Claim CLM-2024-001051

Claim CLM-2024-001051
15/60

Key Facts

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Loss Type:Water Damage - Escape of Water
Outcome:Settled
Amount:GBP 11,771
Risk Score:20 (low)
Date of Loss:2024-11-21
Settlement:GBP 11,771

Timeline

2024-11-21Incident occurred
2024-11-22Claim reported
2024-11-25Assessment completed
2024-12-02Decision made
2024-12-06Claim closed

Analysis

NEEDS REVIEW
5 FAIL4 WARN18 PASS
FAILS1Duplicate Payments / Near-Duplicates
FAILS2Repair Route Scope/Completion Evidence
FAILS2Payment Without Supporting Document

Inspections

30 inspections
Summary
RepairRepair Route Scope/Completion EvidenceFAILS292%No scope of works captured2
FinancePayment Without Supporting DocumentFAILS293%8k payment without invoice2
FinanceDuplicate Payments / Near-DuplicatesFAILS171%Duplicate detected2
FinanceClosed Claim with Open Reserves / Open TasksFAILS286%Claim closed with 5k open reserve2
RecoveryRecovery Received Without Matching ExpectationFAILS295%Expected 3k, received 1k3
FileDocument Quality / OCR RiskWARNS375%Needs attention2
CommsFirst Contact TimelinessWARNS295%Needs attention1
RepairRepair Quality Risk (Rework Loop)WARNS295%Monitor pattern1
RecoveryThird Party Involvement but No Recovery ReserveWARNS193%Needs attention2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)INCS242%Insufficient evidence to determine2
CoverageUnoccupied Condition Breach MaterialityINCS241%Insufficient evidence to determine2
CashCash Settlement Oversight & Monitoring PresentINCS243%Insufficient evidence to determine2
FileRequired Evidence Present (by Peril/Archetype)PASSS295%All required documents present for peril type1
FileClaim Timeline CoherencePASSS284%No sequence anomalies1
FileContents Itemisation CompletenessPASSS275%All items captured1
CoverageSettlement Method Consistent with IndemnityPASSS281%Indemnity properly applied1
CoverageExclusion Invoked Without Evidence PackPASSS187%Exclusion supported by evidence pack1
InvestInvestigation Thoroughness RecordedPASSS289%All steps recorded1
InvestGradual Damage Decisions Supported by ProofPASSS275%Gradual damage proof documented1
InvestMajor Water Damage: Source and Mitigation EvidencePASSS287%Leak source identified1
CommsNo-Update Gaps (Silence Periods)PASSS278%No communication gaps2
CommsTimely and Reasonable InvestigationPASSS285%No unexplained delays2
CommsDecline/Partial Settlement Explanation QualityPASSS276%Decision explanation clear2
CashCash Settlement Offered with Documented RationalePASSS279%Choice justified1
CashVulnerability ConsideredPASSS291%Vulnerability considered1
AltAccAA Need Assessed and DocumentedPASSS283%AA need assessed and documented2
AltAccAA Timeline Aligns with Repair TimelinePASSS288%No gaps1
FinanceReserve/Exposure Structure PresentPASSS282%All cost areas covered1
FinanceLarge Reserves/Payments Have Approval TrailPASSS284%Large payments have approval trail2
RecoveryRecovery Reserve Exists but No Action EvidencePASSS282%Recovery actions documented2
Evidence

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