The General Insurance Code Governance Committee (CGC) has reported strengthened oversight of external experts used in claims assessments, following recommendations issued in 2024.
The CGC this week released a report on a follow-up review of the recommendations and found that eight unnamed insurers have introduced measures preventing external experts from making recommendations to accept or deny claims, in line with the Committee’s view that expert input should be confined to factual evidence within their area of expertise.
The report noted that external experts may still approve a claim where a delegated authority arrangement exists. All eight insurers have also reported progress in strengthening monitoring and quality assurance systems.
Five insurers have amended or introduced new report templates requiring experts to document qualifications, provide supporting evidence, and avoid making recommendations on claim outcomes, according to the report. Seven insurers are updating onboarding programs covering key areas of claims assessment, and five have introduced knowledge checks. Three insurers will deliver annual e-learning training modules, while four are updating existing programs.
Veronique Ingram, chair of the CGC, said the Committee was encouraged by industry action since the original inquiry.
“It is encouraging to see insurers strengthen their controls and set clearer expectations for external experts,” she said. “These improvements will support more consistent decisions and timely and fair outcomes for customers.”
The report, however, noted that progress has been gradual, with implementation timeframes affected by broader transformation programs.
While six insurers have strengthened data collection systems to better monitor external experts and complaint trends, most insurers were unable to demonstrate how they plan to evaluate the effectiveness of reforms or measure customer outcomes .
The CGC said it would continue to monitor implementation over the next 12 months and may consider further action, including potential sanctions for serious and systemic non-compliance with the Code, if insufficient progress is observed.
The follow-up builds on the watchdog’s August 2024 inquiry, which warned that external experts were sometimes providing opinions beyond their technical scope, potentially contributing to poor claims decisions, disputes, and complaints.
That earlier review urged insurers to confine expert input to factual evidence, strengthen training and evaluation, and improve oversight to ensure that expert reports support fair and accurate claim outcomes rather than influence whether a claim should be accepted or denied.
