A new standard agreed by general insurers will provide additional clarity & certainty for customers when independent expertise is required to help determine a claim.
The Expert Report Best Practice Standard has been developed by the Insurance Council of Australia to provide consistency when insurers are using reports by experts such as hydrologists, engineers, builders, or specialist tradespeople.
The best practice standard has been developed using feedback provided by consumer advocates and AFCA.
An Expert Report is a report produced by an External Expert as defined in the GI Code of Practice. The ICA will be recommending to the independent Code Review Committee that the Standard is referenced in the next version of the Code to provide additional certainty and rigour around the use of Expert Reports.
The Standard contains the following requirements:
𝙋𝙧𝙚-𝙧𝙚𝙥𝙤𝙧𝙩 𝙘𝙤𝙢𝙢𝙞𝙨𝙨𝙞𝙤𝙣𝙞𝙣𝙜
1. Relevant expertise – prior to an expert report being commissioned, insurers must ensure the expert being briefed is relevant, qualified, & objective
2. Capacity – The insurer should confirm that for each report commissioned the expert has the capacity to provide an expert report to the highest possible standard.
3. Briefing – The insurer should ensure that the expert has been fully briefed on relevant matters relating to the claim.
4. Advice to customers – The insurer should ensure that the customer is informed about the need to seek an expert report, the intended scope & use of the report, & is provided an opportunity to consider the need to submit any evidence to the insurer or expert in the commissioning process.
5. Exclusions – the insurer should make it clear to the expert exactly what they want the expert to provide an opinion on by including specific questions
𝙏𝙝𝙚 𝙧𝙚𝙥𝙤𝙧𝙩 𝙞𝙩𝙨𝙚𝙡𝙛
Insurers should ensure that reports:
– are neutral & in plain english
– formatted with conclusions
– consider all relevant matters
– rely only on facts
– provide clear & cogent reasoning
– clear on whether an opinion is tenative or firm
– identify the cause(s) contributing to the loss
– provide a statement of objectivity
– provide the expert’s qualifications
𝙐𝙨𝙚 𝙤𝙛 𝙩𝙝𝙚 𝙧𝙚𝙥𝙤𝙧𝙩
– the expert report should be considered by claims managers & critically examined
– provided to the customer & the insurer should explain which parts of the report have been relied on for the claim decision & why
– disregard any statements or opinions outside of the scope or expert’s expertise