Three crises are colliding in insurance claims-and brokers are caught in the middle
Insurers have spent heavily on claims technology, hired data scientists and integrated AI across their operations. Yet fragmented internal teams, record complaint volumes and a surge in deepfake fraud are exposing fundamental weaknesses that brokers will have to navigate for their clients.
The Australian Financial Complaints Authority received 111,373 complaints in 2025, up 14% from the prior year and the highest annual volume in its history. General insurance complaints jumped about 20% to roughly 36,000, with claim delays the leading issue and denial-of-claim disputes up 32%. The first quarter of 2026 is already on track for 120,000 complaints.
New Zealand is seeing similar pressure. Financial Services Complaints Limited reported disputes jumped 41% in the second half of 2025 compared to the same period a year earlier. The Insurance & Financial Services Ombudsman Scheme accepted 600 disputes in 2024-25, up 25% year-on-year and more than double the 2022 total, with general insurance accounting for 67% of cases.
Silos are stopping technology from working
The first problem is organisational, not technical. Only 10% of property and casualty insurers are successfully scaling AI, according to Capgemini's 2026 report. Industry analysts point to structural fragmentation rather than lack of ambition. Claims, underwriting and policy administration systems still operate separately, speaking different languages.
Nearmap's aerial imagery and AI condition scores can confirm whether damage is recent or pre-existing, or whether a customer actually completed repairs. But when this data loads into claims systems, it rarely travels upstream to pricing and underwriting teams. The data gets trapped.
"Even just the question of who we speak to is a challenge," said Nicola Brownlie, Nearmap's senior solution engineer for insurance. "When you go beyond the picture or the data itself, the question is: how do we make sure we connect it to all the right teams internally and all the right use cases?"
Few insurers have appointed a centralised team responsible for moving data across departments. Most remain siloed by function, with no single person accountable for data flow.
Complaints are accelerating because information is incomplete
The unglamorous answer to reducing complaints is information hygiene, according to Isaac Alexander, director of growth and innovation for April9, a Brisbane-based insurance software developer. "In terms of reducing the number of complaints within claims, it is largely about data continuity: getting more accurate information from the claimant from the beginning to the end."
Clients are no longer quietly accepting decisions. They are testing claim wordings, evidence requirements and communications quality-exactly the areas where a broker's documentation at placement and claims advocacy can determine renewal outcomes.
AI is creating a fraud problem while solving efficiency problems
A recent Verisk study found 99% of insurers have encountered manipulated or AI-altered documentation. Seventy-six percent said altered claims submissions have become more sophisticated in the past year.
Swiss Re's latest SONAR report warns that insurers are reporting rapidly rising use of deepfakes in claims fraud, concentrated in low-value claims-the very claims most likely to slip through automated workflows. Personal property lines are particularly exposed, with homeowners, renters and mobile home claims at highest risk because there is usually a single claimant and no witnesses.
"For me, it is how they are going to manage an ever-changing regulatory and technology space as AI continues to disrupt the world we live in," said Lincoln Grace, product manager from Wilbur, a claims management software provider. "I think that is going to have substantial effects on not only processes within insurance organizations, but also the regulatory changes that might come on the back of that."
The carriers that win will connect three dots
The carriers that win the next claims cycle will be the ones that finally connect their data across silos, communicate transparently enough to keep clients out of complaints queues and treat AI as both a productivity tool and a fraud vector.
For brokers, the pressure is immediate. Clients expect faster outcomes. Regulators expect better communication. Fraud is moving faster than detection. The next eighteen months will separate the carriers that have fixed their internal plumbing from those still waiting for the next technology purchase to solve structural problems.
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