Claim CLM-2024-001058

Claim CLM-2024-001058
28/60

Key Facts

LOB:HOME
Loss Type:Theft - Contents
Outcome:Denied
Amount:GBP 36,183
Risk Score:9 (low)
Date of Loss:2024-11-08
Settlement:GBP 36,183

Timeline

2024-11-08Incident occurred
2024-11-09Claim reported
2024-11-13Assessment completed
2024-12-11Decision made
2024-12-16Claim closed

Analysis

NEEDS REVIEW
5 FAIL4 WARN19 PASS
FAILS2Settlement Method Consistent with Indemnity
FAILS2First Contact Timeliness
FAILS2Repair Quality Risk (Rework Loop)

Inspections

29 inspections
Summary
CoverageSettlement Method Consistent with IndemnityFAILS275%Settlement method not documented2
CommsFirst Contact TimelinessFAILS284%5 days to first contact3
RepairRepair Quality Risk (Rework Loop)FAILS286%Repeated defects found2
CashCash Settlement Offered with Documented RationaleFAILS295%No documented reason2
CashCash Settlement Oversight & Monitoring PresentFAILS284%No cash settlement monitoring3
FileContents Itemisation CompletenessWARNS282%Needs attention2
CoverageExclusion Invoked Without Evidence PackWARNS184%Exclusion evidence partial1
RepairRepair Route Scope/Completion EvidenceWARNS284%Scope documented but completion unclear1
RecoveryRecovery Received Without Matching ExpectationWARNS288%Minor variance in expected vs received1
FinanceClosed Claim with Open Reserves / Open TasksINCS232%Insufficient evidence to determine1
FileRequired Evidence Present (by Peril/Archetype)PASSS277%Evidence pack complete2
FileDocument Quality / OCR RiskPASSS378%No OCR issues detected1
FileClaim Timeline CoherencePASSS287%No sequence anomalies1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS273%Loss type coding matches narrative1
CoverageUnoccupied Condition Breach MaterialityPASSS280%Unoccupied breach materiality checked1
InvestInvestigation Thoroughness RecordedPASSS283%Investigation thoroughly documented2
InvestSubsidence Expert Evidence + Monitoring PresentPASSS182%Monitoring data present2
InvestGradual Damage Decisions Supported by ProofPASSS292%Expert evidence supports2
InvestMajor Water Damage: Source and Mitigation EvidencePASSS276%Leak source identified1
CommsNo-Update Gaps (Silence Periods)PASSS294%No communication gaps2
CommsTimely and Reasonable InvestigationPASSS274%Investigation completed timely2
CommsDecline/Partial Settlement Explanation QualityPASSS290%Policy terms linked to outcome2
RepairOutsourced Handling Oversight PresentPASSS275%QA checks recorded2
CashVulnerability ConsideredPASSS281%Vulnerability considered1
FinanceReserve/Exposure Structure PresentPASSS285%All cost areas covered1
FinanceLarge Reserves/Payments Have Approval TrailPASSS295%Authority verified1
FinancePayment Without Supporting DocumentPASSS293%Invoices linked2
FinanceDuplicate Payments / Near-DuplicatesPASSS179%Ledger clean2
RecoveryRecovery Reserve Exists but No Action EvidencePASSS289%Recovery actions documented1
Evidence

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