When I launched Claims Hero, I thought I had a pretty good understanding of how insurance worked. I’d spent years in the industry. I knew the legislation, the policies, the General Insurance Code of Practice. I assumed that if you pointed to a clause, the insurer would apply it. That if the Code said something should happen, it would. I was wrong.
These are some of the most important lessons I’ve learnt from helping hundreds of homeowners navigate claims and challenge poor insurer conduct.
Home Claims Are More Meaningful than Personal Injury
When I worked in personal injury, I saw serious trauma. Life-changing injuries, complex legal battles, years of rehab and recovery. But I’ve come to believe that home insurance claims often carry a deeper, more immediate emotional weight.
The difference is that home claims touch every part of daily life. When someone loses their home, they are not just losing property. They are losing stability, security, and the routine that holds everything together. It’s not just about getting paid. It’s about where your children sleep, where you eat dinner, where you go to feel safe.
In personal injury, the process is slow but structured. There are lawyers, judges, and rules that guide the outcome. Most people have representation. There is a system of checks. In home insurance, people are usually alone. The insurer sets the pace, controls the information, and too often leaves people in the dark. The original disaster may have been fast, but the aftermath drags out over months. Sometimes longer.
I have seen people live through this. A mother sleeping on a friend’s couch with two kids while waiting for repair approvals. A couple who had to move five times in eight months because the insurer would not agree to a stable rental. People going into debt, or burning through savings, just to keep their lives functioning.
What makes it worse is the feeling that no one is accountable. One staff member can derail everything with a single incorrect decision. Promises get broken. Emails go unanswered. And unless you know what to ask, or how to challenge it, you’re left in limbo.
This is what I have learned since starting Claims Hero. Home claims are not about walls and roofs. They are about people’s lives. When insurers mishandle them, the damage is not just financial. It is psychological. It is social. And it lasts.
Getting results in home insurance claims often ends with someone crying on the phone. Not necessarily because they received more than they expected, but because the fight is finally over.
They have spent months living in uncertainty, chasing answers, and feeling ignored by the insurer that was meant to help them. When someone listens, takes them seriously, and delivers a real outcome, the emotional weight lifts.
It is not just about the money. It is about relief. It is about knowing they were not alone. That someone stood by them when everything else was falling apart. That they can finally breathe, make decisions, and begin to rebuild with confidence.
The Rules Say One Thing. The Reality Is Often Different.
Insurers have detailed procedures. They have internal claims manuals, checklists, escalation processes, and commitments under the Code of Practice. But the moment someone picks up the phone or sends an email, all of that can go out the window.
We’ve seen claims go off-track because a single staff member misunderstood the cover, ignored a required step, or made a decision outside their authority. No one reviewed it. No one corrected it. And the customer was left trying to fix the mess.
Your rights under the policy and the Code do matter. But they are only as strong as the people applying them. In theory, there are layers of oversight. In reality, many frontline decisions go unchallenged unless the customer pushes back.
Insurers’ internal dispute resolution teams too often act as a rubber stamp. They back the original decision without real scrutiny. Meaningful change only tends to happen when consumers escalate to AFCA, and only if they know how.
That is the structural imbalance. Most people give up or accept what they are told. Insurers know this. It is a system that quietly saves them millions.
This is why so many valid claims get delayed or underpaid. It’s not always bad intent – often it’s just poor training, lack of supervision, or pressure to resolve claims quickly. But the result is the same: people miss out.
Unless you escalate, ask for the basis of a decision, or insist on a proper review, the internal processes designed to protect you might never be applied. That’s the gap between theory and practice. And it’s where most of the damage happens.
Customers get exhausted and quit
One of the hardest things to witness is how many people give up. Not because they were wrong, or because their claim lacked merit. They give up because they are exhausted.
The claims process is supposed to be straightforward. If your home is damaged by a covered event, the insurer pays what is owed under the policy. In theory, that should be it. But too often, it turns into a war of attrition. Weeks of silence. Confusing correspondence. Repeated requests for documents already provided. Scope changes with no explanation. Promises made then quietly withdrawn. And when you finally think you are close, another delay, another review, another new person asking the same questions again.
This is not just inefficient. It is damaging. People are living through trauma. They are displaced. They are trying to keep their families together, go to work, pay bills, and somehow chase their insurer for a roof over their head.
Eventually, many decide it is not worth the fight. They take a reduced offer, walk away from disputed items, or stop responding entirely. Not because they agree. Because they are burnt out.
This is rarely acknowledged in formal reports or media coverage. But it is one of the biggest drivers of unfair outcomes in home insurance claims. Insurers know that a certain percentage of people will give up if the process is slow and difficult enough. And every one of those walkaways saves them money.
At Claims Hero, we see this dynamic all the time. People come to us saying, “I just can’t deal with it anymore.” When we step in and push back, many of those same claims are suddenly approved or increased. That should not happen. It should not take professional intervention to get what you are already entitled to under your policy.
The real problem is not just the system. It is that the system wears people down on purpose. And until that changes, valid claims will keep going unpaid, not because of the merits, but because exhaustion won.
Insurer Culture Matters More Than Policy Wording
Most people assume the most important factor in their claim is what the policy says. And yes, the wording matters. But in practice, the culture of the insurer often has a bigger impact on the outcome.
You can have a policy that looks generous on paper. It might promise new-for-old replacement, cover for temporary accommodation, and flexible rebuilding options. But if the insurer’s mindset is focused on minimising payouts, avoiding responsibility, or controlling costs at all costs, then the written benefits often fail to materialise.
We have seen claims denied on flimsy grounds, with customers told the damage was “pre-existing” despite no prior issues and clear evidence of a recent event. In some cases, temporary accommodation has been refused even when the home was clearly unsafe or unliveable. These decisions are not always mistakes. They are often signs of an internal culture where declining or limiting claims is seen as good performance.
Sometimes the real barrier is not the policy but how it is interpreted. Claims handlers may follow internal targets or be discouraged from escalating. Reviews are often superficial unless challenged. Some staff rely on stock phrases or assumptions instead of actually engaging with the facts. In more than one case, it was only when a customer pushed hard or brought in external help that the insurer reconsidered.
Culture flows through every part of the process. It influences how claims are triaged, how exclusions are applied, how long things take, and whether customers are treated fairly or just managed. Two insurers can have similar policy wording, but deliver completely different outcomes because one acts constructively and the other defensively.
Tip: If you are comparing policies, look beyond the product features. Pay attention to who is actually backing the policy. Australian-owned insurers that operate under their own name and are focused on building a long-term brand tend to be more accountable. By contrast, some insurers focus on distributing through other brands, dominating search results with paid ads, or acquiring review sites to manage reputational risk. That kind of model often reflects a focus on growth, not claims quality. If the marketing is slick but the name behind the policy is buried, ask why. A good insurer should want to be known for how it handles claims, not just how it sells policies.
Some Insurers Act Openly Breach Obligations
Some insurers do more than just push the boundaries. They cross the line entirely.
We’ve seen firsthand what happens when an insurer operates with no regard for fairness. Patterns of conduct that cannot be explained away as error or misunderstanding. Tactical delays. Policies design to deny claims. Policies cancelled as soon as a claim is made. Denials built on flimsy reasoning. Refusals to provide documents until forced. Reports stacked until the “right” conclusion is found. Customers kept in the dark. Advocates threatened or smeared for daring to push back.
We’ve watched this happen over and over. It is not a mistake. It is a business model.
Regulators do care and do important work. But they are overwhelmed. Processes take time. And some of what we raise is so brazen, so far from the standard expected, that it can be difficult to believe unless you’ve lived it. We have. Many of our clients have.
These insurers count on the system being slow, reactive and limited in what it can address. They count on consumers giving up. And often they’re right. Many people are too exhausted to keep fighting. Others accept half-measures just to move on. The insurer knows this. It is part of the calculation.
We do not name names here. But the industry knows which players this describes. And their conduct continues because there is no real consequence. The Code is unenforceable. AFCA is stretched. They are aggressive with everyone, including the regulators.
What is more disappointing is that the industry knows exactly who these companies are. Yet they continue to welcome them into insurance councils, give them a seat at the table, and stay silent while they undermine trust and take market share. Instead of holding them accountable, the industry protects its own, even when that means enabling conduct that harms consumers and damages the sector’s credibility.
What we have seen is not just poor behaviour. It is conduct that corrodes public trust in the entire system. Witnessing it has only strengthened my resolve. I will continue to work relentlessly to ensure these companies are held accountable, regardless of how many NDAs they force customers to sign. The harm is widespread, and the number of affected customers runs into the thousands. Many of them are still willing to speak up. Their stories deserve to be heard.
Starting with a Lie of Defensiveness is the Status Quo
One of the most frustrating aspects of home insurance claims is how often the process begins with denial, not support. Instead of asking “How can we help?”, many insurers look for reasons not to pay. The starting point is often scepticism or even quiet dishonesty, and the burden is immediately shifted to the customer to prove their case.
We regularly see examples where the initial insurer position is clearly wrong. They might claim a home is habitable when it’s visibly unsafe, or deny storm damage on the basis of pre-existing issues that were never documented before the event. These aren’t always clerical errors. They often reflect internal habits of framing claims narrowly or defensively to minimise exposure.
The tactics run deeper. Questionable “expert” reports are commissioned to support a rejection. We’ve seen stacked reports where multiple assessors are brought in, not to get a fair view, but to find the one opinion that supports the insurer’s preferred outcome. If a builder or engineer produces something inconvenient, the report can be sidelined or contradicted by a second opinion, often without any new evidence. In some cases, insurers outsource to so-called independent firms whose real function is to help defend claims, not assess them impartially.
When it becomes clear the insurer has made a mistake, for example, delaying repairs, wrongly denying accommodation, or underquoting, we also see damage control. Rather than acknowledging fault, some insurers pivot into cost mitigation mode. They try to negotiate lower settlements, drag out payments, or offer partial “goodwill” amounts to avoid full accountability. In the meantime, the customer is left carrying the stress, risk, and financial pressure of trying to recover.
What’s most telling is how quickly some of these positions change when challenged. A firm complaint, a lawyer’s letter, or an AFCA referral can suddenly make the insurer reassess. That shift highlights the truth: many poor decisions are not based on genuine uncertainty but are part of a system that only backs down when pressure is applied.
This is not just a policy issue, it is cultural. An insurer that starts by defending itself rather than serving the customer is already on the wrong path. If experts are used to support a position instead of investigate the truth, or if multiple reports are stacked to create the illusion of rigour, then the process is fundamentally broken.
Customers should not need to become advocates, investigators, or negotiators just to be treated fairly. The process should begin with honesty, not tactics. Until that changes, claims handling will remain a battleground rather than a resolution process.
The industry has to make advocates the enemy, or otherwise they have to accept they may be doing the wrong thing
For the insurance industry to maintain the status quo, it needs to frame anyone who challenges it as a threat. That is why paid advocates and claims professionals are increasingly painted as “storm chasers” or “disaster chasers” rather than as people helping policyholders navigate complex claims.
Over the last few years, the rhetoric has shifted from warning consumers about unlicensed tradies knocking on doors to targeting anyone who offers to help manage a claim. Terms like “disaster chaser” are now being used to cast suspicion on people who have a licence, follow the law, and belong to AFCA. This broadening of labels has blurred the line between misconduct and legitimate advocacy.
The implication is clear. If advocates were genuinely unnecessary, the industry would not need to spend so much time and effort undermining them. But when advocates expose systemic underpayments or call out policy misapplication, they become inconvenient. And so, the narrative shifts. Advocates are accused of causing delays, inflating costs, or confusing customers, even when they are doing nothing more than ensuring the rules are followed.
What is most telling is the tone. We have seen aggressive accusations made directly in AFCA cases, often without any basis and sometimes in front of regulators. The language is designed to intimidate. It reflects a culture that has operated too long without being challenged and designed to paint advocates as the enemy.
Yet, amid this, there are exceptions. There are people in the industry who want claims to be handled fairly. But for that to become the norm, the sector must stop portraying every advocate as the enemy. Doing so avoids the harder truth, that if insurers always did the right thing, most customers would not need help to begin with.
If you’re going to challenge the status quo you’re going to need tough skin
The moment you step into the ring and challenge how things have always been done, you become a target. I’ve seen that firsthand. Since founding Claims Hero, I’ve been on the receiving end of personal attacks, threats, and unfounded accusations. I’ve been asked by ‘independent experts’ how I sleep at night. I’ve had people lie about our motives and claim we take advantage of vulnerable people. None of it is true, but it is relentless.
This industry has a long history of brushing off criticism and framing anyone who questions its practices as the problem. When that doesn’t work, it turns personal. I’ve had moments where it pushed me to the brink. When the pressure gets to that level, it’s not easy to keep going.
But I do. Because I’ve seen what happens when people get real help. I’ve spoken to families who finally got their homes rebuilt after months of being dismissed. I’ve sat with people crying on the phone when you say that you understand what they’re saying. That’s what keeps me going. That’s what matters.
What does weigh on me, though, is the effect this culture of hostility has on my team. Good people, doing honest work, who end up feeling anxious or demoralised because of how they’re treated by insurers. That’s what frustrates me most. If doing the right thing came with support instead of suspicion, we could seek genuine improvements to help consumers.
So yes, if you’re going to challenge the status quo, you will need thick skin. But you also need purpose.
The structural imbalance benefits insurers
The claims process is meant to be fair. The insurer investigates, the customer provides information, and the policy determines the outcome. But in practice, the system is tilted. Insurers control the money, the process, the experts, and the information. Most customers are navigating a traumatic event for the first time. The insurer does it every day.
This imbalance is visible in almost every claim. Insurers choose the assessors, commission the reports, and often refuse to share key documents with customers unless forced. They delay decisions while expecting customers to meet every deadline. They tell people what their policy means, but rarely tell a customer if AFCA has found against them in relation to that term. Customers are left in the dark, unsure what they are entitled to or how to challenge what they are being told.
Internal reviews rarely provide a meaningful check. Insurers’ dispute resolution teams often echo the original position, no matter how flawed. Real change tends to occur only when a customer knows how to escalate, or when external pressure is applied. Most never reach that point. They are worn down, confused, or simply give up.
Withholding information is part of this dynamic. Reports are delayed or redacted. Key facts are downplayed or hidden. Insurers argue their position without sharing the full basis for it. When customers finally see the evidence, they often find flaws that had been covered up. But by then, months have passed and trust is eroded.
This imbalance saves insurers money. It relies on silence, fatigue, and asymmetry. It rewards those who control the narrative, not those who follow the rules. Until that structure is corrected through enforceable obligations, transparency requirements and real oversight, the process will continue to favour insurers. Not because they are right, but because they have designed a system that lets them win by default.
Self-Regulation is a Myth and Can’t Work
The idea that insurers can regulate themselves is a convenient illusion. The General Insurance Code of Practice is not enforceable at law. It is drafted and maintained by the industry itself. The very body meant to protect consumers is a lobby group for insurers. It is like letting defendants write the rules of court, then asking them to enforce their own penalties when they breach them.
Compare this to regulated personal injury schemes, like workers compensation or motor accident insurance in most Australian states. In those systems, independent regulators set the rules. There are statutory obligations. Timeframes are binding. There are penalties for delay or misconduct. Insurers are answerable to external agencies, not to themselves. Claimants have rights enshrined in legislation, not just “best practice” guidelines that can be ignored without consequence.
In general insurance, we ask consumers to rely on voluntary commitments written by insurers, enforced by insurers, and judged by insurers. Then we wonder why customers are mistreated and nothing changes. When the Code is breached, there is often no fine, no enforcement action, no true consequence unless the customer escalates. And even then, the best outcome is often a private settlement rather than systemic reform. They self-report tens of thousands of breaches, and yet, we then ask them to draft the next version of the Code.
In general insurance, we continue to rely on self-regulation long after it has been proven inadequate. Even when reviews and inquiries find systemic misconduct, the industry response is to tweak the same broken structure and assure government it will be better this time. It never is.
If insurers want public trust, they must accept real accountability. That starts with enforceable standards, independent oversight, and a willingness to be judged by someone other than themselves. Until then, the promise of the Code will remain exactly that, a promise, that is easily broken.
The AFCA Process Routinely Fails
AFCA was designed to provide a fair and accessible path for consumers to challenge poor outcomes. It is meant to act as a safeguard when insurers fail to do the right thing. But in practice, the process often reinforces the very power imbalance it was meant to fix.
Insurers lie through the process. They provide selective or misleading information, omit key documents, and submit lengthy responses designed to confuse and exhaust. Rather than simplifying disputes, they escalate complexity. We have seen straightforward issues turn into months of back-and-forth, not because the facts are unclear, but because insurers make them appear so.
This tactic works. Most consumers do not have legal training. They are navigating a traumatic experience while juggling work, family and finances. Insurers have full-time staff, internal legal teams and outside counsel. They know how to stretch timelines, wear people down and make every argument sound plausible, even when it is not.
AFCA should not need to police insurer conduct. Yet many cases become less about the original claim and more about untangling insurer behaviour: delays, document tampering, baseless denials, sudden shifts in position. Why do so many insurers feel they can act this way? Because there are rarely consequences.
AFCA relies on insurers participating in good faith. But when that faith is absent, the process breaks down. Consumers are told to compromise with parties who have not acted honestly or fairly. Even where misconduct is obvious, remedies are limited. There are no fines. No public findings. No systemic accountability. Just a closed-door determination and a hope the insurer will comply.
Too often, the process rewards insurers who delay, deflect and deny. Consumers who expect fairness and fact-based outcomes are routinely let down. Determinations can be based on incorrect facts or flawed reasoning, but there is no right of appeal for consumers. Their only option is court, a path that is costly, risky and out of reach for most. Insurers know this. They know that even if they lose at AFCA, there is little consequence. And if they win, the consumer has nowhere else to turn.
Insurers are AFCA members. They attend closed-door forums, deal with AFCA staff regularly and build ongoing relationships. This creates an uneven playing field. It benefits those who understand the system and know how to work it. Unsurprisingly, that is not everyday customers navigating it for the first time. It is the insurer, with experience, resources and inside knowledge.
Until the system changes, those with the most resources will continue to shape the outcome. And that outcome will not always be just.
Staring with genuinely trying to help someone, and your business will grow
Some of the most important work we do begins without any expectation of return. We take hundreds of calls, reply to messages, support people in Facebook groups, and answer detailed questions, all without charge. Most of the time, those people never become clients. That has never been the point.
This business did not start with a marketing plan or a funnel. It started by helping one person who needed support. And over time, that built trust. One genuine conversation led to another, and a reputation began to form.
Starting by genuinely helping someone creates something no advertising can replicate. When people feel respected and informed, they remember. They share their experience. Bit by bit, the business grows. Not through gimmicks, but through trust and the value of doing the right thing in every interaction.
We recently reached 200 five-star Google reviews. That milestone came from a simple approach: genuinely trying to help every person who contacts Claims Hero. Behind those reviews are thousands of individuals who received support without paying us a cent.
It might sound hard to believe for a company the industry often tries to portray as taking advantage of vulnerable people. But the truth is, doing the right thing consistently leaves a mark. People remember when they are treated with respect, listened to, and given honest guidance, especially when there is nothing in it for us. That is what built our reputation, and it is what continues to drive our growth.
Would I do it all again?
There have been moments where I’ve asked myself that question. This work has left a mark on every part of who I am. It has shaped how I think, how I react, how I live. When I started, I was naïve. I believed doing the right thing would be enough. I believed facts and fairness would prevail. That belief has been tested time and again.
If I had known how relentless this would be, how much personal sacrifice it would take, I might have hesitated. The pressure, the responsibility, the toll on my health and relationships, it is not something you can prepare for. The industry is not just resistant to change. It is structured to wear people down until they give up. That experience hardens you. But it also clarifies your purpose.
Because what we do has meaning. I have seen what it means for someone to finally be heard. To have someone believe them. To win a claim they thought they would lose. To rebuild when they thought they had no chance. That kind of impact is rare. It makes every setback worth it.
Claims Hero has grown into something far bigger than when we started it. We have a team of people who care deeply and fight just as hard. We have gained thousands of supports, we receive countless messages thanking us for doing what we do, often from people anonymously within the industry. And that gives me the strength to keep going. If I had to do it all again from the beginning, knowing what I know now, I honestly don’t know if I could. But standing here, with the people around me and the purpose that drives us, I would never choose to stop.
Final Message to the Industry
If you work in the industry and you’ve made it this far, chances are you’ve got a bit of an itch. Maybe something in all of this rang true. Maybe you’ve seen decisions that didn’t sit right. Maybe you’ve felt the discomfort of working inside a system that doesn’t always reward doing the right thing. If that’s you, get in touch. I’m always happy to talk, whether you’re on the inside, the outside, or somewhere in between.Claims Hero is growing and we’re always looking for passionate people to join our team.
To the industry more broadly, the message is simple. The tides are turning. Consumers are getting smarter. Advocates are getting louder. The silence that once protected poor behaviour is cracking. The question is no longer whether change is coming, but how quickly. So ask yourself: what side of history do you want to be on?
This isn’t about attacking insurers. It’s about making clear that a better path exists, but the first step is acknowledging that there is a problem. Without that honesty, nothing meaningful can change.
Useful Resources
You may also find some of our available resources useful:
- Claims Hero Blogs – https://claimshero.au/blog/
- Claims Hero The Podcast – https://claimshero.au/podcast/
- Insurance Claims & Complaints Australia – Q&A Facebook Group – https://www.facebook.com/share/g/18rxSHx6J3/
- Australian Financial Complaints Authority – https://www.afca.org.au/
Disclaimer
The information contained in this article is general information only and is intended for educational and informational purposes. It does not take into account your personal objectives, financial situation, insurance policy, or individual circumstances. You should seek independent advice before relying on any information contained in this blog or before deciding whether claims advocacy services are appropriate for your individual circumstances.