Tesco pet insurance and Ombudsman

ineluctable

Hi. We recently made a claim through Tesco Pet Insurance which they declined because their contention is that the condition in our cat was pre-existing to the start of the policy. We disputed this through their complaints department, but the refusal was upheld. We have now taken our case to the Financial Services Ombudsman and are waiting for the outcome of their investigation - which we understand can take up to nine months. In the meantime, the veterinary practice concerned have asked us to settle the bill because out dispute is with the insurance company and not with the practice. If we do settle the bill with the practice and then the FSO finds in our favour, can Tesco still be compelled to pay us the value of the claim? The original claim form was submitted direct to Tesco by the veterinary practice.

dacouch

Paying the bill will not prejudice the Ombudsmans decision as they will look at the facts of the case.

Tesco would normally have to abide by the Ombudsmans Decision.

Out of interest how old was your cat when you took the policy out and what was the condition

ineluctable

dacouch wrote: »

Out of interest how old was your cat when you took the policy out and what was the condition

Thanks for your reply. The condition is hyperthyroidism and she's 11 years old. Tesco's refusal is based on a note recorded by the vet during a routine booster vaccination appointment - about two weeks before the start of the policy - that "the owner commented that she may have lost a bit of weight". The vet could, however - at the time of this consultation - find nothing wrong with her or any reason to conduct any tests. They simply said to keep an eye on her. Hyperthyroidism was diagnosed about six weeks later.

dacouch

Its a tricky one, not sure the ombudsman will rule in your favour as the policy says the following.

Pre-existing condition Any condition or symptoms or signs of injury, illness or disease, occurring or existing in any form prior to the start of this insurance.

Tescos are obviously going to say she showed symptoms of the condition before the policy started eg the weight loss.

Its worth going to the ombudsman though as you never know.

Oscar_The_Grouch

dacouch wrote: »

Tescos are obviously going to say she showed symptoms of the condition before the policy started eg the weight loss.
quote]

Dacouch, for once I am going to disagree with you!! This is a very rare occurrence!

I think that Tesco Insurance(I believe it's all part of RBSI who own Direct Line, Churchill, Green Flag and UK Insurance, as well as being part of the Royal Bank of Scotland and up for sale at the moment) would be unable to rely on the "symptoms" exclusion here.

My reason for saying this is that OP took the cat to the vets for a booster and made a comment about the weight loss. The vet would be considered an expert and advised them simply to keep an eye on the cat rather than "I think we need to run more tests".

The FOS will find in favour of the policyholder where there is no evidence that they would or should have known about something. At the time of taking out the policy, OP had done everything in their power to ensure that the cat was fit and well, including checking that the only issue (ie, the weight loss) was not significant. As such, they could not and should not have been aware that the cat was ill and Direct Line Insurance cannot rely on the exclusion.

Ineluctable, please let us know how you get on. If you are interested, here is a link to some of the decisions that the FOS have made in the past on pet insurance. There is one on pre-existing conditions which highlights what I'm saying from the other side (ie a case where the policyholder was aware of the conditions) which may be of interest:

http://www.financial-ombudsman.org.uk/publications/ombudsman-news/65/65-pet_insurance.html