The Australian Consumers Insurance Lobby (ACIL) has cautioned that recent reforms to the way Australian general insurers use external experts in claims handling do not resolve what it describes as structural conflicts in the process.
ACIL’s comments follow the General Insurance Code Governance Committee’s (CGC) latest Oversight of External Experts: Follow-Up report, which outlines changes made by eight code subscribers after the committee’s 2024 inquiry into insurers’ engagement and monitoring of external experts.
The CGC report states that all eight insurers reviewed now prohibit external experts from stating whether a claim should be accepted or denied. Under the revised arrangements, experts are expected to limit their reports to factual findings within their technical disciplines, with claim decisions made by insurers’ internal staff and processes. CGC chair Veronique Ingram said: “It is encouraging to see insurers strengthen their controls and set clearer expectations for external experts. These improvements will support more consistent decisions and timely and fair outcomes for customers. They show a positive commitment to lifting practices.”
According to the committee, insurers have updated templates and instructions for experts, revised onboarding programs, and, in some cases, introduced formal knowledge checks. All eight insurers have also adjusted quality assurance and monitoring frameworks covering external reports.
ACIL has acknowledged the operational changes but warned they may contribute to a perception that long-standing issues with expert reports have been addressed. ACIL chairperson Tyrone Shandiman said the reforms should be treated as incremental rather than a complete solution. “These reforms are welcome progress, but they risk giving the perception that everything is now okay with expert reports. The reality is that the fundamental conflicts and risks for consumers remain,” he said.
Shandiman said the current model – in which insurers select, brief, and pay external experts whose reports can influence claim outcomes – continues to raise conflict-of-interest concerns. “This structure creates a major and unavoidable conflict of interest. While the recent improvements help at the margins, they do not address the core problem – consumers are still reliant on experts who are not genuinely independent,” he said.
ACIL has also linked dispute patterns to the insurance cycle, suggesting that a softer market and improved profitability may reduce visible disputes without changing underlying risks. “If insurers feel less pressure to minimise claim costs, we may naturally see fewer disputes. But that does not mean the system has improved – it simply reflects the market cycle. The underlying risks to consumers will re-emerge in the next hard market,” Shandiman said.
The CGC report indicates that the implementation of some initiatives is ongoing, with certain measures not expected to be fully in place until the 2026 financial year. The committee also notes that insurers have historically lacked comprehensive data to monitor external expert performance, complaint volumes, and report quality.
For insurance professionals, the findings point to increased scrutiny of how expert networks are governed, including documentation of expectations, assessment criteria, and oversight mechanisms. ACIL, however, argues that key consumer protections are still missing. The group said current frameworks do not expressly:
Shandiman said the practical options for policyholders disputing an expert report remain limited in many claim scenarios. “Right now, if a consumer disagrees with an expert report, the most practical option is to fund an alternative report – often thousands of dollars – at a time when they are already financially vulnerable due to a claim being delayed or declined. This is not a fair or balanced system,” he said.
The CGC has said it will continue to track insurers’ progress over the next 12 months to assess whether the new controls are embedded and delivering longer-term changes in claims practices. “Our role is about identifying problems as well as ensuring lasting change. The progress we’re seeing shows the code in action. It is working to lift standards across the industry and drive fairer outcomes for customers,” Ingram said.
ACIL is calling for broader reform of the expert-reporting framework, including clearer independence requirements, more prescriptive conflict management settings, and more practical avenues for consumers to challenge expert evidence. “We acknowledge the improvements made to date, but they do not fix the foundational issues. Without strong guardrails, clearer independence requirements, and accessible avenues for challenge, consumers remain exposed to unfair outcomes,” Shandiman said.
