Claim CLM-2024-001054

Claim CLM-2024-001054
29/60

Key Facts

LOB:HOME
Loss Type:Impact Damage
Outcome:Denied
Amount:GBP 37,935
Risk Score:7 (low)
Date of Loss:2024-10-24
Settlement:GBP 37,935

Timeline

2024-10-24Incident occurred
2024-10-25Claim reported
2024-10-31Assessment completed
2024-11-27Decision made
2024-11-30Claim closed

Analysis

NEEDS REVIEW
5 FAIL1 WARN19 PASS
FAILS2Required Evidence Present (by Peril/Archetype)
FAILS2No-Update Gaps (Silence Periods)
FAILS2Repair Quality Risk (Rework Loop)

Inspections

29 inspections
Summary
FileRequired Evidence Present (by Peril/Archetype)FAILS281%Policy schedule not found3
CommsNo-Update Gaps (Silence Periods)FAILS282%21 day gap with no update2
RepairRepair Quality Risk (Rework Loop)FAILS270%Builder returned 3 times2
FinancePayment Without Supporting DocumentFAILS276%8k payment without invoice2
RecoveryRecovery Reserve Exists but No Action EvidenceFAILS290%Stalled for 60 days2
CashCash Settlement Offered with Documented RationaleWARNS271%Could be clearer2
FileDocument Quality / OCR RiskINCS342%Insufficient evidence to determine2
CommsDecline/Partial Settlement Explanation QualityINCS243%Insufficient evidence to determine1
RepairRepair Route Scope/Completion EvidenceINCS240%Insufficient evidence to determine2
FinanceClosed Claim with Open Reserves / Open TasksINCS243%Insufficient evidence to determine2
FileClaim Timeline CoherencePASSS271%No sequence anomalies1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS274%No field/notes conflict2
FileContents Itemisation CompletenessPASSS280%Contents itemisation complete1
CoverageSettlement Method Consistent with IndemnityPASSS283%Indemnity properly applied1
CoverageExclusion Invoked Without Evidence PackPASSS184%Expert report confirms2
CoverageStorm Claim Definition/Conditions AppliedPASSS185%Weather evidence present2
CoverageUnderground Services Responsibility CheckPASSS282%Ownership documented2
InvestInvestigation Thoroughness RecordedPASSS282%All steps recorded2
InvestGradual Damage Decisions Supported by ProofPASSS279%Gradual damage proof documented1
CommsFirst Contact TimelinessPASSS274%Timely customer engagement2
RepairOutsourced Handling Oversight PresentPASSS292%Supplier oversight documented2
CashCash Settlement Oversight & Monitoring PresentPASSS272%Cash settlement controls present1
CashVulnerability ConsideredPASSS281%Tailored support offered2
AltAccAA Need Assessed and DocumentedPASSS272%AA need assessed and documented2
FinanceReserve/Exposure Structure PresentPASSS294%Reserve structure present1
FinanceLarge Reserves/Payments Have Approval TrailPASSS281%Large payments have approval trail2
FinanceDuplicate Payments / Near-DuplicatesPASSS178%Ledger clean1
RecoveryThird Party Involvement but No Recovery ReservePASSS194%Recovery reserve created for TP1
RecoveryRecovery Received Without Matching ExpectationPASSS288%Expected vs received matched1
Evidence

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