresentPASSS295%All cost areas covered1
FinancePayment Without Supporting DocumentPASSS289%All payments have supporting docs1
FinanceClosed Claim with Open Reserves / Open TasksPASSS271%No open reserves or tasks1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS284%Progress evidenced1
RecoveryRecovery Received Without Matching ExpectationPASSS275%Recovery reconciled1
Evidence

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