M&S Pet Insurance T&Cs

Sooz00

In light of everything happening with Halifax/Lloyds etc. I'm quite anxious about my policy so I have been reading through the T&Cs. I've come across an exclusion I don't completely understand so I'm hoping for some help.

I have M&S premier cover (provided by Royal & Sun Alliance) which was taken out as 'lifetime cover' in 2008 (I have documentation stating this). In December 2010, my renewal details stops mentioning the term 'lifetime cover' but equally don't state that it isn't. The new term used is 'long term'.

Premiums have been £214.08 for 2008-2009, £275.88 for 2009-2010, £359.88 for 2010-2011 and £407.88 for 2011-2012, I have only made one claim of 381.14 less my excess for an infected dew claw in June 2009.

I bought the policy because it was lifetime cover and at the time, the cover was comparable to Petplan but less expensive and covered both complementary therapy and holiday cancellation. I also believed M&S would be a brand I could trust, particularly as there were a lot of lesser known providers around at the time. I have already had problem with them on the complementary therapy front as their definition of 'hydrotherapy' is different to most. Also, I believed their holiday cancellation would cover holiday anywhere but it turn out it's just Europe.

Anyway, on my 2010-2011 renewal, there was an enclosed sheet 'M&S Pet Insurance - Important changes to your policy booklet'. On this is a 'New Exclusion' which states 'The cost of any veterinary treatment if a claim has not been made within 12 months of your pet receiving it first treatment.'

My question is - what does that mean? At the time I thought it meant that if my dog was ill and I didn't put a claim in within 12 months, then they would not pay it. However, I'm now worried it means something else - i.e. that if they have been diagnosed with an illness or condition, which may not need any treatment at the time, but could possibly need it years down the line, then that is not covered because the treatment was not within 12 months of the first diagnosis or treatment.

If the latter, my dogs may well not even be covered... one has a lump that my vet thinks is probably nothing (but wont guarantee it and wants to monitor it). The other dog has a joint condition in her back legs which I buy supplements for online. She also has painkillers if needed. I don't claim for these as the cost isn't as much as the excess. They did say either may need ops at a later date though.

I'm really hoping this makes sense as I'm not finding it the easiest thing to explain. I'd really appreciate any help.

InsideInsurance

I would interprit it as it is written, ie the claim must be made within 12 months of the first treatment and not that the first treatment must be made within 12 months of the symptom/ diagnosis.

It would be worth to check in the policy wording if there is any definition of "treatment" or explicitly "first treatment" to ensure that a simple diagnosis or the investigations for a diagnosis arent considered treatment.

Sooz00

Thank you. I've just checked and there is no definition for 'treatment' or 'first treatment'. There i a definition for 'veterinary treatment' though:

'Veterinary treatment
means any examination, consultation, advice, tests, x-rays, medication, surgery, nursing and care provided by a vet or an employee of a veterinary practice under a vet' supervision. This also includes homeopathy, acupuncture and any other treatment a vet is authorised to carry out.'

... that seems to imply that they do consider those things treatment... what does that mean? I am really very concerned.

InsideInsurance

So from the wording of the policy it would read that the initial diagnosis counts as treatment and therefore would have to be claimed for to ensure that subsequent later claims are to be accepted.

Always best to check with the insurer to make sure. Whilst you can successfully argue policywordings meaning plain english -v- underwriters intention, it is generally easier to find out how they intend to apply it up front and decide if the product is still suitable or not than wait til you have to claim to do it

Sooz00

I just gave them a call and was put through to the claim department. I'm just as confused as before & they wont put what they've said in writing. She did say that it's a recorded line and for me to take a note of time/date/who I spoke to as it could be retrieved if needed. The recorded line doesn't reassure me as I was sold the policy on the basis that hydrotherapy was covered for any problem (whereas the policy document says otherwise) and when I asked them to trace my call to their sales people, they couldn't find it!

Anyway, the lady I spoke to basically said that claims for anything suspected/diagnosed needed to be in within 12 months for them to be covered otherwise they would not pay. She gave me an example which said, if a dog gets diabetes but the owner doesn't claim for treatment for 2 years, they wont cover the treatment. With reference to my two, she said that my girl's joint problem is on their records so will be covered. With my boy, I mentioned the lump on his side and said that the vet wasn't worried and that they did a needle biospy and weren't worried by the results. I said it came to about £40 or something so obviously I didn't put a claim in as it was less than the excess. I asked what would happen if it became something to worry about and she said it would be covered.

I don't understand to be honest as the test for the lump was over 12 months ago so according to her diabetes example, I wouldn't be covered but she aid I would be. Very confused to say the least. Don't know where to take it from here because they wouldn't put it in writing.