Heart murmur and pet insurance

sheramber

If your vet confirm that the current problem is not connected in any way to the previous diagnosis of a heart murmur and Animal Friends refuse to pay out you can proceed through the complaints procedure and to the ombudsman. If he decides in your favour then Animal Friends will have to pay out. It does not cost you anything to do this.

You can check out previous cases where the ombudsman decision was against the insurance company in cases where the vet confirmed there was no connection to a previous condition on the Financial Ombudsman website.

But , if your vet cannot say it is not connected until after more investigations then you will have to decide how to proceed- credit card, payment plan etc.?

LusciousLuce

I'm an assessor, and I'd be looking for the vet to confirm the (presumed transient) murmur detected at the primary vacc is not related to the current symptoms.

However, the vet may not be able to do this without the cardiac work up, which is presumably what the pre-authorisation request was for. (Lots of insurance companies don't do pre-auths under £1k). Could you self-fund the initial consult with the cardiologist? This vet might then be able to state tonthe insurers that it is a new condition and not related.

The main problem you've got is the company you're insured with. The exclusions they place are ridiculous and honestly I don't know how they get away with it. (The example above of the cut to leg, which is an accident, resulting in a whole leg exclusion, is fairly standard with them.)

In your case, if it is unrelated and the insurance co still refuse your claim, I think FOS may well find in your favour. Have a look on their website - they say something about whether it would be reasonable for the policyholder to have known there is a pre-existing condition that would likely need treatment prior to their policy inception. You could not be expected to know this is/could be a pre-existing condition based on the common finding of a heart murmur in a young puppy which then resolved.

None of this helps your immediate situation though, as these battles take time and the most important thing is you have a poorly pet who needs treatment. Maybe your vet could agree to commence work up and treatment in the hope that the insurance will cover it but if not with the agreement that you pay in reasonable instalments over the next few months?