An insurance industry insider who spent a decade working behind the scenes has revealed the companies he would never trust with his own money, warning that Aussies risk being left stressed and out of pocket when disaster strikes.
Luke Dugdell spent 10 years working in risk and compliance teams at major banks and insurance companies, describing his former role as the ‘internal police’.
But after climbing the corporate ladder, he became increasingly disillusioned with what he claims was the treatment of everyday Australians trying to get their insurance claims paid.
After years of watching consumers ‘being taken advantage of’, he decided to walk away from the industry and fight for the people he once watched struggle.
Dugdell is now the founder and managing director of Claims Hero, a company that helps Aussies take on insurers when their claims are delayed, underpaid or denied.
Speaking on the Karl Stefanovic Show, the former industry insider pulled no punches as he revealed the companies on his personal ‘insurance hit list’.
At the top of his list were brands operated by insurance giant Auto & General, including Budget Direct, Qantas Insurance and Coles Insurance.
‘The ones that would be on my list, I think Auto & General, so Budget Direct, Qantas Insurance, Coles Insurance, those are the brands,’ Dugdell told Stefanovic.
‘They’re Just not an insurer that I personally would want to be with if I found myself in that situation.’
Luke Dugdell spent 10 years working in risk and compliance teams at major banks and insurance companies
Dugdell warned that one of the most troubling practices he had encountered was insurers withholding crucial information from customers, potentially leaving homeowners in the dark about problems with their properties.
‘The conduct that we see on some of the claims that we manage is that, you know, they have reports and information, and they just refuse to provide it to a consumer,’ he said.
He pointed to an ongoing case in which a homeowner was kept in the dark for two years about a document outlining restoration work that may have been needed to address mould at their property.
‘We only identified it two years later that they actually had that quote and scope, which is telling them likely that there was mould in the property and they needed to deal with it,’ Dugdell said.
Despite repeated attempts to obtain the document, Dugdell claimed the insurer refused to hand it over, even when requests were made under the General Insurance Code of Practice and the Privacy Act.
‘We’ll request it under the code. We’ll request it under the Privacy Act, and they’ll say no, we’re not giving you that,’ he said.
‘And even as you go up the ranks, they just maintain that decision that there’s no good reason to give that information to a consumer.’
Dugdell did not identify the insurer involved in the case.
After years of watching consumers ‘being taken advantage of’, he decided to walk away from the industry and fight for the people he once watched struggle
Dugdell slammed the practice, arguing that insurers held too much power over customers who were often desperate to have their claims resolved.
‘Withholding information from a consumer is just unconscionable because the power imbalances is massive. That should be against the law,’ he said.
He called for tougher laws forcing insurance companies to hand over relevant documents, arguing that the current General Insurance Code of Practice allowed insurers to exploit a loophole.
‘It needs to be legislated that you have to disclose the information that you have to a consumer, not the current code that says “if we relied upon it”,’ he said.
‘It just gives them [insurance companies] an out. They go, “we didn’t rely upon it, so we’re not giving that information”. So, to me, it’s conduct like that that’s really poor.’
But withholding documents was not the only tactic Dugdell took aim at.
He also raised concerns about vaguely worded ‘good condition’ clauses buried in insurance policies, claiming they could be used to avoid paying for repairs.
According to Dugdell, some insurers use the clauses to argue that a property has not been properly maintained, leaving homeowners facing a potentially enormous repair bill before their insurance claim can be resolved.
Dugdell also named QBE as an insurer on his ‘hit list’, particularly for its use of ‘loss adjusters’
In some cases, he claimed, customers were being handed lists of maintenance work costing tens of thousands of dollars, even when the repairs were unnecessary or unrelated to their original claim.
‘The good condition terminology is so broad it just gives them basically the ability to not repair homes if they don’t want to,’ he said.
‘Often the list that we have from consumers, and we just see these letters being sent every single time, could be tens of thousands of dollars on maintenance items that probably aren’t required or don’t need to be done.’
A spokesperson for Auto & General strongly rejected Dugdell’s comments and took aim at Claims Hero, claiming the insurance advocacy firm does ‘not have a sufficient basis for its comments’.
‘We reject the claims made by Mr Dugdell on the Karl Stefanovich podcast,’ Auto & General told The Daily Mail.
‘Claims Hero is a for-profit claims management business that is driving up the cost of general insurance for Australians.’
‘Since Claims Hero’s inception in 2022, Auto & General has resolved hundreds of thousands of claims for Australians.
‘Over the same period, Auto & General has responded to 9 claims where Claims Hero acted as a claims management company for the customer. It does not have a sufficient basis for its comments.’
Auto & General took aim at Stefanovic’s podcast as well as Claims Hero, labelling the company as a ‘for-profit disaster chasers’.
‘We are disappointed that Mr Stefanovic’s podcast did not explore the issues of how Claims Hero is paid.
‘We welcome the fact that ASIC has recently announced that it will review the practices of for-profit disaster chasers.
‘We confirm that Auto & General meets its obligations under the General Insurance Code of Practice and the Privacy Act as it relates to claims documentation, when requested to provide them by our customers.’
Since 2007, Auto & General, via it related brands, is Australia’s the most award-winning general insurer.
‘A mark of confidence our customers can have in Auto & General, is that we have paid out over $2 billion on car and home insurance claims in the last 12 months.’
Dugdell also took aim at insurance giant QBE, placing it on his ‘hit list’ over what he claimed was its reliance on ‘loss adjusters’ to keep claim costs down.
Loss adjusters are responsible for investigating insurance claims, inspecting property damage and reviewing repair quotes before advising insurers on how much they should pay.
But Dugdell claimed the process could leave homeowners thousands of dollars out of pocket, alleging that some loss adjusters pressured builders to reduce their quotes.
‘We just see with insurers that rely heavily on loss adjusters that you know they’re sort of trying to reduce those costs,’ he said.
‘I’ve seen it in reports where they’ll go, a loss adjuster will take $7,000 out of a quote for a builder, or just go, “Could you remove that $7,000?” And then they’ll write to the insurer and say, “I saved you $7,000”.
‘I’m like, “No, you didn’t. You just ripped off that consumer $7,000 because they should have been paid that”.’
But his criticism of QBE did not stop there.
Dugdell also raised concerns about how the insurer investigated suspected fraud, claiming some companies subjected policyholders to intrusive questioning and demands for personal information.
‘You’ll have QBE where, honestly, some of these insurers think… their policy terms gives them rights more than the police,’ he said.
He claimed that when an insurer suspected fraud, customers could be forced to undergo filmed interviews and hand over sensitive financial and phone records or risk having their claims rejected.
‘If they have what they think is a suspicion of fraud or an inkling, they’ll make you go to a recorded interview that’s filmed,’ he said.
‘You can have a support person that can’t say anything. You got to give your bank records, your phone records, and if you say no to any of it, they’re just going to decline your claim.
‘It just angers me so much because it often causes delay and extreme stress, and it would just be over something simple.’
A spokesperson for QBE told The Daily Mail that Dugdell’s claims did not accurately reflect the insurer’s practices when it comes to a policyholder’s claim.
‘QBE is committed to treating customers fairly and respectfully, and ensuring claims are assessed on their individual circumstances and in line with the terms of the relevant policy,’ QBE said.
Dugdell warned Australians against choosing insurance policies based solely on price, arguing that a cheaper premium could come with costly consequences when it was time to make a claim.
He urged homeowners to read the fine print carefully, challenge decisions they believed were unfair and demand explanations about the information insurers used to assess their claims.
He also called for tougher laws to force greater transparency and accountability across the insurance industry, arguing that consumers deserved better protection when dealing with companies responsible for covering their losses.
