Tesco pet insurance - refusal to pay

Henry1234

Hi,

I have been with tesco for approx 4 years. I took out their maximum cover, which is £4,000 per condition. A year ago my dog suffered a prolapsed disc - the bill came to approx £5000, so we put a claim in and tesco paid £4000 back.

They have since increased their cover to £7500. Our dog has just suffered a further prolapsed disc, and the vets removed 2 discs this time. We have put a claim in for this, but it was declined straight away as they state it is the same diagnosis, and we have already reached the maximum pay out.

I'm after some advice please. The condition was
Obviously due to a different disc, and I took out their maximum cover, which has now been increased. Is there anything I can do to appeal their decision? Given that i took the maximum cover and they have now increased this (to almost double the amount) does this demonstrate a flaw in their policy which could be contested? I was shocked at the cost of the operation, but assumed the maximum cover would have been sufficient when originally taking the policy out. Thank you.

Quentin

Henry1234 wrote: »

Is there anything I can do to appeal their decision?...

You can appeal their decision, and if not happy with their answer complain and escalate the matter along their complaints procedure. You can then use the FOS if you are unhappy with their final response.

The complaints procedure will be set out in the policy document.

opensomehours

Henry1234 wrote: »

Hi,

I have been with tesco for approx 4 years. I took out their maximum cover, which is £4,000 per condition. A year ago my dog suffered a prolapsed disc - the bill came to approx £5000, so we put a claim in and tesco paid £4000 back.

They have since increased their cover to £7500. Our dog has just suffered a further prolapsed disc, and the vets removed 2 discs this time. We have put a claim in for this, but it was declined straight away as they state it is the same diagnosis, and we have already reached the maximum pay out.

I'm after some advice please. The condition was
Obviously due to a different disc, and I took out their maximum cover, which has now been increased. Is there anything I can do to appeal their decision? Given that i took the maximum cover and they have now increased this (to almost double the amount) does this demonstrate a flaw in their policy which could be contested? I was shocked at the cost of the operation, but assumed the maximum cover would have been sufficient when originally taking the policy out. Thank you.

I've just taken a look at their policy and this maybe useful (if you havent already seen it).

Take a look at step one, two and three for their claim complaints procedure:

tescobank.com/assets/sections/petins/pdf/tesco-pet-policy-booklet-Nov11.pdf.

Best of luck.

Henry1234

Thank you both for the very prompt responses. I'm after advice more around whether or not anyone believes the decision can be contested, based on the info I provided or from past experience. I know it's a tricky one, but will definitely pursue the escalation processes you have detailed. Thanks again.

Bigun28

I’ve got a similar issue at the moment. My 15 yr old Cocker Spaniel has been insured with Tesco for at least the last 10 years, if not more, and we have never claimed for anything with him. However, he has now developed cataracts and we were looking at the possibility of having them removed under their insurance cover.

When we enquired about what cover was available on our policy, Tesco spoke with our Vets and discovered that about 6 years ago, my dog suffered from a bit of Dry Eye and was prescribed an ointment to put into his eyes. At the time, the Vet also said it would be cheaper to buy the ointment off of the web, which we did, and every so often we use he ointment when he has a bit of a dry eye. Not frequently, just every few months or so at most.

But of note, we never informed Tesco of the issue because the cost was under the excess value, and it was a one-off prescription from the Vet.

Because of this previous prescription, Tesco now inform us that we cannot claim for another eye condition, such as having the cataracts removed, even though we never claimed on the policy. So now after all these years when we need the policy, Tesco have found a way out of paying for my dogs cataracts to be removed.

Quentin

Randal wrote: »

.........Because of this previous prescription, Tesco now inform us that we cannot claim for another eye condition, such as having the cataracts removed, even though we never claimed on the policy. So now after all these years when we need the policy, Tesco have found a way out of paying for my dogs cataracts to be removed.

It's not because of the previous prescription they are refusing your claim, but because you did not disclose this (as you had agreed when taking out the policy):

We will not cover any treatment for a condition if:
• you have not told us about the condition within three months of your pet’s first treatment for the condition;

You always risk getting an insurance policy voided if you breach a relevant condition.

rs65

Henry1234 wrote: »

I'm after advice more around whether or not anyone believes the decision can be contested, based on the info I provided or from past experience.

It looks like its a choice of £4000 or £7500 so I don't think you would automatically be entitled to it.

For Extra cover you can choose between two cover level limit options of either £4,000 or £7,500

Henry1234

Hi, this is a new option - they have recently increased their level of cover to £7500. This is only available for new conditions, so would not be applicable on their decision (I.e recurring condition).

ihateyes

it beggers belief.

if OP is in a New 12month period, then the values should surely be reset to zero.

but then again, the insurers are shafting us every possible way!

Bigun28

Quentin wrote: »

It's not because of the previous prescription they are refusing your claim, but because you did not disclose this (as you had agreed when taking out the policy):



You always risk getting an insurance policy voided if you breach a relevant condition.

Thanks for the response and I hear what you are saying. But the way Tesco have put it, because he has already had treatment on his eyes, albeit for a dry eye condition (totally unrelated to his current cateracts), I can no longer claim anything to do with his eyes, no matter what the problem is.

So he had a minor conditon (dry eye), which we didn't claim for because it was minor and under the excess amount. The Vet is now saying that the cateracts are a totally seperate thing, but because they are eye related, Tesco won't pay because of the earlier dry eye condition.

I think back to the times through the years that he cut himself out on a run, or broke a nail or had an injection, and we didn't think it worthy enough to tell the insurance, because they were all minor ailments. It seems that the Tesco policy is saying 'Ok, broke a nail. That now excludes all his feet and legs from our insurance. Cut himself? That now excludes anything to do with his body' etc.

marliepanda

ihateyes wrote: »

it beggers belief.

if OP is in a New 12month period, then the values should surely be reset to zero.

but then again, the insurers are shafting us every possible way!

Most pet insurance companies offer per condition amounts, not 'per year' amounts. So if your animal gets a long lasting illness, once you hit your limit thats it on that illness, you are out of cover.

Thats why I went with petplan, as it is £6000 per year, not per condition.