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Ectimo Process Manual

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DOCUMENT INFORMATION

TABLE OF CONTENTS
DOCUMENT INFORMATION....................................................................................................................................................4 1 INTRODUCTION.........................................................................................................................................................................5 2 BACKGROUND INFORMATION.............................................................................................................................................7 INTRODUCTION TO ECTIMO ...........................................................................................................................................................7 SECURITY OF CLIENTS DATA........................................................................................................................................................7 SOFTWARE AND HARDWARE..........................................................................................................................................................7 STORAGE OF CLIENTS DATA UPON RECEIPT.....................................................................................................................................8 CLIENTS DATA FEATURES............................................................................................................................................................8 3 ECTIMO ANALYSIS ................................................................................................................................................................10 CLOSED CLAIMS PROCESS OVERVIEW......................................................................................................................................10 1ST LEVEL ANALYSIS FOR ESURE CLOSED CLAIMS.......................................................................................................................10 Data cleansing..................................................................................................................................................................10 Current Recovery Performance Summary.........................................................................................................................11 2ND LEVEL ANALYSIS FOR ESURE CLOSED CLAIMS......................................................................................................................12 Recovery Potential ...........................................................................................................................................................12 Recovery Prospect Analysis..............................................................................................................................................14 Adjusted Recovery Potential.............................................................................................................................................16 Data Upload......................................................................................................................................................................17 OPEN CLAIMS - PROCESS OVERVIEW..........................................................................................................................................18 1ST LEVEL ANALYSIS FOR OPEN CLAIMS....................................................................................................................................18 Data cleansing..................................................................................................................................................................18 Summarising Incurred Amount of Actual & Factor Reserves ...........................................................................................18 2ND LEVEL ANALYSIS FOR OPEN CLAIMS....................................................................................................................................21 Recovery Potential (Amount and Volume).........................................................................................................................21 Recovery Potential Adjustments........................................................................................................................................26 ..............................................................................................................................................................................................29 CLOSED AND OPEN CLAIMS- PROCESS OVERVIEW........................................................................................................................30 1ST LEVEL ANALYSIS FOR AVIVA CLOSED AND OPEN CLAIMS.......................................................................................................30 Data Cleansing.................................................................................................................................................................30 SPSS Extraction Process...................................................................................................................................................30 Current Recovery Performance Summary.........................................................................................................................30 2ND LEVEL ANALYSIS FOR AVIVA CLOSED AND OPEN CLAIMS......................................................................................................30 Additional Recovery Potential...........................................................................................................................................30 Additional Recovery Potential Adjustments.......................................................................................................................30 Data Upload......................................................................................................................................................................30 ADDITIONAL ANALYSIS: ANOMALOUS PATTERNS ANALYSIS...........................................................................................................31 Time Analysis Example.....................................................................................................................................................31 Frequency of Claims Analysis Example ...........................................................................................................................41 4 APPENDICES..............................................................................................................................................................................51 APPENDIX 1.............................................................................................................................................................................51 How to connect to Ectimo Server drive.............................................................................................................................51 APPENDIX 2 - EVENT TYPE AND EVENT TYPE CODE.....................................................................................................................53 Esure Claims.....................................................................................................................................................................53 APPENDIX 3 ESURE CLAIM INFORMATION ...............................................................................................................................53 Claim Data List ................................................................................................................................................................53 Policy Data List................................................................................................................................................................54 Property type and property codes table.............................................................................................................................56 APPENDIX 4 AVIVA CLAIM INFORMATION.................................................................................................................................57 Claim List........................................................................................................................................................................57 APPENDIX 5 ............................................................................................................................................................................57 Glossary of Terms.............................................................................................................................................................57

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DOCUMENT INFORMATION APPENDIX 6 FILES NAMING CONVENTION .................................................................................................................................62 APPENDIX 7 RECOVERY PROSPOECT ANALYSIS CRITERIA............................................................................................................63

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DOCUMENT INFORMATION

Document Information
Document Name: Authors: Document Status: Version No: Ectimo process manual Ben Hirst Seventh draft to be reviewed 7.0

Review History Version 0.1 0.2 1.0 2.0 2.1 3.0 3.1 4.0 4.1 5.0 6.0 7.0 Date 28.10.2008 28.10.2008 29.10.2008 29.10.2008 30.10.2008 04.11.2008 06.11.2008 14.11.2008 27.11.2008 28.11.2008 06.05.2010 26.03.2012 Description of Change First draft Second draft Updated Draft Updated Draft Third Draft Fourth Draft Updated Draft Fifth Draft Final review and updates Final update Sixth Draft Seventh Draft Changed by: Joanna Siuta Angeliki Karatzaferi Joanna Siuta Angeliki Karatzaferi Joanna Siuta Joanna Siuta Angeliki Karatzaferi Joanna Siuta Angeliki Karatzaferi Joanna Siuta Rosie Best Ben Hirst

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DOCUMENT INFORMATION

1 Introduction
About this User Guide
This process manual will provide you with the necessary information to enable you to:

1. Cleanse Claims files 2. Determine Current Recovery Performance1 3. Determine Actual & Factor Reserves2 Incurred 4. Determine Additional Recovery Potential 5. Adjust Additional Recovery Potential 6. Conduct Anomalous Patterns Analysis
The manual will walk you through each step in the process of cleansing and analysing claims data to identify recovery opportunities for the Client. Also it will provide examples of potential business questions raised that will initiate further analysis. This is done through script and the use of screenshots where appropriate. This user manual is structured into three parts:

1. The First Part Background Information includes: Introduction to Ectimo Security of clients data Software and hardware Storage of clients data upon receipt
Clients Data Features

2. Part Two Ectimo Analysis will explain how to complete claims analysis and consists of four sections:
A. Closed Claims Esure: 1st Level Analysis for Closed Claims which includes:

Cleansing Closed Claims files Summarising Current Recovery Performance


2 Level Analysis for Closed Claims which consists of:
nd

Calculating Additional Recovery Potential Adjusting Additional Recovery Potential


Data Upload B. Open Claims Esure: 1st Level Analysis for Open Claims which includes:
1 2

For closed claims only For open claims only

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DOCUMENT INFORMATION Cleansing Open Claims files

Summarising Actual & Factor Reserves Incurred (Amount & Volume)


2 Level Analysis for Closed Claims which consists of: Summarising Recovery Potential (Amount & Volume)
nd

Adjusting Recovery Potential


C. Closed and Open Claims Aviva: 1st Level Analysis for Closed Claims which includes: Cleansing Closed Claims files

Summarising Current Recovery Performance


2nd Level Analysis for Closed Claims which consists of: Calculating Additional Recovery Potential Adjusting Additional Recovery Potential Data Upload D. Additional Analysis: Anomalous Patterns Analysis Time Analysis Frequency of Claims Analysis

3. Appendices.
This section includes useful information to enable complete the various stages of the analysis: Glossary of Terms How to connect on Ectimo drive Event type and Event code table Claims data and policy data list Property type and property code table Naming conventions Recovery Prospect Criteria

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DOCUMENT INFORMATION

2 Background Information
Introduction to Ectimo
Ectimo is a low risk solution that enables insurers and other large institutions with large books of business to improve their existing recovery rates. It will also provide a consultancy service to enhance operational efficiencies through shortening the recovery cycle, thereby delivering high impact to an organisations bottom line. For more details please refer to the Ectimo website: http://www.ectimo.com

Security of clients data


It is important that the following information is read and adhered to. You must never amalgamate the data of different clients

E-mails of any findings from clients data must only be circulated around the Ectimo Team Discussions of a clients data and findings is also restricted to the Ectimo Team only and must not
be discussed with anybody outside the team. We are under strict confidentiality agreements and governed by the Data Protection Law 1998.

Any disks which arrive from a client containing their data must be stored in a safe; they must not be
left on desks or in drawers.

All paper work on Ectimo which you produce or are passed by the Ectimo Team needs to be locked
away of an evening in a drawer or cabinet, it must not be left on desks. Note: Any files with client data should be password protected, particularly if about to be e-mailed. A common password has been agreed upon by the team. This can be made available to the relevant parties. This password should be changed every 6 months, (January and July) and should always contain a mixture of: lower case characters upper case characters numbers not less than 8 characters.

Software and hardware


Hardware: A dedicated Ectimo folder/drive is located on the State of Flux server which is at the State of Flux Office in London: Ectimo Server on sbserverIn order to get access to the server, please refer to Appendix 1 including a brief guide: How to connect to Ectimo Server drive. Software:

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DOCUMENT INFORMATION Software used for the analyses is split between Microsoft Excel and SPSS. We have a license for SPSS Statistics 17.0, on the Ectimo folder/drive. Additionally there is a license of SPSS Text Analysis for Surveys, on the Ectimo folder/drive on the server. Please consult with IT or the Ectimo service line manger for updates in the hardware infrastructure.

Storage of clients data upon receipt


Clients data can be received on CD/disk or via e-mail. The below process outline the steps that you need to follow to ensure clients data are stored properly: Step 1 - Create a client work folder named [Client Name] within the Ectimo Server on sbserver If a folder with the Client Name already exists on the server create a new folder named Data Analysis ddmmyyyy where the date is the date the client data was received. Step 2 - Create two new folders within this new client folder, one named Original Documents and another called Working Data Step 3 - Copy data from CD/disk or your Inbox into the Original Documents folder for that client. Step 4 - Copy the data within Original Documents into Working Data folder. Step 5 - Begin cleansing the data within Working Data - See Section 4.1.1 on Data Cleansing.

Clients data features


Esure Claims: Client usually sends two separate Books in Excel format:

Open Claims Book this includes claims that are under investigation Closed Claims Book this includes claims that has been settled and some of them recovered
Each of the books has three sections/ tables:

Detailed policy information about the policy itself and the policy holder
Claim details Claim details including descriptions Aviva Claims: Client usually sends one book in excel or access format: Closed & Open Book this includes both closed and open claims under a certain claim segments, i.e. household claims, travel claims, technology claims, etc. The single closed and open book contains all the following information in one table:

Policy information about the policy itself and the policy holder

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DOCUMENT INFORMATION Claim details including descriptions Examples of policy information:

Policy Number Cover End Date and Inception Date Property Type Code and No Of Bedrooms" Buildings, Contents Household Goods, Possessions, Specified Items Sums Insured Years Customer Has Had The Policy and Payment Method Contents High Risk Items, Personal

Examples of policy holder information: Name and Surname Address and contact details Date of birth Occupation Marital status

Examples of policy holder information: Policy and Claim Number Incident and Notification Date Reopen and Reclose Date Actual Close Date Claim Closed Flag Event and Cause Type Incident Description Total Current Estimate and Total Incurred Recovery Estimates and Payments Claims Handler Code

Note: Insurers capture different sets of information within their internal systems. The above are only the examples of the general information that insurers might supply for analysis purposes. A full list of Policy and Claim Data can be found in the Appendix 3 per client. To maximize the value of this manual it is advised you rename the fields of the current dataset to the ones in this manual if applicable.

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DOCUMENT INFORMATION

3 Ectimo Analysis
Closed Claims Process Overview
TBC

1 st Level Analysis for Esure Closed Claims


Data cleansing Once data have been received and copied into the Working Data folder, the process of cleansing the data begins. All claims files should be formatted and checked as below: Note: Client data files may have more than one tab. The data cleansing should apply to all. The data will be received in various formats (depending on the client), but it should be cleansed to a consistent standard. 1. The different tables received should be placed on individual tabs within the same spreadsheet 2. Typically, there should be 3 tabs. Policy information tab should be named as Policy data Claim details with the description column should be named as ectimo.clientname.month descr Claim details only should be named as Claims data 3. Dates formatting:

Columns containing dates all dates need to be converted to short dates (dd/mm/yy) without any
alpha numeric symbols. Example: 14MARCH2001 needs to be converted to 14/03/01. This is done by highlighting the columns, right click, then Format cells option and then Category: Date 14/03/01. Note: Usually dates are located under Incident date and Notification date columns. Other examples are: Reopen date and Reclose date. However, client data vary in form. For this reason make sure you have searched the document thoroughly for dates and convert them to the right format before you move on to the next step. 4. Numbers formatting:

Columns containing monetary values need to be whole numbers (without any decimal places) and
with 1000 Separator.

Example: 1234.10 needs to be converted to 1,243.


This is done by highlighting the columns, right click, then Format cells option and then Category: Number. In there from Decimal places drop down select 0 and tick Use 1000 Separator (,)box.

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DOCUMENT INFORMATION 5. Data check for missing values or miscoding: Some of data fields can empty. To check for blanks and mark them in the data set follow the below steps: Step 1: Highlight the whole data set, press Ctrl+G, select Special and then Blanks. This will show all the empty cells. Step 2: Press Ctrl+Enter to mark the blanks. You can either colour code them in yellow or key in Unknown. Then press Ctrl+Enter again. This will make the same entry in all empty cells. Step 3: Record any problems with data, including missing data, and decide whether the missing information is crucial for further analysis. If this is the case seek clarification from client. Do not proceed with any analysis until you have confirmation that the data set is complete. Note: After each formatting activity perform a consistency check to ensure that data have been formatted properly.

Current Recovery Performance Summary In order to populate the Summary, follow the below steps: Step 1: Open the clean Closed Claims data file and apply filters across all the columns. Step 2: Find Event type column and check how many different event types are in there. Note: Due to a number of different systems that clients have in place, this column and event types may be named differently. Some examples of such column names are as follows: Cause Code Event Type Some examples of such event types are as follows: Fire Explosion Flood Storm Lightning Accidental Damage Theft Step 3: Define codes for each event type. Some examples of such event types and their codes are as follows:

Event Type Fire Explosion FIR EXP

Event Type Code

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DOCUMENT INFORMATION Flood Storm Lightning Accidental Damage Theft FLO STR LGH AD TFT

Note: Each event code should be unique. A list with all event types and their associated codes used to date by Ectimo for Esure can be found in the Appendix 2. To maintain consistency across different projects make sure you use codes assigned to certain event types from this table. If you can not find an event type and associated code matching your client events only then create a new code and inform the Ectimo service line manager about this addition.

This marks the end of the 1st stage analysis.

2nd

Level Analysis for Esure Closed Claims


Recovery Potential

You will need to identify the potential of recovery for each claim. This will allow Ectimo to identify the claims that represent the largest recovery opportunity later in the process. It will also allow Ectimo to group the claims and identify the likely recovery total. The recovery potential is divided into three elements. These are select, type and potential. Step 1: Insert 3 additional columns after the total incurred column and label as select, type and potential. The table headings should look like this:
In c id e nNt o t if ic a t io n o p e n R e c lo s e A c t u a l C la im E v e n t t y p e Re C la im C a s P o N o y N u m b e r e lic D a te D a te D a te D a t e C lo s e DCa loe s e d F lac go d e t IN C ID E N T _ D E S C T o ta l H R IP H G IP H G II P P IP S IIP H R EC B T PP B T PI H G T PP H G T PI S e l e c t T y p e P o t e n tBi a l P a y m e n t IP h a n d le rr e la t io n s In c u r r e d N e t P a y m e n Pt a y m e n Pt a y m e n Pt a y m e n Pt a y m e n Pt a y m e n Pt a y m e n Pt a y m e n Pt a y m e n Pt a y m e n t

Step 2: Identify data with recovery potential by populating additional 3 columns Populate the columns as follows: Select:

This element relates to the suitability of each claim for recovery. The select column for each claim needs to be populated with one of the following: o o yes claim is suitable for recovery no claim is not suitable for recovery

You need to complete the following actions to determine suitability:

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DOCUMENT INFORMATION look at the payment status of the claim. If the payment has been made, enter yes in the select column. review the relevant client insurance policy (or policies). Enter yes in the select column for any claim that is not covered by the policy. Enter no for any claims for which the column is still unpopulated (i.e payment has not been made and is covered by the policy).

o
o Type

This element relates to the party from whom the recovery would be made. Potential recoveries will arise from loss or damage caused by the negligent activity of third parties or by reason of dual insurance. Three categories will be assumed for the purpose of recovery prospect analysis third party, contribution and warranty. Review each claim and decide which of the three is applicable. Populate the column accordingly:

1. Third Party Where the clients property is lost or damaged through the negligence and/or breach of contract of a third party. Breach of duty must be proved as must the extent of damage caused Example: wall damaged by third party vehicle or luggage not delivered by airline It cannot be assumed that a full recovery therefore each identified case will be graded according to their individual recovery prospects as follows:

2. Contribution This occurs where two (or more) insurers cover the same customer, for the same risk and subjectmatter. Subject to the respective terms and sums insured, the loss will be shared between the insurers. In practice one insurer will settle the claim and seek contribution from the other insurer. Example: loss of personal possessions whilst on holiday being covered under both the travel and home insurance policies. The maximum amount to be recovered will be 50% but can be less should there be an imbalance between the respective sums insured and where this occurs the contribution amount will take account of this. The most significant area for contribution involve losses which might also be covered by travel insurance. It will be assumed that most Home insurance customers will have access to travel insurance of one form or another, mainly through the following:

The purchase of annual travel insurance The purchase of travel insurance for a specific holiday Travel insurance provided free as part of a credit card or banking arrangement

3. Warranty This is a type of dual insurance. Often known as extended warranties they are generally purchased at the point of sale of white electrical goods, TVs, sound equipment and laptops. Some, but not all, warranty arrangements include accidental damage to the purchased article within their coverage.

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DOCUMENT INFORMATION These agreements often compliment the manufacturers guarantee and commonly run for terms of 12 to 36 months. For the purpose of recovery analysis we shall adopt a cut-off point of 24 months from date of incident. The maximum amount that will be recovered will be 50% but then each identified case must then be graded according to the recovery potential as follows: Qualifying articles: white electrical goods, TVs, sound equipment and laptops Potential:

All claims need to be assigned a recovery potential. This gives an indication of the likelihood of recovery per claim. It cannot be assumed that a full recovery therefore each identified case will be graded according to their individual recovery prospects. This element is divided between three categories: Low, Medium and High. The criteria for each category differ via Type of claim. Review each claim using the appropriate criteria and populate column accordingly. The criteria are as follows:

1. Third Party LOW MEDIUM HIGH - prima facie case (a matter to be self-evident from the facts) but active causation and/or TP yet to be identified. - TP can be identified but active causation to be determined. - active causation determined and TP identified

2. Contribution LOW MEDIUM HIGH - loss outside the home though clearly not on holiday - loss at place of work or public building and travelling within the UK or from a parked vehicle - whilst clearly travelling on holiday or through an airport or port - loss from vehicle outside the UK

3. Warranty LOW MEDIUM HIGH - It is known the article was purchased within 12 to 24 months of the loss - ditto but between 0 and 12 months of loss - the warranty provider is identified and their agreement covers accidental damage in addition to breakdown

Recovery Prospect Analysis The next stage is to make allowance for the low, medium and high potential by discounting the individual gross recovery values. This is done by discounting each sub-total by the following percentages to create Net Recovery Values:

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DOCUMENT INFORMATION

Recovery type Third Party Contribution Warranty

Low % 50 25 25

Med % 75 35 35

High % 100 50 50

Use the above table to populate the net recovery column and create net recovery totals. Use the following steps: Step 1: You will have gone through the spreadsheet and populated all the three columns appropriately.

Select this column will specify whether a claim is (represented by 1) or is not (when left blank)
suitable for recovery.

Type this column will indicate a recovery type (Third Party, Contribution, Warranty, X) Some
claims will be represented with an X, this refers to claims that do not particularly have recovery potential, but due to their high amount (usually over 10,000) an effort will be made at recovery. Potential this column will grade a claim recovery potential (High, Medium, Low) Step 2: At the bottom of each sheet under the data insert an Additional Recovery Potential table with the following columns: Columns Titles: Recovery Type (Third Party, Contribution, Warranty)

No. (This is a volume of Low potential claims)


Low (This is an amount of Low potential claims)

No. (This is a volume of Medium potential claims)


Medium (This is an amount of Medium potential claims) No. (This is a volume of High potential claims) High (This is an amount of High potential claims) No. All (Totals Volume of Low, Medium, High potential claims) All (Totals Amount of Low, Medium, High potential claims) The x claims will be represented on a separate line. See below the Recovery Potential table:
R c v r P t nia e o e y oe t l
R c v ryty e eoe p T irdPrty h a I d mityC n u n ne n o trib tio Wrra ty a n T ta : o ls N. o 2 2 3 3 2 9 8 4 L w o 3 2 .1 3 ,1 4 2 6 7 .0 3 ,8 0 7 5 9 .4 1 ,4 2 6 5 8 .6 8 ,4 6 5 N. o 1 2 2 3 0 3 5 M d m e iu 0 2 .4 2 ,6 4 3 1 2 .9 1 ,5 8 5 .0 0 0 2 5 .3 3 ,1 3 8 N. o 7 0 0 7 H h ig ,7 8 2 4 9 .3 .0 0 0 ,7 8 2 4 9 .3 N.A o ll 4 1 5 6 2 9 10 3 A ll 8 4 .8 5 ,5 6 7 8 9 .0 4 ,3 9 2 5 9 .4 1 ,4 2 6 2 ,4 8 5 1 2 3 .3

C im a o e 0 0 la s b v 1 ,0 0

1 8

0 ,4 4 0 6 0 5 .0

Note: At this point you should save your document as a new version. (See file naming convention) Example:

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DOCUMENT INFORMATION The following example will explain, with the use of screenshots, how to populate each cell within the Additional Recovery Potential table. In this example we will show how to populate Third Party No. Low 1and Low 2 cells.

Step 3: The first thing to undertake when populating the above table is to filter the claims data table by selecting 1 from the Select column drop-down menu. Delete the rest of the rows with the Blank cells under Select column. Step 4: Once the claims data table contains only claims selected as suitable for recovery, sort the table by Type column. Step 5: In order to determine a volume of third party recoveries with low recovery potential, select from Type drop-down filter menu TP and the from Potential drop-down filter menu L. By using Count formula you will determine the number of third party recovery with low recovery potential. Step 6: In order to determine an amount of third party recoveries with low recovery potential, at the bottom of Total Incurred column run the following formula: =SUBTOTAL(9, N108:N300) Note: Number 9 in this formula will assure that only the displayed numbers will be summed up when the filter is applied. Apply the above methodology to calculate the rest of the numbers. Step 7: To calculate the totals in rows within the Recovery Potential table sum up all the numbers for each Recovery Type. Step 8: To calculate the totals in columns within the Recovery Potential table sum up all the numbers for each column respectively. Adjusted Recovery Potential The calculated Recovery Potential is based on the assumption that Ectimo can recover 100% from all the claims identified as suitable for recovery. However, this figure needs to be adjusted as it is unlikely to recover 100% from all the claims (poor prospects of obtaining missing information; dual insurance, etc.) In order to adjust the additional recovery potential, follow the steps below: Step 1: Under the Additional Recovery Potential schedule insert the Adjusted Potential table with the following columns: Columns Titles: Recovery Type (Third Party, Contribution, Warranty)

% (This column displays discount rates for the Recovery types graded as Low (Third Party,
Contribution and Warranty) Low (This is an amount of adjusted Low potential claims)

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DOCUMENT INFORMATION

% (This column displays discount rates for the Recovery types graded as Medium (Third Party,
Contribution and Warranty)

Medium (This is an amount of adjusted Medium potential claims) % (This column displays discount rates for the Recovery types graded as High (Third Party,
Contribution and Warranty)

High (This is an amount of adjusted High potential claims) Total (Totals Amount of Adjusted Third Party, Contribution and Warranty recovery types)
See below the Adjusted Potential table:
R ecovery type T hird P arty Indem C nity ontribution W arranty Totals: N o. 22 33 29 84 Low 33,124.12 36,870.07 15,492.46 85,486.65 N o. 12 23 0 35 Medium 20,624.43 11,528.95 0.00 32,153.38 N o. 7 0 0 7 H igh 4,798.32 0.00 4,798.32 N All o. 41 56 29 130 All 58,546.87 48,399.02 15,492.46 122,438.35

Claims above 10,000

18 600,454.00

A djus ted Potential


A ctual R eserves R ecovery type T hird P arty Indem C nity ontribution W arranty Totals: % 50 25 25 Low % 75 35 35 Medium % 100 50 50 H igh Total

Step 2: In order to populate cells in the Low, Medium and High columns, multiply figures in % columns from Adjusted Potential schedule by figures in Low, Medium and High columns from the above Additional Recovery Potential schedule respectively. Step 3: To calculate the totals sum up in rows all the subtotals for each Recovery type. Step 4: Once this is complete, conduct a quality assurance review of the data.

Data Upload The recovery potential claims are then uploaded on to the upload master spreadsheet and the system. The analyst populates columns D to Z with the details for claims that have recovery potential and the claims marked as x (see page 17 for an explanation on x claims). Then populate column C (Column A and B are not populated). Upload it to the system. STOP REVIEW

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Open Claims - Process Overview

1 st Level Analysis for Open Claims


Data cleansing Please refer to the section 4.1.1 Data cleansing

Summarising Incurred Amount of Actual & Factor Reserves Incurred Amount of Actual and Factor Reserves Summary presents the amounts placed on claims by event type that reflects the settlement cost to be paid by insurer. It also shows a volume of Actual and Factor Reserves. The Summary comprises of two schedules:

Amounts incurred by Event Type (both all and target) and Total Amount Incurred Reserves Volume by Event Type and Total Reserves Volume
In order to populate the Summary, follow the below steps: Step 1: Open the cleansed Open Claims data file and apply filters across all the columns.

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DOCUMENT INFORMATION Step 2: Find Event type column and check how many different event types are in there. Note: Each event code should be unique. A list with all event types and their associated codes used to date by ectimo can be found in the Appendix 2. To maintain consistency across different projects make sure you use codes assigned to certain event types from this table. If you can not find an event type and associated code matching your client events only then create a new code and inform the Ectimo service line manager about this addition. Step 3: Within the Working Data folder, create a new .xls document named Open Claims Reserves Incurred. Step 4: Within the new file create a tab for each of the event type named [Event Type Code]. Step 5: Go to the clean data set. From Event type filter menu select an event type. Highlight all the rows, right click and select Copy. Step 6: Go to the Open Claims Reserves Incurred file and paste all the rows within the relevant tab. Step 7: Repeat Step 5 and 6 till all the rows for all event types are carried across from the clean data set file to the Open Claims Reserves Incurred document and placed under the relevant type. Step 8: In order to determine Total 801 reserves and Total Actual Reserves per event type, within each of the tabs at the bottom prepare two small tables. 1. 801 Reserves table includes:

# of 801 reserves (in order to identify this number, from the Total Incurred filter drop down menu
select 801. Then apply COUNT formula to such prepared column).

Average cost (this is an average closed claim cost for a particular event type that you have already
calculated when analysing Closed Claims. Go to the Current Recovery Performance and copy and paste those figures here).

Total 801(calculate this figure multiply the # of 810 reserves times by the Average cost).

2. Actual reserves table includes:

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# of Actual reserves (in order to identify this number, from the Total Incurred filter drop down menu
select Custom, then Does not equal 801 and press OK. Then apply COUNT formula to such prepared column).

Total Actual reserves (in order to identify this number, from the Total Incurred filter drop down menu
select Custom, then Does not equal 801 and OK. Then at the bottom of the column run the following formula: =SUBTOTAL(9,K2:K139)). Note: Number 9 in this formula will assure that only the displayed numbers will be summed up when the filter is applied. Perform Step 8 for the rest of the tabs and apply the above methodology to calculate the rest of the numbers. Step 9: Once this is completed within the Open Claims Reserves Incurred spreadsheet, create an Overview tab named All_Claims_Opened_in_July. Step 10: In this tab prepare two individual tables identifying:

Incurred amounts of 801 and Actual reserves incurred by Event Type (both all and target) and
Total Amount Incurred

Claims Volume this includes Claims Volume by Event Type and Total Claims Volume
Figures for Incurred and Claims Volume are presented by event type code (AD, ADD, AL etc columns) and policy sections (Buildings, Contents High Risk, Contents Household Goods etc rows). Note: The break down by policy sections can different from client to client. It depends on the information provided by client. See below the Open Claims Reserves Incurred overview sheet:

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Step 11: In order to populate all the tables, in each of the cells insert =, then refer to the relevant cell within the tabs and press Enter. Step 12: To calculate the totals sum up in rows all the subtotals for each event type. Step 13: You have now completed 1st Level Analysis for Open Claims. Conduct quality assurance and proceed with the 2nd Level Analysis for Open Claims.

2nd

Level Analysis for Open Claims


Recovery Potential (Amount and Volume)

Recovery Potential Summary presents claims indentified as suitable for recovery by recovery type (Third Party, Contribution, and Warranty). This includes two main schedules: Recovery Potential Amounts by Recovery Type per Event Type and Total Additional Recovery Potential

Recovery Potential Volume by Recovery Type per Event Type and Total Additional Recovery
Potential Volume Open the Open Claims Reserves Incurred spreadsheet and insert the two schedules within the All_Claims_Opened_in_July overview tab in the following locations:

The Recovery Potential schedule (amounts) place under the Incurred (amounts) schedule. See
below:

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The Recovery Potential schedule (volumes) place under the Incurred (volume) schedule. See below:

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The following steps help you to populate the above Recovery Potential schedules (amounts and volumes). Step 1: Within each of the event code tabs insert the following three columns after the Incident Description column: Select Type Potential Step 2: Once this is completed go through it and populate all the three columns appropriately.

Select this column will specify whether a claim is (represented by 1 for Actual reserves and 2
for 801 reserves) or is not (when left blank) suitable for recovery

Type this column will indicate a recovery type (Third Party, Contribution, Warranty)
Potential this column will grade a claim recovery potential (High, Medium, Low) Step 3: Save as a new version. Step 4: In order to summarise the total amount and volume of the actual and 801 reserves identified as suitable for recovery, within each of the event tab next to the previously created 801 Reserves and Actual Reserves tables prepare another two tables. 1. 801 Reserves table includes:

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# of 810 reserves (in order to identify this number, from the Select filter drop down menu select 2.
Then apply COUNT formula to such prepared column).

Average cost (this is an average closed claim cost for a particular event type that you have already
calculated when analysing Closed Claims. Go to the Current Recovery Performance and copy and paste those figures here).

Total 801(To calculate this figure multiply the # of 810 reserves times by the Average cost).
2. Actual reserves table includes: # of Actual reserves (in order to identify this number, from the Select filter drop down menu select 1. Then apply COUNT formula to such prepared column).

Total Actual reserves (in order to identify this number, from the Total Incurred filter drop down menu
select Custom, then Does not equal 801 and OK. Then at the bottom of the column run the following formula: =SUBTOTAL(9,K2:K139)). Step 5: Within each of the tabs under the data insert a Recovery Potential table one for the Actual Reserves and one for the 801 reserves with the following columns: Columns Titles: Recovery Type (Third Party, Contribution, Warranty) No. (This is a volume of Low potential claims) Low (This is an amount of Low potential claims) No. (This is a volume of Medium potential claims) Medium (This is an amount of Medium potential claims) No. (This is a volume of High potential claims) High (This is an amount of High potential claims) No. All (Totals Volume of Low, Medium, High potential claims) All (Totals Amount of Low, Medium, High potential claims) See below the Additional Recovery Potential table:

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Note: At this point you should save your document as a new version. Example: The following example will explain, with the use of screenshots, how to populate each cell within the Additional Recovery Potential table. In this example we will show how to populate Third Party No. Low 1and Low 2 cells for Actual Reserves. Step 6: The first thing to undertake when populating the above table is to filter the claims data table by selecting 1 from the Select column drop-down menu. Step 7: Sort the table by Type column. Step 8: In order to determine a volume of third party recoveries with low recovery potential, select from Type drop-down filter menu TP and the from Potential drop-down filter menu L. By using Count formula you will determine the number of third party recovery with low recovery potential. Step 9: In order to determine an amount of third party recoveries with low recovery potential, at the bottom of Total Incurred column run the following standard formula: =SUBTOTAL(9, N108:N300) Note: Number 9 in this formula will assure that only the displayed numbers will be summed up when the filter is applied. Perform Steps 6 to 9 for all event type tabs and apply the above methodology to calculate the rest of the numbers.

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DOCUMENT INFORMATION Step 10: To calculate the totals in rows within Recovery Potential table sum up all the numbers for each Recovery Type. Step 11: To calculate the totals in columns within Recovery Potential table sum up all the numbers for each column respectively. Step 12: Once this is complete, send the spreadsheet to the Ectimo expert for review. The expert will go through it and feedback to you appropriately. When you receive a positive feedback from the expert, you can now start populating the Recovery Potential schedules in the All_Claims_Opened_in_July overview tab. Step 13: Go to the overview tab Step 14: In order to populate the two schedules, in each of the cells insert =, then refer to the relevant cell within the tabs and press Enter. Step 15: To calculate the totals sum up in rows all the subtotals for each event type. Step 16: You have now completed the Recovery Potential Summary. Send the spreadsheet to the Ectimo expert for review. The expert will go through it and feedback to you appropriately.

Recovery Potential Adjustments The calculated Recovery Potential is based on the assumption that Ectimo can recover 100% from all the claims identified as suitable for recovery. However, this figure needs to be adjusted as it is unlikely to recover 100% from all the claims (poor prospects of obtaining missing information; dual insurance, etc.) In order to adjust the additional recovery potential, follow the below steps: Step 1: Open the recent version of the document including the complete the Recovery Potential schedules. Step 2: Within each of the event type tabs under the Recovery Potential schedule insert the Adjusted Potential table one for the Actual reserves and one for 801 reserves with the following columns: Columns Titles: Recovery Type (Third Party, Contribution, Warranty) % (This column displays discount rates for the Recovery types graded as Low (Third Party, Contribution and Warranty) Low (This is an amount of adjusted Low potential claims) % (This column displays discount rates for the Recovery types graded as Medium (Third Party, Contribution and Warranty) Medium (This is an amount of adjusted Medium potential claims) % (This column displays discount rates for the Recovery types graded as High (Third Party, Contribution and Warranty) High (This is an amount of adjusted High potential claims)

Total (Totals Amount of Adjusted Third Party, Contribution and Warranty recovery types)
See below the Adjusted Potential table:

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Note: At this point you should save your document as a new version. Step 3: Once this is completed send the spreadsheet to the Ectimo Expert for review. The Expert will go through it and populate the % columns appropriately. Expert will send you the document with the populated % columns for further course of action. Please see below the Adjusted Potential table with the % columns populated.

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Step 4: In order to populate cells in the Low, Medium and High columns, multiply figures in % columns from Adjusted Potential schedule by figures in Low, Medium and High columns from the above Recovery Potential schedule respectively. Step 5: To calculate the totals sum up in rows all the subtotals for each Recovery type. When you receive a positive feedback from the expert, you can now start populating the Adjusted Potential rows in the All_Claims_Opened_in_July overview tab. Step 6: Go to the overview tab. Step 7: Insert three new rows under the Recovery Potential schedule (amounts): Total Adjusted Actual Reserves Total 801 Reserves Total Adjusted In order to populate the Total Adjusted Actual Reserves and Total 801 Reserves rows, in each of the cells insert =, then refer to the relevant cell within the tabs and press Enter. Step 9: To calculate the Total Adjusted sum up in columns the Adjusted Actual Reserves and 801 Reserves totals for each event type. Step 10: To calculate the total sum up in row all the subtotals for each event type. Step 11: You have now completed the 2nd Level Analysis. Send the spreadsheet to the Ectimo expert for review. The expert will go through it and feedback to you appropriately.

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Closed and Open Claims- Process Overview 1 st Level Analysis for Aviva Closed and Open Claims
Data Cleansing SPSS Extraction Process Current Recovery Performance Summary

2 nd Level Analysis for Aviva Closed and Open Claims


Additional Recovery Potential Additional Recovery Potential Adjustments Data Upload

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Additional Analysis: Anomalous Patterns Analysis


Once the claims files have been cleansed, you can run Anomalous Patterns Analysis. This can be run before, during or after the 1st and 2nd level analysis. Anamalous Patterns Analysis includes: A. Time Analysis (e.g. Incident Date to Notification Date, Notification Date to Actual Close Date, Inception Date to Notification Date) B. Frequency of claims analysis (e.g. by County, Property Type, Number of years customer has had a policy, Payment Method) Note: The type of frequency analysis might vary for different clients depending on the information supplied. Time Analysis Example For the purpose of the Time Analysis use the whole cleansed data files. The following example will explain, with the use of screenshots, how to determine central tendency and spread between Incident Date to Notification Date and how to display the information graphically. These involve calculating: Mean (arithmetic average) and median (value at which half the cases fall above and below) Standard deviation, minimum and maximum (measurements of the variation or spread in the data) Step 1: As the claims files are vast it is useful to copy and paste the Policy Number, Event Type, Incident Date and Notification Date columns to a new speradsheet and saved it as Time Analysis Input file. Step 2: Insert a new column in the file and title it Incident Date to Notification Date. Step 3: Subtract Notification Date from Incident Date. You will receive the results displayed as dates. Change the format results to numbers. Note: Ensure that the figures in the Incident Date to Notification Date are displayed as numbers (not dates). This is very important for further analysis in SPSS. Step 4: The rest of the analysis is done in the SPSS application. In order to access SPSS application, from the Start Menu choose: All Programs -> SPSS Inc -> Statistic 17.0 -> SPSS Statistics 17.0

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Then the Data Wizard opens. Close the window.

Step 5: From the menus choose File -> Open -> Data

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Step 6: Select Excel (*.xls) as the file type you want to view.

Step 7: Browse and select the Time analysis Input.xls file and click Open.

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The Opening Excel Data Source dialog box is displayed, allowing you to specify whether variable names are to be included in the speardsheet, as well as the cell that you want to import. Make sure that Read variable names from the first row of data is selected. This option reads column headings as variable names. .

Step 8: Click OK to read the Excel file. Step 9: The data now appear in the Data Editor with the column headings used as variable names. An Output window will open. This is where your graphs and any analysis output will appear.

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Step 10: From the menu bar choose Analyze, Descriptive Statistics and then Frequencies.

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DOCUMENT INFORMATION Step 11: Select Incident Date to Notification Date and move into the Variable(s) list.

Step 12: Click Statistics

Step 13: Select Mean, Median, Standard Deviation, Minimum and Maximum.

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Step 14: Select Continue. Step 15: Deselect Display frequency tables in the main dialog box.

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DOCUMENT INFORMATION Step 16: Click OK to run the procedure. Step 17: The Frequencies Statistics table is displayed in the Viewer window.

Step 18: From the menu bar choose Analyze, Descriptive Statistics and then Frequencies again. Step 19: Click Charts. Step 20: Select Histograms and With normal curve.

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Step 21: Click Continue, and then click OK in the main dialog box to run the procedure.

Step 22: In order to save the analysis output, right click within the Viewer box and copy the contents to a new Excel sheet.

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Step 23: Tidy up the cells within Excel so the information can be easily read.

Step 24: Save this Excel sheet as Time Analysis Output to the relevant folder on the Ectimo Server and e-mail to Ectimo experts.

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DOCUMENT INFORMATION Step 25: Apply the same methodology for determining central tendency and spread for the rest of the dates: Notification Date to Closure Date, Inception Date to Notification Date Frequency of Claims Analysis Example The following example will explain, with the use of screenshots, how to determine Frequency of claims by Property Type and how to display the information graphically. Note: When performing analysis in relation to property type please use the codes provided in appendix 6. If not applicable then new codes need to be created. Inform the Ectimo service line manager of this addition. In order to get data set in Excel format ready for the analysis in SPSS tool a more complex preparation process is required. The below steps will guide you through this process. For the purpose of the Frequency of Analysis use the whole cleansed data files. This involves using information from both tabs:

Policy Data in here you look at the Policy Number and Property Type
Claim Data in here you look at Policy Number and Event Type Step 1: As the claims files are vast it is useful to first copy and paste from the Policy Data tab the Policy Number and Property Type columns and to a new speradsheet and saved it as a Frequencies (Property Type) - Input file. Step 2: Select both columns and sort them in an ascending order. This is crucial for further analysis when running VLOOKUP function. Step 3: Go back to the cleansed data file and from Claim Data tab copy and paste Policy Number and Event Type columns to the Frequencies (Property Type) - Input file. See below. Note: You need to be aware that the number of rows within the Claim Data can differ from the number of rows within the Policy data. If this is a case, you will have fewer rows within the Policy data than within the Claim Data. This is because there can be more than one claim made under the same policy.

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In order to assign a property type to an event type run a VLOOKUP function. Step 5: Within the new file after the Event Type column insert a new column titled Property Type. Step 6: Select the first cell in the Property Type column and from the menu bar choose Insert, Function and VLOOKUP. The below are the data you should be using for Function Arguments: Lookup value is the Policy Number from the Claim Tab (Column D). Table you look for a Property Type is the table consisting of Policy Number and Property Type Code from Policy Data tab (Columns A & B) Value you want to be returned is the Property Type Code from table consisting of Policy Number and Property Type Code from Policy Data tab (Columns A & B).

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Step 4: Click OK and then the cell should be automatically populated with an appropriate Property Type. See below:

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Step 5: To populate the rest of the cells in the Property Type column, drag down Fill handle (The tiny black square in the lower-right corner of the cell cursor).

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DOCUMENT INFORMATION Step 6: The rest of the analysis is done in the SPSS application. In order to access SPSS application, from the Start menu choose: All Programs -> SPSS Inc -> Statistic 17.0 -> SPSS Statistics 17.0

Step 7: From the menus choose File -> Open -> Data

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Step 8: Select Excel (*.xls) as the file type you want to view.

Step 9: Open Property Type Analysis Input.xls file.

The Opening Excel Data Source dialog box is displayed, allowing you to specify whether variable names are to be included in the speardsheet, as well as the cell that you want to import. Make sure that Read variable names from the first row of data is selected. This option reads column headings as variable names.

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Step 10: Click OK to read the Excel file. Step 11: The data now appear in the Data Editor with the column headings used as variable names. Note: Property types here have been previously converted in excel to their respective codes.

Step 12: From the menu choose Analyse, Descriptive Statistics and then Crosstabs.

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Step 13: Select Property Type Code and move into the Row(s) list. Then select Event Type Code and move into the Column(s) list.

Step 14: Click OK to run the procedure. Step 15: The Crosstabs Statistics table is displayed in the Viewer window.

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Step 16: In order to save the analysis output, right click within the Viewer box and copy the contents to a new Excel sheet.

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DOCUMENT INFORMATION Step 17: Tidy up the cells within Excel so the information can be easily read.

Step 18: Save this Excel sheet as Frequencies Analysis Output (Property Type) to the relevant folder on the Ectimo Server. Step 19: Apply the same methodology for determining Frequency of claims by County, Number of years the customer has had the policy, etc.

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4 Appendices
Appendix 1
How to connect to Ectimo Server drive 1. Go to Start and then click on my computer

2. System will open a window similar to below, from the toolbar, select Tools

3. Select Map Network drive

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4. Select the drive letter (in above case it show the letter Y) and then in Folder section enter the following string \\sbserver\Ectimo Server (without quotes). Please also make sure that you checked the Reconnect at logon check box

5. Click Finish to end the process.

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Appendix 2 - Event type and Event Type Code


Esure Claims Event Type Accidental Damage Accidental Damage to Drains Accidental Loss Aircraft / Airborne Devices Burst Pipes Earthquake Escape of Water from Water Apparatus Explosion Falling Aerials Falling Trees Fire Freezing - Water Instl or Heating / Esc Oil Frozen Food Impact Lightning Malicious Damage Personal Liability Public Liability River Flooding Smoke Storm Subsidence Theft Event Type Code AD ADD AL AIR BP ETQ EOW EXP FA FT FIR FRZ FZF IMP LGH MD PSL PUL RIV SMO STO SUB TFT

Appendix 3 Esure Claim Information


Claim Data List Claims : Information Policy Number Claim Number Handler Code Claim Type: Cover Section Peril Cause Claim Details: Date / Time Of Loss Date / Time Of Initial Notification Location Agents Names / Addresses / Code Of: Loss Adjusters Engineers Reclamation Agents

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Other Police / Fire Brigade: Reported : Yes / No Report Number Address Data Checks: CUE Hunter / CIFAS DLVC Claim Status: Open Closed Reopened Reclosed Recovery O/s File Estimates: Future Expenditure: Buildings Future Expenditure: Contents Future Expenditure: By Peril Future Expenditure: By Policy Section Future Expenditure: Split Reserves Per Claimant Future Expenditure: Reserve For LAE's By Agent Recovery Reserves: Buildings Contents By Peril By Policy Section Payments: Building Codes Contents Codes Peril Codes Policy Section Payments Per LAE Agents Settlement Method Policy Data List Customer Data : Information Name Address Flood Coding Security Protections Number Of Rooms Sole Occupancy Sub-let Business Use Phone Number - Home Phone Number - Work Phone Number - Mobile Date Of Birth Occupation

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National Insurance Number Marital Status Next Of Kin Previous Insurers Types Of Policies Other Policies Held (Current) Other Policies Held (Expired) Premium Payment Record Claim Experience Under Each Policy Current Broker Previous Brokers Claim Data : Information Policy Number Branch Number Broker Code Key Dates: Inception Date Renewal Date Additions Deletions Amendments Customer and/or identity or address changes Convictions Losses / Claims - Current Policy Losses / Claims - Previous Policies Losses / Claims - Previous Insurers Cover: Risk Address Buidling Description Mortgage Number Occupancy Buildings Sum Insured Contents Sum Insured Schedule Of Coverage Individual Sums Insured List Of Declared Valuables Special Endorsements Additions Deletions Amendments Premium: Premium Payment Record - Current Policy Premium Payment Record - Previous Insurers Payment Method Under Each Current Policy Claims Experience - Current Policy Type Of Claim Amount Settlement Type Claims Experience - Previous Insurers Type Of Claim Amount Settlement Type

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Property type and property codes table Property Type Code BSD CB CW CTG CD CSD DB DH ETB ETH FPB FCD GFFC LNK MST MTB MTH OFFC PBF

Property Type Bungalow-Semi Detached Converted Barn Converted Warehouse Cottage Cottage Detached Cottage-Semi Detached Detached Bungalow Detached House End of Terrace Bungalow End of House Terrace

Flat-Purpose Built Flats (Conversion to Dwelling) Ground Floor Flat Conversion Link Maisonette Mid-Terraced Bungalow Mid-Terraced House Other Floor Flat Conversion Purpose Built Flat

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Self Flat

Contained

SCF SDB SDH TB TH TNH

Semi-Detached Bungalow Semi-Detached House Terraced Bungalow Terraced House Town House

Appendix 4 Aviva Claim Information


Claim List Claims : Information Claim Number Estimated Amount Paid Amount Incurred Amount Number of Payment Comments Customer Data: Information Policy Holder Initial Policy Holder First Name Policy Holder Surname Policy Holder Address Policy Holder Postcode Claim Data : Information Risk Address Claim Reported By Loss Date Date Reported Claim Status Latest Settlement Date Product Cause Description Claim Type Description

Appendix 5
Glossary of Terms Term Description

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Accidental (loss or damage)

An unlooked-for mishap. A fortuitous event Often redefined in the policy document and subject to exclusions

Actual Estimate/ Estimated Amount Average Claims Cost

An estimate placed on a claim that reflects as near as possible the ultimate settlement cost Commonly expressed over the book and then sub-divided by peril (Home book and then by Fire etc) Usually calculated over a given period and used for benchmarking. It is the sum of the average incurred amount (both open and closed claims), including nil settlements, less the sum of recoveries received.

Average Settled cost

Commonly expressed over the book and sub-divided by peril (Home book and then by Fire etc) The average cost of settled claims, including nil payments and recoveries received

Buildings Estimate

Buildings is a specific section of the policy The amount that should reflect the estimated settlement cost in relation a claim under this section of the policy

Buildings Payments

Buildings is a specific section of the policy Payments made under this section of the policy

Cause Type Causation (active)

The active cause of the event type operating, eg fire would be the event type and faulty electrics the cause The primary or active cause of the claim event. For example, property damaged by water from the flat above the primary or active cause being defective installation of the third partys washing machine A unique ref number the insurer allocates to the claim A code unique to the person handling the claim This depends on how the insurers system is configured. With some systems, it is possible for cases with a nil estimate to remain open. In otherwords, the system has to be told a case is closed by activating a closed claims flag Various codes to facilitate IM over the claims book, eg - Peril/Event - Cause (active) - Property Type - eg, fire - eg, neighbours bonfire

Claim Number Claims Handler Code Closed Claim Flag

Codes

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Some insurers also adopt a series of codes to denote various types of claims payment - eg: - claims settlement - payment to supplier (ie part of claims settlement) - payment to agents (eg loss adjusters, solicitors) Contents: High Risks Estimate Contents: High Risks is a specific section of the policy The amount that should reflect the estimated settlement cost in relation a claim under this section of the policy Contents: High Risks Payment Contents: High Risks is a specific section of the policy Payments made under this section of the policy Contents: Household Goods Estimate Contents: Household Goods is a specific section of the policy The amount that should reflect the estimated settlement cost in relation a claim under this section of the policy Contents: Household Goods Payments Contents: Household Goods is a specific section of the policy Payments made under this section of the policy Contents: Personal Possessions Estimate Contents: Personal Possession is a specific section of the policy The amount that should reflect the estimated settlement cost in relation a claim under this section of the policy Contents: Personal Possessions Payment Contents: Personal Possessions is a specific section of the policy Payments made under this section of the policy Contents: Third Party Injury Estimate Contents: Third Party Injury is a specific section of the policy The amount that should reflect the estimated settlement cost in relation a claim under this section of the policy Contents: Third Party Injury Payment Contents: Third Party Property Estimate Contents: Third Party Injury is a specific section of the policy Payments made under this section of the policy Contents: Third Party Property is a specific section of the policy The amount that should reflect the estimated settlement cost in relation a claim under this section of the policy Contents: Third Party Property Contents: Third Party Property is a specific section of the

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Payment

policy Payments made under this section of the policy

Contribution

Dual insurance will exist between two or more insurers who insure the same client, for the same subject-matter and peril at the same time. Usually, one insurer will pay the claim and seek contribution from the other insurer(s) Often, an insurer will seek a contribution from a customer towards the settlement, usually to allow for betterment where the damaged article is being replaced

Dates: Incident / Loss Date Inception Cover End Notification / Reported Date Reopen Reclosed Actual Closed Dual Insurance The date of incident The original date of policy and cover inception The date the cover period ends The date the incident is notified to the insurer A claim reopened after being closed prematurely Closed after having first been reopened The date of final closure Dual insurance will exist between two or more insurers who insure the same client, for the same subject-matter and peril at the same time. Usually, one insurer will pay the claim and seek contribution from the other insurer(s) The event or peril covered by the policy An insurers exposure to financial risk resulting from claims events Insurers often use a factor estimate (eg 1 or 801) for those cases where, due to inadequate information, the creation of an actual reserve would be guesswork. The factor would be based on the average settled cost of those types of claims. Incident Description / Comments Loss Adjuster Usually recorded by the claims handler of the event or loss description provided by the customer. Often recorded in free-text format An agent instructed by the insurer to investigate losses to determine applicability of coverage and then, where appropriate, proceed to adjust the loss and agree settlement with the customer

Event Type / Claim Type Description Exposure Factor Estimate

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Has a responsibility to identify recovery prospects and dependant on the contract, actively pursue recoveries on the insurers behalf Policy Number Premium Payment Method Recovery A unique ref number the insurer allocates to the policy Eg. monthly/annual direct debit, credit card or cash The option an insurer has to seek reimbursement, in the name of its customer, of either all or part of its expenditure. The main areas of such activity comprise: - subrogation (usually from a third party) - salvage (through disposing of the subject matter - over-payment - contribution from other insurers (see contribution) Recovery Estimate Recovery Payment An (-) estimate to reflect the value of recognised recovery potential. An actual recovery received. It may be partial or full and not always represent the full recovery potential. For example, a salvage recovery of 100 may be made against total payments of 2,000. The balance (1,900) may still be recoverable against a third party. Usually calculated over an underwriting year and is usually expressed as the percentage of actual recoveries made over actual payments made

Recovery Performance (current) Recovery Performance (additional) Gross Net Relations/Suppliers Used Replacement

The additional recovery potential identified during a first cut analysis expressed in value and percentage Is the gross netted-down recovery potential following adjustment to allow for Low, Medium and high prospects Identifies the suppliers retained by the insurer for a specific claim. Can be either code driven or free text An insurer will often choose to replace the damaged or lost articles (as new) rather than make cash settlements. It is perceived to be a deterrent against fraud and the insurer will benefit from discounted from discounted prices The insurer will pay the claim in full and then assume ownership of property that it might then sell-off as salvage. An insurer generally has choice of settlement method and will adopt one or more of the following: - pay cash

Salvage Settlement Method

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- replace the lost or damaged article - repair or reinstate Specified Items Estimate Specified Items is a specific section of the policy The amount that should reflect the estimated settlement cost in relation a claim under this section of the policy Subrogation Supplier Supplier (replacement) Supplier (contractors) Target Event Types (Cause) Third Party (recovery) The legal right of an insurer under contract to seek recovery of its expenditure in the customers name Retained by the insurer for the supply of specific services Retained by insurer to replace damaged or lost articles with new. The insurer will benefit from discounted prices. Various categories of contracted services eg. carpet cleaning, glass replacement, builders, decorators A series of types specifically selected as likely to have recovery potential A recovery achieved or pursued against a third party considered being at fault for the damage suffered. It is necessary to prove active causation and that a duty of care has been breached. Total Estimate/ Estimated Amount Total Incurred / Incurred Amount The amount that is placed on the claim that reflects the outstanding settlement cost or incurred The insurers financial exposure usually calculated by the sum of outstanding estimates and payments less recoveries received The ultimate settlement cost to the insurer Warranty Dual insurance applies where the subject matter of the claim is also covered by a warranty arrangement usually backed by an insurance contract. Contribution (see above) might exist where the loss (and peril) is covered by both the warranty arrangement and the Home policy

Appendix 6 Files Naming Convention


For files saved on the ectimo server, the naming convention is the following: File name v1 JS YYMMDD (when there is a version tracking) File name JS YYMMDD (when there is no version tracking)

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DOCUMENT INFORMATION Please note that JS are the initials of the files author (JS = Joanna Siuta here).

Appendix 7 Recovery Prospoect Analysis Criteria

1. Accidental Damage (AD) This event type can be defined as an unlooked-for mishap and a fortuitous event. Following this definition therefore, the damage may have been caused by a third party but to the customer the loss is accidental and will be covered by the policy. Example of esure claim: 4001029085 possessions damaged by contractors during house removal: Description: Customer was moving house. She hired a company (White and Company) to move furniture. When she arrived at her new home - and furniture was unloaded, a number of items were damaged. This includes: 1 Chest of drawers (7 drawers) completely shattered - 200 1 chest of drawers (5 drawers) cracked - 150 1 Standing lamp (6ft) ripped - 30 1 Wine cabinet (18months old) - 250 'White and Company' details: 01489 788 118 - Southampton branch Recovery potential in the main originates from the three categories of third party, contribution, and warranty. Examples as follows: Third Party Contribution Warranty - floor damaged by careless contractor doing work within the home. - camera damaged on holiday (also covered by travel insurance) - TV knocked off its pedestal (also covered by warranty agreement)

The selected items will then be categorised Low, Medium or High as described earlier

2. Accidental Damage to Drains (ADD)


It will probably be impossible to include this event type within an analytical review due to the need to examine paper files. The system free-text loss description is not sufficient on its own to identify active causation and thus recovery prospects. It is often the case with these cases that such data is obtained during post new claim investigation activity. Example: Drains damage by contractors working on clients property or perhaps due to encroachment of neighbours tree roots. Example of esure claim: 4000763477 Description: I noticed last night that there was water coming into my property at ground level. I thought it was coming from next door as there kitchen adjoins the wall where the water is. When I went round there was a small water leak under her sink so she has called a plumber out who has confirmed this is not what is causing the damage and it must be from my property. It has damaged the walls, carpet, a couple of rugs, overalls and a couple of bags. I threw the overalls and bags away and the bin men have been and taken them already.

3. Accidental Loss (AL)


This relates to the accidental loss of property as opposed to actual loss through theft which is an event cateredfor by its own event type. Bear in mind, however, that there will be miscoding between these event types.

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DOCUMENT INFORMATION Example of esure claim: 19995891 luggage lost transiting through airport. Third party recovery against airline and/or contribution recovery against travel insurer. Description: I have lost my luggage whilst comng back from holiday. I am waiting to hear from the airport to see if they have found it. Recovery potential in the main originates from the three categories of third party and contribution. Examples as follows: Third Party Contribution - luggage lost by airline - camera lost on holiday (also covered by travel insurance)

A similar process will then be adopted as with Accidental Damage (AD)

4. Aircraft/Airborne Devices (AIR)


This relates to airborne devices damaging the customers property. Example of esure claim: 4001216947 Description: A firework as hit my roof and a hole has been made.

5. Burst Pipes (BP)


Typically, this would relate to water damage resulting from burst pipes within either the customers property or a third parties. Example of esure claim: 19220998 pipe burst in neighbours property allowed water to infiltrate into the clients property Description: We came home to find, that the neighbour upstairs had a burst. The water has come in to our flat. Water coming through bathroom and bedroom which was covered by the building insurers. There was damage to university books and photographs and a wool rug (purchased from ikea 350 approx 1 year old). Note: there will be a degree of miscoding at the new claim stage between this event type and EOW and AD

6. Earthquake
Not included since most unlikely recovery prospects will exist. Example of esure claim: 27868806 customers property damaged by mini-earthquake Description: PH has noticed that during the Earthquake cracks started to appear on the walls/ceiling of the loft conversion - PH witnessed this happening at the time. Conversation has been done for a while - was in property when PH moved in.

7. Escape of Water (EOW)


Typically, this means escape of water from the customers water apparatus including tanks, pipes, washing machines and the like. The defective device is not generally covered but policy will cover the resultant water damage to the property and contents. This event type will also embrace damage caused by water that escaped from a neighbours property. Example of esure claim: 23481071 the shower in the flat above was leaking and water has infiltrated into clients flat

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DOCUMENT INFORMATION Description: My neighbours showr had been leaking amd the escape pf water has leaked through the wall on the upstairs bedroom wall in our house and also the downstairs hallway wall. I have had a quote for the repair to both walls at a cost of 825 for building and re-plastering plus vat. 875 plus vat for the decorating and redecoratimg the bedroom. Examples of potential recoveries: Third Party Contribution Warranty - neighbour allowed water to seep into the customers home - unlikely - damage to TVs, computers, laptops etc may also be covered by a warranty agreements.

A similar process will then be adopted as previously

8. Explosion (EXP)
This relates to resultant damage to the customers property and contents following either an internal or external explosion. Examples: Typically, this might be a recently fitted and defective boiler (claim against manufacturer or installer) Example of esure claim: 544249 Description: we have had a gas explosion as thats what the fire brigade and the police have told us although there not too sure how. There is quite alot of fire damage , and smoke damage through out the property. Windows have been damaged , external doors , internal walls ect. .... Not sure of all the house hold goods etc at the moment. We have been advised not to stay in the property as its not livable. myself and my 3 kids are staying at our mum and dads at the moment , although its a bit squashed. My wife is in intensive care. Examples of recovery potential: Third Party Contribution Warranty - plumber installs central heating boiler negligently - unlikely - the damaged article might be covered under a warranty agreement

A similar process will then be adopted as previously

9. Falling Aerials (AER)


Examples: TV aerials and the like falling onto the roof during high winds Example of esure claim: 168347839 TV aerial blown onto the roof Description: during high winds last night my tv aerial has been blown down along with its pole. I have obtained two estimates for the repairs. The aerial is a digital aerial around 2 years old.

10. Falling Trees (FT)


This relates to resultant damage caused by trees or part of trees causing damage to the property. Its possible that the contents might also be damaged. Example of esure claim: no recoveries identified from data Typically, this might be damage to the property by a tree negligently felled by a neigbour

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Examples of recovery potential: Third Party Contribution Warranty - neighbours tree fell on customers house during felling - unlikely - damaged articles might be covered under warranty agreements

A similar process will then be adopted as previously

11. Fire (FIR)


This relates to resultant damage to the customers property and contents following either an internal or external fire. It would also include smoke damage. Example of esure claim: 26644021 fire in neighbours property spread to customers property Description: There has been a fire at my neighbours property - I am unsure at this stage as to how the fire has started. I have suffered damage to my property from the fire - i have damage to the french doors (they have melted in the heat) Cladding to the back of the property/ window (upvc window - double glazed above - soffit above that. The majority of the damage is to the back of the property. I have smoke damage to the property also. The property is still secure - there is damage to contents in the attic. Examples of recovery potential: Third Party Contribution Warranty - contractors working on neighbours property causing fire that spreads - unlikely - the damaged article might be covered under a warranty agreement

A similar process will then be adopted as previously

12. Freezing Pipes and Escape of Oil (FRZ)


This relates to resultant damage to the customers property and contents following either an internal or external event. Example of esure claim: 16440645 customers property damaged by oil that originated from his neighbours property Description: Phs property has been contaminated by escape of oil. It is coming from his next door neighbours property. When the LA for his neighbour were doing remedial work at his property they realised there is more oil underneath the property. Examples of recovery potential: Third Party Contribution Warranty - escape of oil from a neighbours property spreading to the customers - unlikely - the damaged article might be covered under a warranty agreement

A similar process will then be adopted as previously

13. Frozen Food (FRZ)


Examples: Typically, freezer contents compromised by power failures or defects.#

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Example of esure claim: 28978099 failure of freezer purchased 4 months previously Description: EDF electrical company where working in the area and the main power cable to the properties in the street wasfaulty. We also had BT working in the area so they may have cuased this problem. As a result of this there was a power cut from 18.30-04.30 and i have discovered in the morning that the frozen foods has been spoiled. Age of freezer - 4 mths old Whirpool Chest freezer purchased 4 months ago, estimated value for spoiled goods 300.

14. Impact (IMP)


This commonly relates to accidental damage to the property and contents by external impact. Example of esure claim: 26814933 a contractors lorry damaged the customers property Description: i has a skip on the drive way and when the lorry came to collect this and lift it on to the back of the truck it has clipped the hosue and ahs done some structural damge to the property. TP (company details) Tom white waste ltd stone brook way long ford coventry CV6 6LN Paul white (director of company) tel 02476 66 25 25 fax 02476 662 121 tp ins James and Brown insurance Byran James (02476 553 011). Examples of Recovery Potential: Third Party Contribution Warranty - an identified third party vehicle reverses into customers wall - unlikely - the damaged article might be covered under a warranty agreement

There will, unfortunately, be a number of hit and run cases where offending drivers and their vehicles have not been identified and these will not be selected for potential recoveries. However, where the police have recorded the incident as a road traffic accident it may well be that they have identified the third party A similar process will then be adopted as previously

15. Lightning Damage (LGH)


Damage to property and contents due to lightning strike. Example of esure claim: 27282068 customers computer damaged by lightning strike. Possibly also covered under a warranty agreement Description: Lightning damage to computer, it was not switched on when the lighning struck, but was still plugged in. CD button is not working- it is a dell dimension 5150 purchased 21.3.2006 - price not known The anwermachine and the phone is not working- baout 14 months ago.

16. Malicious Damage (MD)


This is damage to the customers property and contents caused maliciously by a third party. Example of esure claim: 25357308 clients property damaged by ex boyfriend who was subsequently apprehended and charged by police Description: have recieved an ooh fax stating - ins advised that her ex boyfriend damaged the front door . police hve arrested the boyfriend . the front door is a upvc and this was kicked and the bottom pannel is damaged.

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DOCUMENT INFORMATION Examples of Recovery Potential: Third Party Contribution Warranty - an identified perpetrator of deliberate damage - unlikely - the damaged article might be covered under a warranty agreement

For recoveries to be made the perpetrator must have been apprehended and capable of being identified. The problem is that the acts were deliberate and most unlikely therefore to be covered by insurance and so the individual would have to be pursued in person. The question then would be, does he/she have sufficient funds to pay? A similar process will then be adopted as previously

17. Personal Liability (PSL)


Most unlikely to result in recovery prospects. It concerns a customers legal liability for injury or damage to third parties. Example of esure claim: 26581417 client allowed dog off lead and it ran into road and damaged a car Description: I was out walking the dog - and it has cought sight of a rabbit and has broken off the lead (came out of my hand) and has ran accross the grass (for about 1/2 mile) and through a fence and on to the road. the dor has been hit by a car and killed and has damged the tp vehicle. car reg: EN53VCM Mazda estate Stephen Mattison 21 Shilling ford close Dudlows Green Appleton Warrington WA4 5QB Tp ins: Zurich tel:0141 303 7460 (laura White) claim ref: CKU 338 5698.

18. Public Liability (PUL) Similar to PSL 19. River Flooding (RIV)
Damage due to flooding by external water courses Example of esure claim: 27716801 property flooded by water that overflowed from culvert Description: Yesterday the culvert near our property has overflowed due to the heavy rainwater and the water has come down into our garden and into out garden shed. Items in the shed: Box of elecrical equiptment. Black and Decker Multi Speed Hammer Drill - Bought 1995 from B&Q approx 70 or 80. Bosch Mutlispeed Jigsaw - Bought 1995 from B&Q approx 70 or 80 Black and Decker Power Shot Electrical Stapler - Bought 1999/2000 approx 39 - Bought from Great Mills. Flymo approc 89 - Bought from Great Mills - bought approx 2000/2001. Extension lead from B&Q approx 21 - bought 2003/04. Italian Chainsaw - Bought from Screwfix Direct - It was 99.99 - bought approx 2003. There may be other items - PH will check and call us back. The PH feels that the culvert was poorly maintained and there was debrsi in it that needed cleaning - he is taking out a personal claim with them for other items. There details are: Enviroment Agency. National Rivers Association - Brian Jones or Richard Bentley - Tel No 0845 988 1188.

20. Smoke (SMO)


Smoke damage usually originating from a fire. There will be a degree of miscoding between this and the fire event type.

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21. Storm (STO)


Damage to buildings and contents by storm. Example of esure claim: 27107469 water damage to TV originating from a storm. The TV was probably also covered under a warranty agreement Description: PH - I sat down on Sunday afternoon to watch some football and noticed that the TV wouldnt turn on. I then noticed that there was some water underneath the TV and that water was dripping down from the roof so seems like we have some roof damage after the weather at the weekend. The water has came down from teh roof and seems to have got into the back of the TV. The roof is flat felt and is approx 7/8 years old. The TV is a 42" Toshiba 42WLT66 LCD , which was purchased in June 06 for 1700+VAT.

22. Subsidence (SUB)


This is damage to the building due to movement in the site upon which it rests. It will probably be impossible to include this event type within an analytical review due to the need to examine paper files. The system free-text loss description is not sufficient on its own to identify active causation and thus recovery prospects. It is often the case with these cases that such data is obtained during post new claim investigation activity. Example of esure claim: 20276898 Description: I noticed hairline cracks at the beginning of June and they were ocurring just at the top of my living room window my bedroom window and I noticed some more cracks above the doors on the landing and my Wife that the bathroom door is sticking, this was on Thursday night and this weekend it now will not close. This weekend we have noticed crack marks horizontally in the lounge and bedrooms. There is also cracking in one of the retaining walls in the front garden. There is also a problem with the back door which will open but I cannot lock it.

23. Theft (TFT)


This relates to loss of property due to theft as opposed to accidental loss. Note, however, that a degree of miscoding occurs between these event types. Example of esure claim: 26843230 processions stolen whilst on holiday Description: PH - We were at a bar whilst in Prague and my partner has put her bag between her feet. When we went to leave we noticed that the bag wasnt there, so it seems that someone has swiped the bag withour us noticing. The bag itself is a Fendi Spy leather bad, which I purchased for my partner as a present about 12 months ago for approx 600. In the bag she had some money, which was equivelant to 150 in Czech Crona It was reported to the Police in Prague and they have given me a CRN, but I dont have it to hand. I also have travel insurance who said they would only pay out for the sunglasses that were in the bag. Examples of recovery activity: Third Party Contribution - the perpetrator has been apprehended and identified. - holiday villa broken-into and possessions stolen (also covered by travel insurance)

For recoveries to be made the perpetrator must have been apprehended and capable of being identified. The thief would not be covered by insurance and so would have to be pursued in person. The question then would be, does he/she have sufficient funds to pay. A similar process will then be adopted as previously.

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