Pet Insurance Complaint - Advice needed

Kreacher

rs65 wrote: »

This bit suggests your mum knew there was a concern cover would be exhausted.

Yes, the problem arose because the policy changed. Se we have a policy that covers conditions with a £7500 renewing pot every year, my mum phoned to confirm that this would cover his existing back condition, they said it would. We proceeded with treatment.

They then informed us that because the treatment was started before the policy changed it had a lifetime limit of £6000 as stated in the old policy, not the £7500 renewing pot in the new policy.

sheramber

Kerryfd wrote: »

Yes, the problem arose because ASDA changed their policy. Se we have a policy that covers conditions with a £7500 renewing pot every year, my mum phoned to confirm that this would cover his existing back condition, they said it would. We proceeded with treatment.

They then informed us that because the treatment was started before the policy changed it had a lifetime limit of £6000 as stated in the old policy, not the £7500 renewing pot in the new policy.

What does it say in the policy documents?

That is what the Ombudsman will look at.

Was it clearly explained in your mother's policy document that pre existing conditions would not be covered by the new policy conditions?

Kreacher

sheramber wrote: »

What does it say in the policy documents?

That is what the Ombudsman will look at.

Was it clearly explained in your mother's policy document that pre existing conditions would not be covered by the new policy conditions?

I will have to find the policy, I'm sure it does in the small print, but as she was unsure she called them to confirm. Will it make no difference that the helpdesk gave her the wrong information? That is my main concern, I know that she should have read the policy carefully, but surely they are equally in the wrong for providing wrong information?

rs65

Kerryfd wrote: »

Will it make no difference that the helpdesk gave her the wrong information? That is my main concern, I know that she should have read the policy carefully, but surely they are equally in the wrong for providing wrong information?

It has made a difference - they are paying £900 for their mistake.

rs65

Kerryfd wrote: »

Yes, the problem arose because ASDA changed their policy.

What do you mean by they 'changed their policy'? Your mum's policy is the policy that she bought. It can only be changed at renewal - and by renewing she has agreed to the changes.

Kreacher

sheramber wrote: »

What does it say in the policy documents?

That is what the Ombudsman will look at.

Was it clearly explained in your mother's policy document that pre existing conditions would not be covered by the new policy conditions?

So it does explain in the policy document that existing conditions would continue to be covered up to £6000: however; in the renewal schedule, which is what my mum read which caused the confusion it doesn't state that anywhere. It does clearly state 'If you are unsure about any of the statements or information above, please call us immediately on the number provided on your covering letter'. Which is why she called to confirm, I do think they have a responsibility to give out correct information on the phone, which they didn't do and have admitted to.

Kreacher

rs65 wrote: »

What do you mean by they 'changed their policy'? Your mum's policy is the policy that she bought. It can only be changed at renewal - and by renewing she has agreed to the changes.

Yes, at renewal, sorry that's what I meant. The renewed policy has a pot of £7500 each year to treat conditions. The insurance policy schedule doesn't say that the pot is only for new conditions; it does say that in a separate policy document though. Unfortunately, when my mum phoned she only had the schedule in front of her and the call handler told her that we could use the £7500 renewing pot to treat the existing condition, so she didn't have a reason to question it. The paper she was reading confirmed what the call handler was telling her.

Kreacher

rs65 wrote: »

It has made a difference - they are paying £900 for their mistake.

Yes, but had they informed us correctly in the first place, we would have skipped the MRI and removal of the old wire and gone straight for the £3000 operation which would have left us with a bill of around £1000 (as we wouldn't have spent £2000 on MRIs and wire removal).

Because of their mistake the vet carried out the MRI and removal of the wire so that he could do a more exact operation. This cost around £2000 pushing us out of the £6000 limit and leaving us with a £3000 bill for the operation.

The problem is that the call handlers seeming small mistake will cost us over £2000.

rs65

Kerryfd wrote: »

Yes, at renewal, sorry that's what I meant. The renewed policy has a pot of £7500 each year to treat conditions. The insurance policy schedule doesn't say that the pot is only for new conditions; it does say that in a separate policy document though. Unfortunately, when my mum phoned she only had the schedule in front of her and the call handler told her that we could use the £7500 renewing pot to treat the existing condition, so she didn't have a reason to question it. The paper she was reading confirmed what the call handler was telling her.

I'm not really following this. If all she had was a renewal schedule saying she had £7500 to spend, why did she phone to query it.

Her complaint might be better aimed at the documentation rather than the advice on the phone.

Kreacher

rs65 wrote: »

I'm not really following this. If all she had was a renewal schedule saying she had £7500 to spend, why did she phone to query it.

Her complaint might be better aimed at the documentation rather than the advice on the phone.

She phoned to confirm rather than query it, as the vet advised her to. We knew this would be an expensive process and wanted to ensure we had the funds to complete it. I don't think that its unusual to want confirmation for something so major and expensive?

If she hadn't phoned and had just gone along with the schedule wording thinking we had a budget of £75000 everyone would be questioning why she didn't seek advice before proceeding.