The Australian Consumers Insurance Lobby (ACIL) is calling for stronger protections for consumers in disputes involving expert reports, warning that AFCA’s draft guidance fails to address entrenched power imbalances.
AFCA is currently consulting on its Approach to General Insurance Claims Handling, which sets out how it considers key issues such as expert evidence, cash settlements, delays, and non-financial loss. The consultation is intended to provide clearer guidance for both insurers and consumers on how disputes will be assessed.
Click Here to View ACIL's Submission:
ACIL Chairperson Tyrone Shandiman said consumers in Dispute Resolution situations are routinely disadvantaged by insurer-appointed experts whose reports are often flawed, biased, or erroneous. “Consumers face an impossible task. Unless they can afford their own expert report—which is often prohibitively expensive—they are left to challenge insurer evidence that AFCA without any professional counter-point is almost too often obliged to accepts at face value. That system needs to undergo fundamental change,” he said
Recent interventions by ASIC have highlighted these systemic problems. In June 2025, ASIC warned insurers to improve their oversight of independent experts, noting that insurers had no systemic approach to checking the quality of reports they rely on when making claims decisions. The General Insurance Code Governance Committee has also documented widespread failings in the use of expert reports.
“Given ASIC & IBCCC’s previous findings, it is clear that insurer misuse of expert evidence is not an isolated issue—it is systemic,” Mr Shandiman said. “That is why we have written to ASIC asking it to provide greater direction to AFCA to ensure fair practices are applied when expert evidence is in dispute.”
ACIL has recommended that AFCA be required to:
Commission independent expert reports where appropriate, or require insurers to fund them.
Reimburse consumers’ reasonable costs for obtaining their own expert evidence.
Require an insurer’s retained expert to disclose conflicts of interest and repeat insurer engagements of experts.
Treat repeated reliance on flawed reports as systemic misconduct warranting higher compensation and consideration given by AFCA to refer these patterns of behaviour to ASIC
Maintain a directory of independent experts accessible to consumers.
Mr Shandiman said: “AFCA’s draft guidance on expert reports sets out factors such as independence, qualifications, and plausibility, but in practice AFCA continues to place heavy reliance on expert opinion. A report can satisfy each of these criteria and still be biased or erroneous. This risks turning the framework into a simple checklist for conflicted experts, without addressing the deeper structural imbalance between well-resourced insurers and consumers already under stress after a loss.”
There is a persistent problem with the quality of expert reports in insurance disputes. ACIL believes this stems from the heavy reliance placed on them in the dispute process and the fact that experts are paid by insurers, leaving the system open to abuse. Greater scrutiny of these reports would create stronger accountability and force insurers misusing the process to think twice.
