Human Claims Advocate vs AI Claims Processing

Insurance claims processing in Australia is changing rapidly. A growing number of insurers are deploying AI-driven platforms to triage, assess, and in some cases fully close property damage claims — often without a qualified human assessor ever visiting the damaged property.

Two platforms driving this shift in the Australian and New Zealand market are handdii and HOMEE. Both are positioned as technology solutions that help insurers reduce claim handling costs, accelerate resolution times, and standardise scope decisions across high claim volumes. Pacific Equity Partners-backed JLG has been actively accelerating adoption of these tools within its managed repair network.

From an insurer's perspective, this is an efficiency gain. From a policyholder's perspective, it raises a critical question: when an algorithm is deciding the scope of your property damage claim, whose interests is it optimised for?

Insurers invest in these platforms to reduce claim costs and improve throughput. That is a legitimate commercial objective — but it is a different objective from maximising your payout.

AI claims platforms and human restoration advocates are optimised for fundamentally different outcomes. The table below sets out what each approach prioritises.

The most significant practical risk with AI-driven claims processing is the scope gap — damage that exists in your property but does not appear in the AI-generated scope of works.

AI assessment tools rely on the information fed into them: photos submitted via app, reported damage items, and pattern-matching against historical claim data. What they cannot reliably do is identify damage that is not immediately visible, not photographed, or does not match the pattern of a "normal" claim in their training data.

In property restoration, invisible damage is common and significant:

An NRPG IICRC-certified contractor conducts an on-site physical assessment using moisture meters, thermal imaging, and psychrometric equipment — producing a documented scope that reflects the actual extent of your loss, not a photo-based estimate.

The General Insurance Code of Practice (administered by the Insurance Council of Australia) sets minimum obligations for how Australian insurers must handle your claim — including claims managed via automated or AI-assisted processes.

Key rights you hold under the Code and the AFCA Rules:

• Right to an explanation: Your insurer must explain any decision to accept, partially accept, or decline your claim. A claim closed by an automated system without adequate explanation can be challenged.
• Internal Dispute Resolution (IDR): All insurers must have a free internal dispute resolution process. You can dispute scope decisions, partial payments, or claim closures through this process. Insurers must respond to IDR requests within 30 calendar days (Code standard).
• Independent assessment: You have the right to obtain an independent assessment of your damage. That assessment can be submitted as evidence through the IDR process or to AFCA.
• AFCA escalation: If your insurer fails to resolve your dispute through its internal process, you can escalate to the Australian Financial Complaints Authority (AFCA) at no cost. AFCA is independent of insurers and can require additional payments, reassessment, or reopen closed claims. Complaints must generally be lodged within 2 years of the insurer's final decision.
• Hardship provisions: If the claim process is creating financial hardship, the Code requires insurers to have processes to assist you. Raise hardship formally with your insurer in writing.

AFCA publishes its determination data publicly. Recurring patterns in published insurance restoration cases include scope undervaluation (where the insurer's approved scope missed significant damage items) and repair quality disputes (where work completed by insurer-assigned contractors did not meet IICRC standards). An independent IICRC-certified assessment is the most effective piece of evidence to support both types of dispute.

Source: AFCA Case Studies | General Insurance Code of Practice

NRPG (National Restoration Professionals Group) is a network of IICRC-certified restoration contractors operating across Australia and New Zealand. We are restoration specialists — not insurance lawyers or claims advocates. Our role is to assess, document, and restore your property to its pre-loss condition using certified methods and equipment.