The General Insurance Code Governance Committee (CGC) said Australian general insurers have adjusted controls on how they oversee and engage external experts in claims assessment, adding measures that change role definitions, accountability settings, and the use of expert evidence in decision-making.
In a new report, the CGC details how insurers have responded to recommendations from its 2024 inquiry into the oversight of external experts engaged in claims, including assessors, engineers, and other technical specialists. The committee found that all eight insurers reviewed now prevent external experts from recommending whether a claim should be accepted or denied. Under the revised arrangements, experts are required to confine their reports to factual findings and professional opinions within their area of expertise, while the ultimate coverage decision rests with the insurer.
According to the CGC, insurers have updated templates and instructions for expert reports to reflect these changes. The materials are intended to draw a clearer line between technical evidence and decision-making, limiting experts to the provision of information that supports, but does not determine, claim outcomes. CGC chair Veronique Ingram said the sector has changed its governance around the use of third-party input in claims handling. “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,” Ingram said.
The report also points to broader changes in how insurers select, brief, and monitor external experts. According to the CGC, seven of the eight insurers have refreshed onboarding programs for external experts, giving more detailed guidance on code obligations, reporting standards, and how expert opinions feed into claims workflows. Five insurers have introduced formal knowledge checks or similar mechanisms to test understanding of requirements, including the limits of the expert’s role.
All insurers examined have strengthened quality assurance and monitoring processes for expert reports. These steps include more structured internal review of reports, clearer escalation channels when performance concerns arise, and closer tracking of timeliness and consistency across expert panels. Ingram said these developments are intended to change how external input is incorporated into claims assessment and to build confidence in that process. “The improvements reflect a recognition that there needed to be a shift in the way the industry worked with its experts. We now expect to see better quality decisions and better outcomes for customers,” she said.
The CGC plans to monitor the implementation of these measures over the next 12 months, including how they affect the consistency, transparency, and speed of claims decisions that rely on expert evidence. Ingram said: “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 a fairer outcomes for customers.”
While the latest report centres on the use of external experts, the CGC has also set its wider monitoring and enforcement priorities for 2025-26, based on its data, previous reviews, and stakeholder submissions. The committee received 11 written responses to its consultation on monitoring priorities, including from consumer advocacy groups, financial counselling organisations, legal assistance services, industry bodies, and an insurer.
For 2025-26, the CGC has identified three main priority areas:
In addition to its main priorities, the CGC has named several “areas of interest” that it plans to monitor, including financial hardship support, management of temporary accommodation, and trends in motor vehicle insurance complaints. Some of these issues, such as scopes of works, cash settlements, claims delays, and the role of external experts, are already the subject of targeted reviews, with findings expected in late 2025. The committee’s enduring focus remains on code breaches that cause significant detriment, conduct that has disproportionate impact on vulnerable or disadvantaged customers, emerging risks, and the quality and timeliness of reporting from insurers.
