By Paul Muir, MD at Compliance Advocacy Solutions

Claims professionals are the cornerstone of the insurance industry. Always have been. Always will be.

Yet some can feel like modern-day Sisyphus figures, pushing a rock uphill, day after day, as they navigate complex claims, competing demands and distressed customers. Paid advocates can find themselves pushing the same rock from the customer’s side.

This raises a question that should sit at the centre of the debate about claimant intermediaries: why does a customer believe they need to pay a third party to obtain a fair outcome under an insurance policy for which they have already paid a premium?

Does that mean the claims system is broken? The existence of paid advocacy alone does not establish that. Complex claims can require specialist help even within a well-functioning system. But when customers seek assistance because they feel unheard, overwhelmed or unable to challenge an assessment, we should examine what their experience tells us.

The Australian Securities and Investments Commission’s 2026-27 general insurance priorities include a review of for-profit claims management companies, following concerns raised by insurers and consumer advocates. Its focus includes client acquisition, fees, cancellation arrangements and supplier relationships. That provides an opportunity to understand both consumer risks and the role these businesses play.

We should distinguish professional claimant intermediaries operating under an appropriately authorised Australian financial services licence from predatory conduct commonly described as storm or disaster chasing.

One describes a regulated service; the other describes behaviour. They are not interchangeable, and licensing does not guarantee good conduct. Nor should roofers and builders be characterised as disaster chasers simply because they work after a catastrophe. The questions are what they do, how they approach customers and whose interests their arrangements serve.

There is also a practical difference between helping someone lodge a straightforward claim and helping resolve a disputed, delayed or potentially underpaid one.

I support the role of professional claimant intermediaries in helping customers secure fair outcomes, particularly when claims become complex, disputed or overwhelming. An advocate may help test a repair scope, obtain technical evidence, interpret policy terms or challenge an assessment. For a family displaced from home and navigating a water damage or mould dispute, that assistance can reduce the administrative and emotional burden.

Insurers appropriately draw on loss adjusters, engineers, repairers and other specialists. It is understandable that a customer facing the same technical complexity may also want expertise on their side.

The Australian Financial Complaints Authority provides free, independent dispute resolution, and consumers do not need paid representation to use it. That is an essential protection. However, access to a free process does not mean every customer feels equipped to organise evidence or explain a complex dispute. Paid help may add value in some cases; customers should understand the free alternatives before committing.

Effective advocacy can also help customers understand the limits of their policy, distinguish supportable concerns from unrealistic expectations and reach resolution sooner. Supporting someone through distress is valuable, while recognising when qualified counselling or other specialist support is needed.

The comparison with insurance brokers is instructive. Brokers operating under an AFSL are paid for expertise, access and assistance, including claims support. We recognise that remuneration can coexist with consumer benefit.

Should we apply the same reasoning to licensed claimant intermediaries? Their authorisations and services differ, but both should be assessed on competence, conduct, conflicts and value. Are we focusing too heavily on how advocates are paid, and too little on what customers receive?

Remuneration still matters. A percentage fee can reduce the funds available for repairs. It may also create incentives around settlement size or cash outcomes. The relevant question is whether the customer is demonstrably better off after fees, with a clear understanding of costs, alternatives and commercial relationships. A larger settlement alone does not answer that question.

Licence obligations – including providing services efficiently, honestly and fairly, and adequately managing conflicts – provide important guardrails. A claimant intermediaries representative industry body and a dedicated code could build on them through practical standards, transparent fees, vulnerability support and credible disciplinary processes.

The objective should be a common customer goal: fair, timely resolution under the policy. That requires room for professional advocacy, accountability for poor conduct and constructive engagement between everyone involved.

The question remains: why does the customer believe they need to pay again to secure the promise they have already purchased?