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Insurance News magazine June/July 2026

Claims leaders held a roundtable to analyse some of the pressures reshaping the sector

By John Deex

Variously described as the moment of truth, fulfilling the promise or where the rubber hits the road – the claims function’s importance is undeniable. But it’s also an area undergoing rapid change as regulatory demands, consumer expectations and technology reshape the landscape.

To explore the challenges and opportunities, Insurance News and accident management specialist AAMC brought together a select group of industry experts for a roundtable discussion ahead of Insurance News’ Outlook 2026 conference in March.

The group consisted of: Steadfast Claims Solutions CEO Susan Donaldson, Zurich head of fast-track claims Tegan Brusentsev, Honey Insurance’s head of claims Justyn Ryder and COO Louise Mercer, AAMC’s strategic relationship manager Daniel Lukich and COO Luke Hill, and Achmea Farm Insurance COO Danielle Whitelock.

Complaints and compliance

Australian Financial Complaints Authority disputes are dominated by claims, with delay in claim handling the most common issue last year (9274 complaints from a total of 111,373). Denial of claim (6362) appeared in fourth place.

Roundtable participants were keen to address some of the reasons behind these statistics, including consumer confusion, involvement of third parties, rigid processes and compliance demands.

Some noted that comments once treated as simple dissatisfaction or negotiation are now routinely escalated as formal complaints, adding delay and complexity.

AAMC’s Mr Lukich said the shift has narrowed the room for pragmatic resolution, explaining that what used to be a quick conversation to resolve or negotiate an outcome now triggers a formal process that “elongates a claim”.

One member of the group shared an example in which a colleague followed procedure by requesting a document that ultimately was not needed.

The technically correct action led to a poor customer experience and a complaint. “What’s the right outcome?” they asked, highlighting the tension between compliance and service.

Steadfast’s Ms Donaldson made the point that claims complaints often relate to misunderstandings around coverage.

“The complaints might come in through the claims channel, because claims, as we all know, is where the rubber hits the road.

“But it may not be a complaint about the claim. It might be a complaint about not understanding the insurance coverage that was bought.”

While accepting regulation is well intentioned, the panel outlined practical issues it can cause on the claims front line. “It can become so prescriptive or rigid that it actually means you are limited in exercising judgment in the customer’s interest,” Honey’s Ms Mercer said.

Others agreed it can “get in the way” of the customer experience.

“We inhibit people … with a whole bunch of rules and regulations that constrain their ability to get the right outcome for the customer,” one said. “It is on the industry to reflect, and find a way forward.”

Passion and purpose

Despite the pressures, the group was unanimous about the dedication of claims professionals.

Achmea’s Ms Whitelock said claims handlers regularly support people through some of the worst moments of their lives, and many choose the vocation because it offers a sense of purpose.

Honey’s Mr Ryder said his team feels most energised when they can directly help customers. He notes claims staff placed in transactional service environments enjoy it less because it removes the impact they can have on customers, which is where they realise their sense of purpose. They want to “step in and make a difference”, he said.

Ms Donaldson argued portraying claims work as inherently difficult does the profession a disservice. Insurers and service providers are dedicated to ensuring staff are well trained, well supported and motivated by care and problem-solving, she said. The satisfaction often comes from simply knowing a customer can move on.

The group reflected on why positive claims stories rarely make headlines, despite the vast majority of cases being handled well.

Zurich’s Ms Brusentsev said claims people are not motivated by praise, and a quiet “thank you” is often enough.

Ms Mercer added there is a humility in the profession – if it does not make the news and quietly delivers, “that’s a success”.

Another panellist drew attention to the commitment of claims staff during natural catastrophes, which is rarely noted outside the industry.

“Loads of people give up their lives, and leave their homes and families, to go and respond to major events. All the adjusters, builders, restorers, internal claims teams – it’s never talked about.”

Technology and AI

Panellists were asked for their views on tech and AI, as opportunities for advancement and efficiencies are clear but so much remains uncertain.

Ms Whitelock said it’s vital to consider the issue from the customer perspective.

“A lot of people may say they expect no-touch claims. I’m not convinced that’s always correct. We deal with a lot of clients who prefer to have a conversation. I don’t see AI as replacing what we do, but supporting what we do. And so in claims, if it takes away some of the administration tasks … that’s where the value of the expertise at the insurance company can have greater impact.

“If you’re having personalised conversations, instead of processing, I can’t see why that wouldn’t be well received, but you need to do it with the right structure.”

Deploying AI behind the scenes could be a better initial bet than customer-facing applications, Ms Mercer said, fearing consumers could be confused whether an AI agent is acting for them or the insurer.

“Is it safer to drive for efficiency under the hood? Then, as the insurer, you’re managing the complexity and nuance of the claims experience, and utilising emerging technology to do so,” she said.

“You’re carrying the risk better for when it gets it wrong, versus offering an ‘am I covered for that’ AI bot, which is fraught with risk.”

Mr Lukich said AAMC’s research – which has included travelling to the UK and recent ITC Tech conferences in the US – has found comprehensive technology solutions are still lacking, as insurtechs look to address particular pressure points but not the overall claims experience.

“There’s a whole range of vendors promoting smart technology, AI, machine learning, image recognition – you name it, they were there. But what we found was there wasn’t a solution for total overview of claim, or total claim experience. They were point solutions.

“They’re all struggling to sell their businesses to insurers because they’ve got this great idea that they think is going to revolutionise the industry, but the
insurer looks at it and goes, ‘Well, that fixes 3% of my issues. How do I implement that? That’s too hard.’ ”

Fraud

Insurance claim fraud remains a major issue, but nobody knows the true scale of the problem and deterrents are falling short.

Panellists felt it is one of the few crimes that is still considered socially acceptable, and police action should be more common.

“Insurance, unfortunately, is still one of those industries you can brag about to your mate at the pub,” Mr Lukich says. “ ‘So, I ripped off my insurer.’ ‘Good on you, mate, well done.’ ”

“There are really smart people out there. They’re targeting insurers with fabricated claims, and when a new insurer comes to market, they’re found to be the most susceptible.

“They don’t have a history of claims. They’re building, they’re growing. And they’re seen as an easy target.”

AAMC’s Mr Hill said fraudsters shopping vehicles around panel shops is common.

“They’re sharing the same vehicle and going to different insurers. And it obviously goes well, because it consistently happens with the same people, so they’re getting away with it.

“What I say to the industry is, what are you doing about it? Because I think all they do is deny the claim. But it’s fraud – it’s police, it’s prosecution. But they don’t go down the legal route, so there are none of those consequences.”

Ms Mercer noted insurers sharing data more effectively at an industry level would help in the fight against fraud, but regulation and competition concerns also need to be addressed in the solution.

“If you’ve got a higher capability of fraud detection, that can provide a competitive advantage to insurers, along with downward pressure on costs, which can lead to greater affordability.”