Claim CLM-2024-001052

Claim CLM-2024-001052
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Key Facts

LOB:HOME
Loss Type:Impact Damage
Outcome:Repaired
Amount:GBP 6,293
Risk Score:4 (low)
Date of Loss:2024-11-02
Settlement:GBP 6,293

Timeline

2024-11-02Incident occurred
2024-11-03Claim reported
2024-11-09Assessment completed
2024-12-05Decision made
2024-12-09Claim closed

Analysis

NEEDS REVIEW
1 FAIL3 WARN20 PASS
FAILS2Large Reserves/Payments Have Approval Trail
WARNS2Gradual Damage Decisions Supported by Proof
WARNS2Repair Route Scope/Completion Evidence

Inspections

28 inspections
Summary
FinanceLarge Reserves/Payments Have Approval TrailFAILS272%Authority not recorded3
InvestGradual Damage Decisions Supported by ProofWARNS295%Review recommended1
RepairRepair Route Scope/Completion EvidenceWARNS278%Scope documented but completion unclear2
FinanceReserve/Exposure Structure PresentWARNS284%Needs attention1
CoverageSettlement Method Consistent with IndemnityINCS244%Insufficient evidence to determine2
CoverageExclusion Invoked Without Evidence PackINCS144%Insufficient evidence to determine2
CashVulnerability ConsideredINCS250%Insufficient evidence to determine2
FinanceClosed Claim with Open Reserves / Open TasksINCS247%Insufficient evidence to determine2
FileRequired Evidence Present (by Peril/Archetype)PASSS284%All required documents present for peril type1
FileDocument Quality / OCR RiskPASSS394%No OCR issues detected2
FileClaim Timeline CoherencePASSS275%No sequence anomalies2
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS283%No field/notes conflict1
FileContents Itemisation CompletenessPASSS293%Contents itemisation complete2
InvestInvestigation Thoroughness RecordedPASSS281%All steps recorded2
InvestMajor Water Damage: Source and Mitigation EvidencePASSS293%Mitigation actions documented1
CommsFirst Contact TimelinessPASSS292%Timely customer engagement2
CommsNo-Update Gaps (Silence Periods)PASSS279%No communication gaps2
CommsDecline/Partial Settlement Explanation QualityPASSS287%Decision explanation clear1
RepairRepair Quality Risk (Rework Loop)PASSS276%No rework detected2
RepairOutsourced Handling Oversight PresentPASSS283%QA checks recorded1
CashCash Settlement Offered with Documented RationalePASSS288%Choice justified1
CashCash Settlement Oversight & Monitoring PresentPASSS276%Monitoring active1
AltAccAA Need Assessed and DocumentedPASSS292%Habitability checked1
AltAccAA Timeline Aligns with Repair TimelinePASSS284%No gaps2
FinancePayment Without Supporting DocumentPASSS292%Invoices linked2
FinanceDuplicate Payments / Near-DuplicatesPASSS185%No duplicate payments detected1
RecoveryRecovery Reserve Exists but No Action EvidencePASSS280%Recovery actions documented2
RecoveryRecovery Received Without Matching ExpectationPASSS291%Recovery reconciled1
Evidence

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