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Sainsburys Pet Insurance - Any excuse not to pay out
Annie._2
Posts: 516 Forumite
The only thing that Sainsburys Pet Insurance is good at is to find any excuse to avoid paying.
I have two rescue cats.
Last year one of the cats had a stomach problem which turned out to be nothing more than constipation. The poor cat was unable to eat and straining to go to use the litter tray.
Fortunately, I had taken out Sainsburys Pet Insurance six months previously. The vet diagnosed a swollen abdomen and was able to feel the lumps in his stomach and took him in. Due to being unable to eat, he was out on a drip until the contents of his stomach cleared.
I claimed through Sainsbury's Pet Insurance and all went well.
Unfortunately, within a year, the poor boy picked up an infection. He was hot, his bed was wet with sweat as was his coat. He was unable to stand, did not want to be touched and was very ill.
The vet diagnosed an infection, he was taken in, put on a drip for the dehydration and given antiboitics.
I submitted the claim to Sainsbury and it has been rejected on the grounds of it being the same condition. This is despite the vets report to say that the treatments were unrelated.
Where do I go from here ? Its a genuine valid claim.
I have two rescue cats.
Last year one of the cats had a stomach problem which turned out to be nothing more than constipation. The poor cat was unable to eat and straining to go to use the litter tray.
Fortunately, I had taken out Sainsburys Pet Insurance six months previously. The vet diagnosed a swollen abdomen and was able to feel the lumps in his stomach and took him in. Due to being unable to eat, he was out on a drip until the contents of his stomach cleared.
I claimed through Sainsbury's Pet Insurance and all went well.
Unfortunately, within a year, the poor boy picked up an infection. He was hot, his bed was wet with sweat as was his coat. He was unable to stand, did not want to be touched and was very ill.
The vet diagnosed an infection, he was taken in, put on a drip for the dehydration and given antiboitics.
I submitted the claim to Sainsbury and it has been rejected on the grounds of it being the same condition. This is despite the vets report to say that the treatments were unrelated.
Where do I go from here ? Its a genuine valid claim.
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Comments
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What did Sainsburys say on the renewal documents you receive in between the claims.
The cheaper policies eg non "Life time" policies typically apply exclusions to existing conditions / treatments they have paid for in the previous year's cover?0 -
It excluded any previous conditions, but this was an unrelated condition as submitted in the vets report.0
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No.
It was an infection. The first treatment was for a stomach problem.
As far as Sainsburys were concerned, it was a pre existing condition and an exclusion.
He had a high temperature, he was wet with sweat, could not eat, did not want to be touched and was shivering.
The only thing was being put on a drip which is standard to counteract dehydration.0 -
What was the exact wording of the exclusion they placed on your renewal?0
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'Your insurance policy does not cover any pre existing conditions. If your pet was ill or injured at any time before your insurance started, we will not cover any claim relating to that illness or injury. Please read your Terms and Conditions for full details.
This animal is added to the policy from 7.4.14.
Your insurance does not cover any illness which starts in the first 14 days of your pets first policy year or any pre existing conditions. If your pet was ill or injured before the cover for this pet started, we will not cover and claim relating to that illness or injury.'0 -
If the Vet states it has no connection with the condition they have already paid out for or any other pre existing conditions from before the pet was added or any conditions you have not claimed for. Then you should make an "Official Complaint" to Sainsburys.
If possible include a report from the Vet confirming this (Sainsburys will not cover the cost of the Vet's report but may pay for it if the claim is accepted).
They must properly investigate the complaint and report back to you within eight weeks. If you're still not happy you can then take the matter to the Ombudsman.
For best results to a complaint, keep the letter as concise as possible, avoid using too much emotion and identify the outcome you would be happy with.0 -
If the Vet states it has no connection with the condition they have already paid out for or any other pre existing conditions from before the pet was added or any conditions you have not claimed for. Then you should make an "Official Complaint" to Sainsburys.
If possible include a report from the Vet confirming this (Sainsburys will not cover the cost of the Vet's report but may pay for it if the claim is accepted).
They must properly investigate the complaint and report back to you within eight weeks. If you're still not happy you can then take the matter to the Ombudsman.
For best results to a complaint, keep the letter as concise as possible, avoid using too much emotion and identify the outcome you would be happy with.
Totally agree... and if you have to take the matter to the Ombudsman Sainsburys will have to show that in all probability the two cases are connected. Your vet's opinion that they are not connected is a big plus in your favour.
For example in a recent case ruled on by the Financial Ombudsman (where Allianz claimed two cases of diarrhoea were connected).. the Financial Ombudsman's case report says
"As the party seeking to rely on the exclusion, Allianz has the burden of proof. Yet it’s provided no comparable expert evidence to counter the report and independent opinion of Mr M’s vet. It’s simply not enough for Allianz to assert that the report contains assumptions. The report has the evidential weight of expert veterinary opinion, so can’t reasonably be undermined just by the opinions of insurance claims-handlers (however experienced they may be in pet insurance). It’s well-established that tribunals shouldn’t substitute their own opinions, much less opinions of the lay parties involved, for those of expert witnesses."
You might be interested to read the full case report here. All cases are examined individually by the Financial Ombudsman and this is of course just one example.. but I think does show that it is Allianz who will have to prove the two cases are connected!
http://www.ombudsman-decisions.org.uk/viewPDF.aspx?FileID=924690 -
And switch to a decent insurer who offer lifetime cover and don't add on exclusions every year! Although those two conditions would be excluded, any new ones wuoldn't.Changing the world, one sarcastic comment at a time.0
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And switch to a decent insurer who offer lifetime cover and don't add on exclusions every year! Although those two conditions would be excluded, any new ones wuoldn't.
A Lifetime Cover provider would not (Normally) exclude the two conditions, that's the whole point of a lifetime policy0
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