Tesco Pet insurance - Policy Wording

uberalles

Hello all.
Not sure what I am expecting to get out of this except to make others aware of the problems I am having in getting Tesco to pay a legitimate claim. However if any body has any helpful comments I'd be grateful.
I've also posted this in the Pet Forum.

Here goes with the details:-

• Melvin our SBT had Pet Insurance with Tesco from 13 August 2010 until 12 August 2011.
• On the 25 July 2011 I advised Tesco I would not be renewing as they had added 60% to the premium for the next year. I advised I'd go elsewhere from 13th August 2011, which I did.
• On the 12th August2011 Melvin was out with me until 1900 hrs and he pulled up whilst running, carrying his rear leg. He has done this before, I think of it as when a human may twist an ankle, tread on a stone, etc etc
• At home one hour later and he is still carrying the leg. I look at it and tell my wife I think he has broken a toe.
• I decide to call the Tesco Clain Line at 2035pm to report his injury. The offices are shut and the answerphone advises they'll be back in the morning.
• Having been a victim of Tesco in the past I decide that I must speak to somebody and get through to various parts of Tesco Ins. and ask them to take details. Two employess were sympathetic and took details and I got their names. One person discussed with me if I felt it required an emergency vet for Melvin to which I replied he is not crying and that I felt he was in discomfort rather than pain. We concurred that it could wait until Saturday, my big mistake.
• At 0830 hrs Saturday 13th August I took him to the vets where he was diagnosed and treated for a broken toe.
• I put in a claim to which Tesco have quoted an item from the policy that says this "You will only be able to receive refunds for treatment whilst you continue to pay the monthly premiums and the policy is in force"

Okay, I cannot refute the above term in the policy wording, although I was not aware of it, but it really does not sound fair to me.
My thoughts as follows:-

• In that instance the length of insurance is only as long as the timeframes allow you to get a vet. Using my example, if I had called the emergency vet at 2100 hrs on the 12th (when still covered), but he got out to me at 0001hrs on 13th August I still would not be covered for payout.
• The policy does not really allow for switching to another insurance provider unless you overlap with dates. Therefore you could argue you are not getting one full year of insurance each time.
• Do all Pet Insurance policies have this term?
• Could I therefore claim under my new insurance provider? I doubt it.
• I advised Tesco that whilst I cannot refute the policy terms that it makes a mockery of the whole thing. Why would I bother to get insurance. I'd just wait until something unfortunate may happen to poor Melvin, get insurance coverage, then have him treated.
• Tesco (or the RSA Underwriters) asked me why I bothered trying to speak to Tesco on the eveing of the 12th but then in their refusal note state they have never heard of the individuals I named.

Not sure what else to add except to say I'm not best pleased.
Sorry for a long post. It may help some and some may be able to help me.

dacouch

They are not interpreting the wording correctly, it is designed to not pay claims were customers default on their instalments / the policy has expired.

You have a contract with them to pay valid claims that occur within the twelve months of your policy cover providing you continue paying the premiums.

Send them a letter titled "Official Complaint" by recorded delivery letter stating the facts etc.

uberalles

dacouch wrote: »

They are not interpreting the wording correctly, it is designed to not pay claims were customers default on their instalments / the policy has expired.

You have a contract with them to pay valid claims that occur within the twelve months of your policy cover providing you continue paying the premiums.

Send them a letter titled "Official Complaint" by recorded delivery letter stating the facts etc.

Hello dacouch

Now that is very interesting and makes for a far more logical interpretation, thank you.

I will follow your advice.

dacouch

Unfortunately to reduce costs, many Insurers made their more experienced staff redundant as their wages were higher. They replaced them with inexperienced staff who cost much less. This means they often have very little understanding of the product they are selling or handling claims.

Write a nice well worded and concise letter, mention that if you do not receive satisfaction your next step will be the Insurance Ombudsman.

Post back if you need any more advice

uberalles

An update - payout received. Below the ++++ line is what I just posted on the Pet Insurance board in this thread :-

https://forums.moneysavingexpert.com/discussion/comment/47842695#Comment_47842695

A very big thank you to dacouch.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Whilst I had suspicions that the terms of the insurance, as explained to me by RSA as current underwriters of Tesco Pet Insurance, was wrong, I owe a big Thank you to forum member dacouch who offered advice through this thread, Thank you.

https://forums.moneysavingexpert.com/discussion/3560405

• The main problem I had, I was to find out, is that when I called Tesco Pet Insurance to claim I was put through to underwriters RSA. They were correct that I was not insured with them as the underwriters Tesco used when I took out the policy were UKI. That was not my fault, as far as I was concerned my contract was with Tesco, and every letter I had from them had the Tesco Bank logo, not RSA or UKI.
• However, whilst RSA were correct, as stated in my first point, they were fully incorrect in their assessment of the policy wording, as explained by dacouch.
• I didn't send any letters I emailed the CEO and within days had a member of the Tesco Executive Complaints Team assisting me, he was very good to be fair
• At first he concurred with me that the policy wording had been misinterpreted and UKI would definitely had paid out without incident. At this stage he said that he believed that RSA still believed that they were correct in their interpretation of the wording, however he agreed that it did not make sense. He agreed to investigate
• His conclusion was that both insurers would ordinarily interpret the wording in just the same way that Car and House insurance is, in the same manner dacouch mentioned, and they would payout. However I asked for this in writing and he added a slight caveat in the wording he used by stating something akin to "for everyday incidents like a broken toe then payment is expected". I guess what he is saying is that these type of incidents are always going to be 'one off' claims whereas ongoing illnesses/treatments might not be covered
• So four months after the claim I received payout. Before I had a chance to ask what they were going to offer me for the inconvenience I had gone through, a £50 gift card dropped through my door.

So, in summary, I would like to thank you all for help and I appreciate your viewpoints and input.
I would however say that it is worth challenging the interpretation of the wording as I have always felt that Pet Insurance should not differ to Car Insurance etc when dealing with the timeframes of claims and the experiences I had.

Cheers.

dacouch

That's a great result and a valid claim was paid.

You did a lot to help yourself in a fairly unusual situation by leaving an auditable trail eg by speaking to different Tesco staff AND having the foresight to take a NOTE OF THEIR NAMES. Without this it may have been difficult proving the incident actually happened when the Tesco policy was operative.

I'm guessing your time with MSE has taught you to send a concise and polite complaint letter rather than a long rant which also greatly improves your chances of your complaint being taken seriously before having to take the Ombudsman route.

Well done and thanks for giving us an update