axa pet insurance

honey06

hi,

my friend has a puppy who has been insured with this company- he took the policy out based on it being lifetime cover, supposedly good terms etc and had it in place from getting the puppy.
She was diagnosed with a serious heart murmur and apparently needs an op- around £7k!! :eek:

AXA are refusing to cover the claim as they say its a pre-existing condition. I dont agree- yes its congenital as in she was born with it, but there were no signs and it was only diagnosed when he took her to the vet a few weeks after taking the policy out.

THe wording on the policy under excluisions is any pre-existing medical conditions or conditions which show symptoms within 14 days of policy starting. (no mention of congenital)
they say its pre-existing as she had it from birth..:mad:
though she showed no signs at all and it was only diagnosed when taking her for her routine vaccinations


However, money.co.uk website shows their policy as covering congenital and hereditary conditions.
as does Debenhams, esure and several other policies all underwritten by AXA insurance.
the person spoken to on the phone said they are different companies and would therefore have their own terms and conditions (even though the wording on the policy documents is the same????)
and that they consider the report from the vet about the condition and will cover it after 2 years if there havent been any ongoing symptoms.

I have said he should escalate his complaint to the Head of customer care at AXA insurance (the same details are on all the above noted policies)

has anyone else had any experience of this or claiming for congenital conditions from AXA insurance?
an example of a case where they had upheld a claim would be great, or suggestions as to how to progress this

CFC

I think your friend's first step is to call back and ask to speak to the complaints department. The person who took your friend's call may have given the wrong advice. If he's already had the decision in writing he needs to register a complaint and ask for it to be investigated.

honey06

hi CFC,

he has a letter fromt he managing director saying the claim is not covered as the illness showed signs and symptoms prior to the start of the policy.

She did not have any signs or symptoms (and still doesnt!)
and the first examination by a vet for her first vaccination over 2 weeks after the policy was taken out.
Heart mumurs are generally only picked up on examination by a vet so he wouldnt have known.

When he spoke to them, their stance is that as she was born with it, it was pre existing (even if it wasnt known about)
looking at their own definitions of condition/pre exisiting etc, there is nothing to indicate that this is described in the exclusions- there were no clinical signs of illness and she hadnt been seen by a vet, she appears perfectly healthy and happy.

A letter to the head of customer care at AXA insurance is the next step....

CFC

I'm with Axa and just had my renewal notice through - I have read the policy document and it says nothing about congenital conditions. The definition of pre-existing that they have used with your friend seems very strange - any dog could have a problem that only just got discovered. Im going to call them tomorrow and quiz them, they may not be the insurer I want to have now I have read this.

Is this a mongrel pooch or bought from breeder? If from a breeder I could understand that they may be suspicious that the breeder knew about it already, but that doesn't necessarily follow that they advise a purchaser of the issue

If you have a letter from the MD turning down the claim then your friend's next step is to tell AXA that he/she is officially complaining, particularly in relation to their obligation to Treat Customers Fairly, as you congenital conditions are not mentioned and that pre-existing is not being fully defined in the policy document ie common practice is to exclude pre-existing conditions which are known about already. As it is impossible to prove that many problems other than accidents are not pre existing, although not yet diagnosed, they should be further defining this in the policy statement. Your friend should call the FSA helpline for advice as to how to complain further if this complaint is not resolved to your friends' satisfaction.

honey06

hi CFC,

before taking the policy out, it was a question that he asked customer services and they said hereditary and congenital conditions are covered.
(reason he thought to ask was from shopping around he noticed some of the policies which axa underwrite, including debenhams, esure etc have website FAQs saying they do cover hereditary and congenital provided they havent already been discovered, so he checked with AXA customer services, was told they did so he went with them direct)

I think it was from a breeder, she was and is apparently perfectly healthy and showed no signs of being ill.

the definitions in their policy do give clarification on how they define pre existing- and refer to clinical signs (ie changes from normal healthy state etc) none of which are applicable in this case. It may have been present from birth and so by default must be pre-existing but was unknown and undiscovered, so under their terms and definitions was not pre-existing.
I kinda knew about the FSA regs in relation to PPI misselling (thanks to MSE :T) and checked with the FOS and FSA yesterday on his behalf and they were very helpful and supportive.

He has made some progress yesterday I believe, thanks to his vet speaking to this MD by telephone and it is going back for re-assessment- (not ideal as its another delay) Apparently this "MD" didnt know what congenital meant!!!

CFC

Glad it looks like it is being sorted out. I had an interesting phone convo with one of their advisors, at one point I had to tell her that I didn't expect her to be a medical expert, but I did expect her to be able to explain to me what the insurance actually covered - I felt that the advisor wasn't really sure. However at the end of it she did have to confirm that 'pre-existing' meant either something you knew was a problem even if not diagnosed, or had been diagnosed by the vet. If your friend gets further gyp from Axa he/she should ask for the call recording to be listened to if he/she actually asked about congenital conditions and was told they are covered!

forestlands

Thanks for the great posts folks! Very pleased the little pup getting his op. Loads of good wishes for a speedy recovery and long and happy life!

Have a claim going with Axa. :mad: Keep some rare breed sheep. Eddie, my ram, broke a leg when 2 dogs got into his field and chased him and his companions. The dogs had a previous history of killing livestock. Vet was called and initial cost of treatment was put at around £400. Owner of dogs offered to claim from her Axa house insurance.

Eddie was hand reared and is a pet as well as a registered rare breed sheep. Eddie is resistant to scrapie and registered exempt from any livestock cull under EU regulations due to the risk status of his breed.

Total cost of treatment £6.000 including Xrays etc. Fracture was found to be very complicated and required a plate fixing to repair it. Thanks to the Royal Vet College:T Ed has made a full recovery and will be ready to earn his keep this summer. He has 10 or more good years of life in front of him and is back with his family and his special friend Raggie who he grew up with.

Axa's answer is that Eddie should have been written off and another ram purchased for £100, claim their researchers have found one - I don't think so. Eddies unique statue makes that very difficult, which is why the E.U. give protection to his breed.

Eddie is a much loved sheep, whole family love him especially the younger ones, would not part with him and planned to go on spinning his fleece for many years.

Was very surprised that Axa should consider that Eddie should be "written off" so looked for posts to see how other folk found Axa. Will not be considering taking our pet insurance with them :eek:

Any suggestions as to where to go from here - I have got a solicitor, will be most welcome!!

CFC

Crikey that's a difficult one, I do think you'll have to speak to a solicitor. The trouble with owning an unusual animal to keep as a pet is that the law around them probably isn't as clear and obviously AXA are treating it as a normal sheep. How much would it cost to replace Eddie with the same breed, there must be other breeders or Eddie wouldn't exist - because that presumably is the actual market value for him, I should have thought there would be no issues at least about them paying up to that amount. (Ie you might need a proper livestock valuation if there is only a tiny market)

honey06

hi,

my friends claim is by no means sorted yet...

they agreed to reassess it. he asked them when he could expect a response he was told they were currently dealing with claims from 15th december!!!
his vet got in touch, explained the life threatening nature of her illness and after much pressure got it moved to next in line but my friend STILL hasnt had a response from them!!! :mad::mad::mad:

the claim was submitted over a month ago now....

Pixiechic

Sorry I have no advice to give, just a thank you for sharing experiences as I was pretty sure that I would go with AXA for pet insurance and will follow this thread as doesn't seem like such a great option now. I thought that they were one of the best for lifetime cover! I really hope things get sorted properly for both pets. Its heartbreaking to think that the peace of mind that you pay for will essentially not take care of much loved pets.