Help Animal Friends pet insurance declined claim

SeduLOUs

sallyj17 wrote: »

For example Animal Friends define a pre-existing condition as

"any condition, symptom or sign of a condition occurring or existing in any form and at any time prior to the commencement date" or

"any illness, symptom or sign of a condition occurring or existing in any form during the first 14 days of the commencement date".

The way I see it diarrhea in it's own right is not a condition. Nor is it a symptom or sign of a condition. It's often just one of those things that happens sometimes, and 9 times out of 10 does not need vet intervention anyway.

If dog had diarrhea 'because' of an underlying gastro condition, and this condition and related symptom was recorded on the vet notes, then I can perfectly understand the gastro problem being recorded as an existing condition for the purposes of insurance. On that basis, future bouts of diarrhea that a vet has diagnosed as being related to that condition would not be covered - rightfully so.

However, separate bouts of unrelated diarrhea due to a bit of stress, eating a bit of grass etc would not be related to the 'gastro' condition (or any other condition) and should continue to be paid if vet treatment is needed.

Not an easy argument to have with an insurance company though!

Paradigm

SeduLOUs wrote: »

Not an easy argument to have with an insurance company though!

You don't argue with them, use their complaints procedure & if not satisfied take it to the Financial Ombudsman.


Insurance companies can include all the T&Cs they like but if they're ruled as unfair then they count for nothing.

sallyj17

Found this when looking at some previous pet insurance cases on the Financial Ombudsman site.

" When considering complaints about pre-existing conditions, this service considers whether the consumer had reasonable knowledge that there was something wrong with their pet which might later give cause to make a claim under the policy. It is not necessary for a diagnosis to have been made; the consumer simply needs to be aware that future treatment or further investigation may be required."

If it were me I would certainly pursue this case with AFI and then with the Ombudsman if necessary!