More Than Pet Insurance refusing 11K Claim

mistylynmouth

Hello,

Have a bit of a problem in regards to our pet insurance refusing to pay our vet bills which add up to 11k!

We got our puppy and all was fine (took her for her puppy check up and first vaccinations etc) and took out a premium choice insurance policy with More Than - which did up to 12k a year cover. We took this out on the 29th of October. We were aware of the 14 day "induction period" in which claims in this time would not be covered etc.

Our puppy got sick on the 16th of November. We know the exact date due to the 15th being my brothers Birthday and we originally thought she must of pick something up at the birthday tea and got sick. But the next two days (over the weekend) she was very ill and on the sunday - the 17th of November we took her to our vets.

To cut a long story short she was VERY ill, to the point we thought we would loose her. She had lots of tests and exploration surgery and finally diagnosed with Megaesophagus. She was then transferred over to a specialist in Birmingham to have a feeding tube fitted in december.

Now before the tube was fitted - this specialist centre phoned up our insurance company, told them the situation and that the bill would be 5k and was it ok to go ahead etc. And they said yes.

Now thankfully she has had her tube removed and the Megaesophagus seems to have resolved itself (which is very rare as in a 2 - 5 percent chance) and she is very healthy and our miracle baby!

Now, More Than have been dragging their heels over this insurance claim and talked to everyone and in ours (and the vets) personal opinion they have been trying everything to wriggle out of paying - as it has been 5 months!

Now they have refused to pay the claim at all stating that she got sick on the 11th of November and for 48 hours were on the induction period. Well this is a lie as i stated we know the exact date so we asked them were they have this information to which they responded the vets notes.

We then phoned our vets (we have 4 dogs - all insured - so we know the vets on a first name basis) and they told us that on the notes that the vet we saw on the sunday put, was that we had said she was throwing up for a week.

Now we took her into the emergency hospital sunday evening and the vet herself stated that she had to go get our pup settled into her crate and then come back and write her notes and she said herself that she normally rounds up the number of days the symptoms have been present. She even went and phoned up More than and informed them that her notes were written a while later and its custom for vets to round up dates etc and that her notes may not be accurate etc but they are still refusing!

We have sent them photos of our pup at the birthday tea showing that she was happy and healthy etc but they just simply dont want to pay. Its so frustrating as we specifically no the date she was ill, the fact the vets argree they round up and may have the dates wrong and that if she had been throwing up for a week we would have taken her in sooner and she would have been in a much worse state.

Now the vets bill is a total of 11 thousand pounds and we are at a loss as to what to do!

Any help appreciated!! :(:(:(

Tashatutuw

Nothing constructive to offer OP I'm afraid but I sincerely hope that you get this sorted and that your pup remains healthy and well. Thinking of you.

olias

Not sure whether it will help, but if the vet has admitted putting 'incorrect' information on the notes, and this has directly resulted in the insurance claim being refused, then would the vet not be liable?

Olias

Katiehound

Has the vet contacted the insurers direct and stated that they have made a mistake- they have consulted their notes..? in writing I mean, because anyone can say anything in a phone call.

zaksmum

Katiehound wrote: »

Has the vet contacted the insurers direct and stated that they have made a mistake- they have consulted their notes..? in writing I mean, because anyone can say anything in a phone call.

I think this would be the best course of action for you, OP.

Ask the vet to put in writing that the dates given were incorrect and supply the right dates.

Tell More Than you will contact the Insurance Ombudsman if they persist in dismissing your claim.

dispossessed

I don't know what is common practice in Veterinary Medicine but in Human Medicine we NEVER "round-up" dates. Clinical notes are legal documents and accuracy is of paramount importance. This applies just as much to Veterinary case notes as those of the human variety.

In human medicine, if someone states they have been vomiting for X number of days, then that is what is written down. Often this is expressed as an imperial fraction such as "5/7" for five days or "1/52" for a week (such practise is slightly frowned upon but old habits etc....).

Obviously, if the patient is unsure as to the precise number of days, then we usually prefix it with the Latin word "Circa". It is just as acceptable to use words such as "about", "in the region of" etc.

Without giving too much away about me - I recently dealt with a similar case (albeit with people not animals). A G.P. had been rather slap-dash in completing the paperwork for an insurance company and this led to a refusal to settle a claim for £3,500

Ultimately, the GP admitted their error (in writing) to the insurance company, completed a new set of paperwork, and the insurance were happy to settle the claim.

As modern case notes are invariably kept digitally (i.e. on computer) the operating system (e.g. Windows XP) will automatically "date-stamp" the time of the documents creation (right-click, "properties"). Obviously this only works as supporting evidence to when a record was created or modified rather than the event to which it refers but, occasionally, this feature can be helpful.

As recording 'phone calls (ostensibly "for training purposes") is something of standard practice within the Insurance industry, they almost certainly have a record of the 'phone call with your veterinary specialist (where the sum of £5,000 was ageed upon). These 'phone records are "digitally signed" (to prevent tampering) and are normally retained for at least three (and more usually 6 to 8) years. I would be inclined to draw their attention to this fact.

I hope this may be of some help.

Hillbilly2

As a vet nurse I have never heard of this "rounding up". It sounds like the vet trying to get out of making a mistake in writing up notes.


Best practice is to write the notes there and then - unless the patient crashes of course!


Usually histories would start with "owner reports V+ for 24hrs" or similar, as this is information the vet is relying on some one telling them.

Paulaviki

Write them a succinct letter explaining the reasons why you feel the claim should be paid and make it clear this is a complaint. They will then have 8 weeks to investigate the case and issue you a final response. If they still won't pay then you can go to the ombudsmen.

Unless you have knowingly withheld information or tried to change dates to make the claim eligible (which they'd have to evidence) I fail to see how they can retract the agreement to cover the £5k agreed as a minimum. Just be aware you might not get the full amount paid if this was all they agreed.