- Claim Guide
5 Expert Evidence Mistakes That Are Impacting Your Settlement Offer
- Claim settlement
Introduction
When an insurance claim reaches the settlement stage, expert evidence becomes the battleground.
Assessment reports, scopes of works, quotes and valuations are what insurers rely on to decide how your claim is settled and how much you’re paid. When that evidence is weak, incomplete or biased, your settlement will usually be too.
Below are five common problems with expert evidence that regularly undermine otherwise valid claims, and what they mean for your outcome.
1. Unqualified or inexperienced experts
Not all “experts” are equal. We regularly see claims assessed by people who:
- Lack relevant qualifications for the damage being assessed
- Have limited experience with complex losses like water, mould or structural damage
- Are outside their area of competence but still making conclusions
For example, a general building assessor commenting on mould contamination, or a desktop reviewer opining on structural movement without proper testing.
Damage can be concealed and repairs complex. If your assessor doesn’t know where to look, or how to recommend the right works for the job, you could be left shortchanged.
2. Poor instructions or guidance from the insurer
Expert evidence is only as good as the instructions behind it.
Claimants lodge detailed concerns with their insurer’s scope of works. But when the insurer’s next step is to appoint their supplier with instructions to “re-assess damage and provide scope of works”, they are hardly set up for success.
Common problems we see include:
- Experts being asked questions that are narrow and leading, or vague and unclear
- Insurers withholding the policy, claim history, or your own evidence
- Insufficient context provided about the key issues in dispute
Without clear instructions, your insurer’s assessment can be off-track, one-sided, or focused on the wrong issues.
3. Assumptions without evidence
This is one of the most damaging issues we see. Examples include:
- Visual inspections of surface-level damage
- Assuming materials are restorable without property analysis or rationale
- Assuming damage is pre-existing without proving it
AFCA repeatedly confirms that insurers cannot rely on untested assumptions, particularly where damage may be concealed or progressive.
4. Ignoring your evidence
Claimants often provide strong evidence, but it is frequently sidelined or outright ignored as some assessors focus on forming pre-conceived conclusions.
This includes:
- Photos and videos taken immediately after the event
- Builder or specialist reports you commissioned
- Information you’ve communicated about the history of the claim or damage
Ignoring this evidence, or failing to address it in an assessment report, is a serious flaw.
5. No report at all, straight to a scope of works
This one surprises many people.
In some claims, insurers skip a proper assessment report entirely and move straight to a scope of works or quote. This often occurs for delayed or complex claims, where the insurer’s expert pulls together a rushed scope of works to help the insurer settle the claim, without a thorough and recent assessment of damage.
This creates major problems where:
- The extent or severity of damage was never properly documented
- Damage may have developed over time
- Missing scope items cannot be traced back to an assessment
- The scope relies on undocumented assumptions
Without a proper assessment of damage, the risk of the scope of works being incomplete rises dramatically.
Conclusion
If your settlement offer feels low, rushed or incomplete, the problem is often not the policy. It’s the expert evidence being relied on.
Identifying how the issue occurred, then challenging that evidence methodically and with better evidence, is usually the fastest way to turn a bad offer into a fair one.
Jump To
What could I do next?
Step 1 – Ask for a detailed explanation
If your insurer is relying on evidence that seems unfair, you can request from the insurer:
- A copy of the evidence (report, scope, quote, etc)
- An explanation of how their offer aligns with their policy wording
Often, just getting a clear explanation helps you spot gaps, misunderstandings, or assumptions worth challenging.
Step 2 – Lodge a complaint
If you spot issues with the evidence, you can escalate the matter to the insurer’s Internal Dispute Resolution (IDR) team. At this stage, it’s important to provide any further evidence you can that challenges the insurer’s evidence (e.g., your own report or evidence which disproves their findings). Complaints teams will usually uphold the original decision unless you raise new points, provide new evidence or challenge the reasoning clearly.
Step 3 – Escalate to AFCA
Still not resolved? Lodge a complaint with the Australian Financial Complaints Authority (AFCA) at www.afca.org.au. AFCA is independent and free to use.