Insurance Claim Assessments and Expert Reports

A practical guide for homeowners navigating inspections, reports, and claim decisions.

If you have made a home insurance claim, one of the most important stages is the assessment process.

This is where insurers send builders, engineers, or other specialists to inspect your property and produce expert reports. These reports often determine whether your claim is accepted, declined, or underpaid.

Many homeowners assume these reports are definitive. In reality, they are opinions. And as recent regulatory reviews have shown, they are not always accurate or complete.

This guide explains how assessments work, what to expect, common problems, and how to protect your position throughout the process.

What is a Claim Assessment?

A claim assessment is the process an insurer uses to investigate and assess the damage to your property after you lodge a claim.

This may involve the insurer attending the property directly, or more commonly, appointing third-party providers such as builders, loss adjusters, engineers, roofers, or other specialists to carry out the inspection on their behalf.

At its core, a claim assessment is intended to answer three key questions:

What damage is present at the property
What caused that damage
Whether that cause is covered under the insurance policy

The assessment usually involves a site inspection where the assessor or expert:

Reviews visible damage
Takes photos and measurements
May carry out limited testing
Speaks with the homeowner about what occurred

They then prepare a report for the insurer, which is used to inform the insurer’s decision on whether to accept, decline, or limit the claim.

It is important to understand that an assessment is not a final decision and the report is not definitive. It is an opinion based on the information available at the time, and it can be incomplete, incorrect, or challenged if it does not properly reflect what occurred.

What Happens During an Insurance Claim Assessment

During the assessment, the insurer or their appointed expert, such as a builder, engineer, or loss adjuster, will attend your property to:

Inspect and document the visible damage
Take photos and measurements
Assess the condition of the property
Consider possible causes of the damage
Ask questions about what occurred
Create a scope of works or quote

They may also carry out limited testing, depending on the type of claim. The purpose of the inspection is to gather information that will later be used to prepare a report for the insurer.

Important – You should always ask the insurer and their appointed experts to assess the entire property for damage, not just the areas you have identified. They are often experts in identifying hidden damage or damage that you may not immediately recognise as being claim related. If areas are not inspected, they may not be included in the report. This can lead to parts of the claim being excluded or disputed later, even if they are related to the same event.

How to Prepare for A Claims Assessment

Preparing properly for a claims assessment can have a direct impact on the outcome of your claim. Assessors are often working within limited timeframes and may not have complete information when they attend, so it is important to ensure they are provided with a clear and accurate picture of what has occurred.

Before the assessment

Document all damage – Take clear photos and videos of all affected areas before any repairs or changes are made. Include wide shots and close-ups.
Record what happened – Write down a timeline of the event, including when the damage occurred, what you observed, and any steps you have taken since.
Gather supporting evidence – This may include prior photos of the property, maintenance records, invoices, or any previous reports that show the condition of the property before the loss.
Identify all impacted areas – Do not assume the assessor will find everything. Walk through the property and make a list of all areas you believe are affected.

This will ensure that you are prepared for when the insurer or their representatives attend the property.

Types of Expert Reports/ Assessments in Home Insurance Claims

Different experts are used depending on the nature of the damage. The table below summarises the most common assessments and some of the issues that arise:

Report Type	What It Covers	Common Issue
Building reports	Assess visible damage to walls, ceilings, floors, and structures. These reports often include a repair scope and cost estimates, and may also comment on the cause of damage.	The inspection may be undertaken quickly missing key damage. The builder fails to appoint other expert and/or comments on matters outside of their expertise. The quote may include provisional sums (estimates) for items.
Engineering reports	Assess structural issues such as cracking, movement, or subsidence. These are typically used in more complex or disputed claims.	Conclusions based on assumptions rather than testing. Engineers can common on matters outside their area of expertise (i.e. mould). The incorrect engineering speciality is appointed to assess the claim (i.e. structural instead of geotechnical).Favourable assumptions to an insurer may not be fully articulated.
Leak detection reports	Identify the source of water ingress and may involve testing showers, roofs, or plumbing systems.	Artificial testing conditions that do not reflect real-world use (i.e. flooding a shower base).Leak detection may be rushed missing other leak sources.
Roofing reports	Assess roof condition and damage caused by storm or hail events, often with a focus on maintenance and wear.	Over-reliance on generalised maintenance observations. Assessments undertaken during normal conditions do not identify storm related openings or water ingress points.
Mould and moisture assessments	Measure moisture levels and identify mould presence. These may involve visual inspections or more detailed scientific testing.	Reliance on visual or smell-based assessments instead of proper scientific testing. Relying on assumptions to not link mould to insured events. Providers have limited experience and qualifications.
Hydrology reports	Assess how water has moved across or through the property, particularly in flood or storm events. These reports analyse rainfall, drainage, overland flow, and site conditions to determine the source and pathway of water.	Heavy reliance on modelling or assumptions that may not reflect actual site conditions or the specific event. Hydrologists can provide conflicting reports for similar properties.

Common Problems with Expert Reports

This is where many insurance claims begin to go wrong. From our experience, and consistent with regulatory findings, there are several recurring issues with expert reports that can materially impact the outcome of a claim.

Rushed inspections – Experts may spend limited time on site, which increases the risk that important areas are not properly inspected. As a result, reports can be based on incomplete observations, with damage missed or not fully understood.

Assumptions instead of evidence – We often see reports that assume damage is pre-existing or attribute it to maintenance issues without proper investigation. In some cases, conclusions are provided without supporting data or testing. Where an insurer relies on an exclusion, it must be supported by evidence, not assumption.

Experts working outside their expertise – This may include builders commenting on mould causation, engineers commenting on plumbing failures, or leak detection specialists commenting on structural defects. When conclusions are made outside the expert’s discipline, the risk of error increases significantly.

Inconsistent findings – Reports may contain observations that support the claim, but conclusions that contradict those observations. We also see inconsistent outcomes across similar properties or claims, which raises questions about how conclusions are reached.

Poor explanation of causation – Many reports fail to clearly explain how the damage occurred and why it falls within or outside policy coverage. Without a clear and logical causal link, the conclusions drawn in the report may not be reliable.

Conflicts of interest and undisclosed ownership – In some cases, experts or providers may have commercial relationships with insurers or related entities that are not clearly disclosed. This can raise concerns about independence, particularly where the same providers are repeatedly appointed or where there are shared ownership structures. Without transparency, it becomes difficult to assess whether conclusions are being formed objectively, which can undermine confidence in the report and the overall claims process.

Failure to properly brief the expert with relevant evidence – Experts are often engaged based on limited or selective information provided by the insurer. If key documents, timelines, photos, or prior reports are not included in the brief, the expert’s assessment may be incomplete or based on incorrect assumptions. This can lead to conclusions that do not reflect the full circumstances of the claim, particularly where important context or competing evidence has not been considered.

Failure to address errors or mistakes in reports – Even where clear errors, omissions, or inconsistencies are identified in an expert report, they are not always acknowledged or corrected. In some cases, insurers may continue to rely on the original report without obtaining clarification or commissioning further assessment. This can result in flawed conclusions being carried through the claims process, increasing the likelihood of disputes and incorrect outcomes.

Misidentification of maintenance issues as claim-related damage
We often see situations where damage caused by an insured event is incorrectly attributed to maintenance, wear and tear, or pre-existing conditions. This can occur where superficial observations are made without properly assessing causation or the sequence of damage. As a result, legitimate claim damage may be excluded or reduced, even though it was triggered or materially worsened by a covered event.

How Insurers Use Reports to Make Decisions

Insurers rely heavily on expert reports when making decisions about home insurance claims. This is largely because they do not inspect properties themselves and instead depend on third-party experts to provide technical input. These reports form the foundation of the insurer’s assessment of what damage has occurred, what caused it, and whether it is covered under the policy. In practice, the conclusions set out in these reports often directly influence whether a claim is accepted, declined, or partially paid.

This approach can work well where the damage is clear, the cause is obvious, and the inspection is thorough and well documented. In those situations, evidence-based conclusions can support efficient and accurate claim outcomes.

However, issues arise when there is an over-reliance on a single report, particularly where that report may be incomplete or based on limited information. We also see situations where conclusions are accepted without sufficient scrutiny, or where inconsistencies within the report are not properly addressed. In these cases, the insurer’s decision may reflect the limitations of the report rather than the true circumstances of the claim.

Regulatory reviews have identified inappropriate reliance on expert reports as a key issue in claims handling, particularly where conclusions are not adequately tested or supported by evidence.

How to Review and Challenge an Expert Report

Once you receive an expert report, it is important to review it carefully rather than assume it is correct. You are entitled to request a copy of the report under the Privacy Act and, where the insurer has relied on it to make a decision, the General Insurance Code of Practice. This gives you an opportunity to understand how the insurer is assessing your claim and whether the report accurately reflects the damage and circumstances.

When reviewing the report, look closely for missing damage, incorrect observations, lack of supporting evidence, unsupported assumptions, or conclusions that fall outside the expert’s area of expertise. It is also important to watch for common red flags, such as statements made without explanation, heavy reliance on terms like “pre-existing” or “maintenance” without proper substantiation, no reference to standards, codes, or testing, and contradictions within the report itself.

If you identify problems, respond in a clear and factual way. Set out the specific issues you say are wrong, provide any supporting photos, documents, or timelines, and ask direct questions about how the conclusions were reached. Where appropriate, request clarification, correction, or reconsideration of the report.

You may also consider obtaining your own independent expert report, particularly where the insurer’s report appears incomplete or incorrect. An independent report can provide an alternative view on causation and scope, and in many cases, if it leads to a change in the insurer’s decision, the insurer may be required to reimburse the reasonable cost of obtaining that report.

If the insurer does not properly address the issue, you can escalate the matter through the insurer’s internal complaints process and, if necessary, to AFCA. For further guidance on disputes, see our article on how to complain about an insurance claim.

Read our others blogs for further information:

Accessing Reports

You are entitled to access the expert reports and information your insurer relies on when assessing your claim. This is an important right, as it allows you to understand how decisions are being made and to identify any errors or omissions.

There are two key pathways to request this information.

Under the Privacy Act

The Privacy Act gives you the right to access personal information held about you by an organisation, including insurers and their representatives. This typically includes:

Expert reports relating to your claim
Assessment notes and findings
Correspondence that identifies you or relates to your property

To request this information, you can:

Make a written request to the insurer
Clearly state that you are requesting access under the Privacy Act
Ask for all documents and reports relating to your claim

The insurer is generally required to respond within a reasonable timeframe. They may redact certain information, but they cannot refuse access without a valid reason.

Under the General Insurance Code of Practice

The General Insurance Code of Practice also requires insurers to be transparent in how they handle claims.

Where an insurer relies on an expert report to make a decision, they are expected to:

Provide you with a copy of that report
Do so in a timely manner
Ensure you have enough information to understand the decision

If the insurer declines your claim or limits the scope of repairs, they should clearly explain the reasons and provide the supporting material, including relevant reports.

Practical steps

Request the report as soon as possible after the assessment, ensure you reference the Privacy Act and GICOP
Follow up in writing if it is not provided within 30 days
Ask specifically for any reports relied on in making the decision
Keep a record of all requests and responses

When to get help

There are many claims that progress smoothly, particularly where the damage is clear and the insurer’s assessment is thorough. However, once issues arise, claims can quickly become complex and difficult to manage without support.

You should consider getting help if your claim is delayed, denied, underpaid, or not progressing as expected. This is particularly important where the insurer has relied on an expert report that you believe is incomplete, incorrect, or does not properly reflect the damage.

Adverse reports can significantly complicate a claim. Once a report concludes that damage is not covered, is pre-existing, or relates to maintenance, that position often becomes the foundation of the insurer’s decision. Challenging that outcome requires a detailed understanding of causation, policy interpretation, and how to properly respond to technical findings. Without addressing the report directly, it can be difficult to shift the insurer’s position.

You should also consider getting help where:

There are conflicting expert opinions
The scope of works does not reflect the full extent of damage
The insurer is not responding to concerns or requests
The claim has been ongoing for an extended period
You are considering lodging or have lodged a complaint

Early support can often prevent issues from escalating and improve the likelihood of a fair outcome. Once a claim becomes entrenched, particularly where adverse reports are involved, resolving the dispute typically requires a more structured and strategic approach.

If you are unsure whether your claim is being handled correctly, seeking a second opinion can provide clarity and help you understand your options before the situation becomes more difficult to resolve. Claims Hero offers a free initial consultation.

Helpful Resources

Some helpful resources:

Claims Hero Blogs – https://claimshero.au/blog/
- Claims Hero The Podcast – https://www.youtube.com/@ClaimsHeroAu
- Australian Financial Complaints Authority – https://www.afca.org.au/

Disclaimer: This article is general information only. It is not legal advice, financial advice, or a substitute for professional advice tailored to your circumstances.

We have not considered your personal objectives, financial situation, needs, or claim details. You should consider obtaining independent advice before acting on the information in this article.

For privacy reasons, any examples and templates are generic and should be adapted carefully to your situation.