I’ve just landed back home after a packed few days of meetings across Sydney and Melbourne last week. It wasn’t the usual agenda. These weren’t client meetings, regulatory sessions, or insurer claims meetings. I was meeting with investors. The ones who are funding, scrutinising, and shaping the future of general insurance in Australia. In many cases, their influence moves faster and more decisively than that of regulators.
It’s not a space I usually write about, but after these meetings, it should be. Because what I heard from these investors confirms what we’ve seen at Claims Hero for years. The core questions they asked weren’t about premium income or underwriting results. They were about people. They were about failure. And they were about what happens when a customer is forced to rely on a third party to get the fair outcome they should have received in the first place.
They Wanted to Understand the Why
These weren’t conversations about balance sheets or share price performance. These investors wanted to understand the heart of the matter. Why are so many Australians struggling to get fair outcomes from their insurer? Why are claims being delayed, denied, or outsourced into confusion? And why does a company like Claims Hero exist in the first place?
These problems are not new. They’ve appeared in inquiries, media exposés, and investor risk reviews for years. Yet the industry can’t seem to fix them. The real challenge is not awareness, but inertia. Poor practices become embedded. Culture resists change. Conflict of interest remains undisturbed. Even when the right people want to act, they’re often not empowered to or structural issues make doing the right things practically difficult.
Insurers know these issues exist. But some prefer to deflect, delay, or deny until the pressure subsides. That is not a sign of strong governance. It is a signal that more failures are on the way and for investors this is concerning.
Claims Hero Isn’t the Problem
Some insurers still see Claims Hero as the enemy. If that were true, we’d be creating chaos, not resolving claims that have been stuck for years. One executive recently claimed our involvement and the volume of complaints we lodge threaten the viability of the entire industry. It’s a bold claim, and one that misses the point entirely. The only reason those complaints exist is because of that insurer’s own conduct. The need for escalation isn’t driven by a targeted campaign from us, but by their consistent pattern of deflecting responsibility, ignoring valid concerns, and focusing on discrediting Claims Hero instead of helping their customer. That view isn’t shared by the majority of the industry. Over 80 percent of the insurers we work with engage constructively, and most of those interactions are resolved without a single complaint being lodged.
For those who choose to work with us, the outcomes are markedly different. We’ve worked with insurers who have recognised when a customer is vulnerable and have streamed them to specialised claims teams. They’ve taken the time to understand recurring problems and acted swiftly to resolve disputes. This doesn’t just reduce complaints. It starts to rebuild consumer trust. Importantly, it is also reduces the reputational risk associated with claims that have not been managed in accordance with the insurer’s own expectations.
Some insurers now meet with us regularly. They review insights not just from the clients we represent, but from the leads we decline and the social media enquiries we receive. They use this feedback to inform internal reviews, improve processes, and train their teams. These conversations are not about blame. They are about visibility and understanding the issues their customers will not raise directly. The perspective is coming not from storm chasers or opportunists, but from experienced professionals in claims, risk, and compliance. Ironically, the same people some insurers try to discredit are the ones they would have paid thousands of dollars a day to consult with if they were not working for Claims Hero.
In other cases, insurers have worked with us to address long-standing issues with their own providers. They’ve recognised that tension often arises when loss adjusters, builders, assessors, or experts hold entrenched views that are difficult to challenge from within. Given Claims Hero does not lodge claims, much like internal quality assurance functions, Claims Hero reviews these claims retrospectively, identifying the decisions, behaviours, and breakdowns that have caused claims to veer off track or escalate in cost. As an external voice, we are not influenced by internal relationships, past decisions or contracts with providers. This independence allows issues to be seen more clearly and gives insurers the opportunity to course-correct before the financial and reputational cost of inaction becomes even greater.
The results speak for themselves. Some insurers who once saw every claim escalate to AFCA now see very few, and in some cases none at all. When these insurers choose to engage with us early and constructively, claims are resolved faster, more fairly, and with far less friction. For customers, it means avoiding the emotional toll of prolonged disputes and often rebuilding trust in the insurer they once felt let down by. When they see genuine progress and a willingness to resolve issues, they become more open to reasonable outcomes. For insurers, it means fewer front-page headlines, fewer regulatory interventions, and a significant reduction in the cost and complexity of remediation. It is a better outcome for everyone involved.
Yes, These Claims Cost More. But They Cost Even More When Ignored
Several investors raised a natural question. Do these claims cost more to resolve?
The short answer is yes. By the time a claim reaches our desk, it has often already gone off track. People are not coming to us because their claim is being handled well. These are typically claims that have already been delayed, denied, or derailed. As consumers become more informed about their rights and risks, especially around emerging issues like mould, the volume and complexity of disputes is growing. What might have been resolved early with a simple fix or small payment often escalates into a much larger settlement. That is not because of our involvement, but because of how far the claim has deteriorated before we ever see it. These claims are not just line items. They are warning signs. Each one offers insurers a valuable opportunity to learn, intervene earlier, and prevent broader failures. That is where the real value lies.
The root of many cost blowouts lies in the insurance supply chain. Builders, restorers, engineers, and other experts are often operating in systems where their incentives are not aligned with fair and timely resolution. Show me the incentives and I’ll show you the outcome. When providers earn minimal profit on the initial job, there is little financial motivation for them to return and rectify poor work. Lifetime guarantees may sound reassuring, but in reality they can entrench a culture of avoidance, where accountability is pushed aside. We are also seeing new trends emerge, such as national building panels becoming overwhelmed after large events, suddenly identifying maintenance issues to justify cash settlements simply because they cannot deliver the work. In many cases, they are not avoiding responsibility maliciously, they are simply unable to meet demand. These dynamics are critical to understand, because they are not just inflating costs, they are fueling dissatisfaction and repeat complaints. In other cases, it is the insurer whose pricing model has made the work unappealing so they find excuses to cash settle, while other insurers offer better rates and attract the more willing or capable trades. These are not isolated problems. They are structural flaws. Until insurers properly engage with these realities, they will continue to see inflated costs, dissatisfied customers, and a growing risk of systemic failure.
We also spoke with investors about the broader leakage and inefficiencies hidden within parts of the claims supply chain. One ten-page whistleblower complaint we received painted a troubling picture. It alleged inflated supplier charges used to fund social trips, undisclosed ownership links between loss adjusters and the expert firms they appoint, and incentive structures that reward superficial savings while pushing up long-term remediation costs. Some insurers appear to be following playbooks focused on short-term cost reductions, even where those approaches drive poor outcomes for customers and lead to more complaints, regulatory scrutiny, and brand damage. Perhaps most alarming was the fact that, after reading it, not a single allegation in the letter surprised us.
The result is a market where rising claims costs are less about unreasonable customers and more about processes that have been left to decay. Recovery against suppliers is sometimes possible, but rarely pursued. After all, if no one made a profit on the original job, there is little appetite to spend more fixing it. When the industry raises concerns about premium pressure in response to reforms aimed at helping consumers, it is worth asking what costs they are willing to protect. Significant savings remain within their control. From inflated supplier arrangements to the commissions paid to brokers and other intermediaries, the pressure is not always where they claim it is. It should not only be considered a cost problem when the change does not favour the insurer.
We Strengthen the System, We Don’t Replace It
When we step in, it’s not because we want to bypass insurers. It’s because something has broken down. Communication. Trust. Or sometimes just basic logic. Customers don’t always know what they need to resolve a claim. Insurers don’t always explain it well. Expectations spiral. Emotions rise. Staff on both sides suffer.
We are well aware that in many cases, the customer is not just frustrated, they are lost in the process. They are overwhelmed by jargon, confused by shifting scopes, and unsure of the difference between what they want and what they actually need to resolve the claim. This confusion is especially common in cash settlement scenarios, where the onus shifts to the customer to manage repairs or replacements with little practical guidance. Insurers may be willing to resolve the claim, but it becomes near impossible when the outcome keeps changing. We work with these customers to clarify their position, set realistic expectations, and help them articulate exactly what is required to bring the matter to a close. This is not about inflating demands. It is about translating complexity into clarity so that insurers are not chasing a moving target. In doing so, we help resolve claims faster, with less friction, and restore trust between both sides.
We fix that. We manage expectations, clarify evidence, and take the heat out of conflict. And in doing so, we help insurers avoid the exact kind of high-profile failures that investors are worried about. The kind that attract regulatory scrutiny, trigger remediation programs, and damage brands for years.
The stories we encounter often reveal the industry at its worst. These are not minor oversights or one-off errors. They are systemic failures that cause real harm and, left unaddressed, have the potential to damage trust in the entire sector. Some are among the most shameful examples of insurer conduct we have seen. But there is a clear divide. Those who confront these issues head-on, acknowledge what went wrong, and commit to change are not only protecting their own reputation, they are lifting the standards of the entire industry. Those who deflect, deny, or shift blame risk dragging everyone down with them. In the eyes of the public, and increasingly in the eyes of regulators and investors, silence or defensiveness speaks louder than any apology.
What Mature Insurers Do Differently
The insurers who impress us the most aren’t perfect. They know problems happen. But they empower their teams to fix them. They are open to feedback. They don’t need it filtered through a consultant or buried in a report. They take it direct. And they act.
That speaks volumes to investors. It shows there’s a mature risk and compliance culture in place. Not one that just ticks the right boxes but one that makes changes when issues are identified. It says something important about the executive team behind it. That they trust their people to lead from the front, not shield the organisation from the truth.
Engagement Isn’t Weakness, It’s Good Governance
Working with a third party like Claims Hero isn’t a loss of control. It’s a sign of good governance. It shows you’re listening, adjusting, and responding to the real world, not just what your internal data tells you. The insurers who do this are looked upon favourably by the same investors I just met with. Because they know that risk management in insurance is not just about pricing. It’s about culture.
And for those who still choose to deflect or deceive, we’re more than happy to support their competitors in demonstrating why they’re different. Some insurers are already doing just that, highlighting to customers and investors that they listen, they act, and they’re prepared to lead. In a competitive market, trust and transparency are assets. For those unwilling to change, that trust is moving elsewhere.
In an environment where consumers are becoming increasingly informed, empowered by AI tools, online communities, and greater access to information, the old ways of obfuscating policy terms or misleading customers during claims are running out of road. The time is limited for insurers who rely on confusion and delay to control outcomes. Customers are not only noticing, they are documenting, sharing, and escalating. Those who continue to prioritise short-term savings over long-term trust will find themselves outpaced by competitors who see transparency as a strength, not a threat. Engagement is not a liability. It is a strategy for resilience in an industry that cannot afford to be caught looking backwards.
The recent Federal Court action brought by ASIC against Hollard has sent a clear message across the industry. The allegations relate to the mishandling of insurance claims, particularly those involving vulnerable customers affected by flood and mould damage. ASIC’s case highlights serious concerns about Hollard’s compliance with its obligations under the Corporations Act and the Insurance Contracts Act. At the heart of the matter is the failure to handle claims efficiently, honestly, and fairly. This action underscores the growing regulatory expectation that insurers not only meet the letter of the law but also demonstrate genuine care for the people behind the policies. It is a reminder that cultural shortcomings in claims handling will not be overlooked, and that regulators are increasingly willing to hold insurers to account when consumer harm occurs. At Claims Hero, we have always worked constructively with regulators and will continue to do so. Our role includes shining a light on insurers who, even when presented with clear and compelling evidence, choose defence and deflection over resolution and accountability. When insurers are given the opportunity to do the right thing and still refuse, it raises serious questions about culture, leadership, and their commitment to fair customer outcomes. We do not raise these concerns lightly. We do so to protect vulnerable consumers and to support a stronger, more trustworthy insurance sector and reward those that do the right thing.
What Comes Next
The future will belong to insurers who are transparent, fast-moving, and consumer-focused. Information asymmetry is disappearing. Consumers are better informed than ever. AI, advocacy, social platforms, and online ratings are giving them more tools than they’ve ever had. Ignoring this doesn’t delay the consequences. It just guarantees they’ll be worse.
That is why now is the time to rethink how the industry engages. Imagine an ecosystem where customers, insurers, brokers, and advocates work together, not in opposition. Where early intervention prevents escalation. Where third-party insight is welcomed, not resisted. And where good claims experiences become the norm, not the exception.
An Invitation to Lead
If you’re an executive reading this, ask yourself:
- Are we truly learning from our most difficult claims?
- Are our governance and compliance teams empowered to act when the same issues arise again and again?
- How are we benchmarking ourselves, not just against competitors, but against community expectations?
If you want to know what’s really happening in the industry, ask the people who are hearing directly from your customers. Invite Claims Hero to share our insights. Benchmark your IDR outcomes. Review how your complex claims are being resolved.
We’re not here to fight. We’re here to help. And we’re ready to work with any insurer who wants to lead.