Argos Pet Insurance Declined Claim Resulting in us paying over £9,000

Taylorj151

Hi everyone,

Hoping for some advice on the below.

We bought a puppy cockapoo (Bertie) at the end of last year. We took him to the vets to have his jabs and we were provided free insurance through petplan. This would have expired on the 30th December so to ensure we had no period of no insurance we signed up to Argos Pet Insutance on the 10th December and had it start on the 30th.

Bertie then started to slightly limp on the 6th January and the vets diagnosed with a sprain (slight 2/10 severity) and advised us to rest. On the 10th we went back as he was being sick and we saw a different vet, this vet noticed his hips were not right and sent him in for an x Ray the next day (severity 10/10)

On the 11th January following on from his scan he was diagnosed with severe hip dysplasia. Argos declined the claim as they are claiming the hip dysplasia was noticed during the 10 day qualification period. (Unsure on this as there was nothing from the vets stating hip dysplasia during the first 10 days) it was only the 10th where the vets thought this may be the case

Bertie has had 3 operations now as the first 2 failed and we have also racked up £1,000 of hydrotherapy bills which have also been declined because it is linked to his hip dysplasia.

We have complained with Argos, and are now due to pursue this with the ombudsman.

We are a young couple and moved into our first home at the end of last year so as you can imagine this is putting severe stress on us both.

Has anyone experienced something similar or can provide advice on if you think we have a case?

paddyandstumpy

Taylorj151 wrote: »

Hi everyone,

Hoping for some advice on the below.

We bought a puppy cockapoo (Bertie) at the end of last year. We took him to the vets to have his jabs and we were provided free insurance through petplan. This would have expired on the 30th December so to ensure we had no period of no insurance we signed up to Argos Pet Insutance on the 10th December and had it start on the 30th.

Bertie then started to slightly limp on the 6th January and the vets diagnosed with a sprain (slight 2/10 severity) and advised us to rest. On the 10th we went back as he was being sick and we saw a different vet, this vet noticed his hips were not right and sent him in for an x Ray the next day (severity 10/10)

On the 11th January following on from his scan he was diagnosed with severe hip dysplasia. Argos declined the claim as they are claiming the hip dysplasia was noticed during the 10 day qualification period. (Unsure on this as there was nothing from the vets stating hip dysplasia during the first 10 days) it was only the 10th where the vets thought this may be the case

Bertie has had 3 operations now as the first 2 failed and we have also racked up £1,000 of hydrotherapy bills which have also been declined because it is linked to his hip dysplasia.

We have complained with Argos, and are now due to pursue this with the ombudsman.

We are a young couple and moved into our first home at the end of last year so as you can imagine this is putting severe stress on us both.

Has anyone experienced something similar or can provide advice on if you think we have a case?

I think you may have a case.

If the vet on the 6th didn't think it was anything more severe than a sprain, that would be the argument to pursue.

Also, point out to them the 10 day qualifying period is to prevent fraudulent claims (i.e. taking out cover when a problem arises and claiming straight away).
Given that you bought the cover on the 10th December to start 30th December, this indicates to me it was a genuine request for cover and therefore a fortuitous claim.

Once you have exhausted the insurer's complaints procedure and they have issued their final decision then you can approach the FOS at no cost to you.

Best of luck, more importantly I hope Bertie is recovering.

sheramber

The date the condition was noticed is normally taken as the date of the condition starting.

. A pre existing condition is any condition or illness or sign of anything that can be related to it.
In your pup's case the first indication was the limp on the 6th. This could be taken as the first indication of the hip dysplasia although final diagnosis was not until 11th.

The fact that you got a quote early does not change the start date of the policy which you elected to be 30 Dec.

To avoid a period of no insurance you need to overlap the policies by the necessary number of days. Your policies only overlaped on 30th

If your pet develops a condition during that period it will be covered by the old insurance but then you will need to stick with the old company or any further treatment for that condition or anything that can be related to it will be a pre existing condition under the new policy.

I am sorry to say that I doubt the ombudsman will uphold your complaint but it is worth trying. it does not cost you anything.

garth549

Am I missing something here? If you select the insurance to start at a date in the future then wouldn't you expect to be fully covered from that date? I would

What Argos are suggesting is that to be covered from the 30th you need to select the 20th as the 'start' date for the policy! Sounds like a very unfair term to me.

You could understand the exclusion if it counted from the day you took the policy out (ie within 10 days from the 10th).

Quentin

You are missing that they have a 10 day period from the policy start where you cannot claim for anything..

Only conditions developing after the 10 days are covered.

The OP's policy was not in force when this condition first presented.

To win an appeal about the claim rejection would mean medical evidence that the initial diagnosis of a sprain prior to the subsequent diagnosis of this hip problem was totally unrelated.

As advised it looks unlikely to win

But escalating to the FOS is always worth a try and is at no cost to the policyholder

sheramber

garth549 wrote: »

Am I missing something here? If you select the insurance to start at a date in the future then wouldn't you expect to be fully covered from that date? I would

What Argos are suggesting is that to be covered from the 30th you need to select the 20th as the 'start' date for the policy! Sounds like a very unfair term to me.

You could understand the exclusion if it counted from the day you took the policy out (ie within 10 days from the 10th).

that is the way pet insurance works.

The first 10 ( sometimes 14) days of the policy are excluded for any condition or illness arising during that time. This is to prevent someone for taking out insurance after they find out their pet is ill.

It could be that an owner takes their pet to the vet because it is limping,
The vet indicated a sprain but it might be more than that . However, he would treat as a sprain first to see if it resolved.

On hearing this the owner decided to take out insurance in case it was something more serious.

The exclusion period is to prevent this happening.

Usually they will cover injury from an accident ( but not all policies do) as that could not be known about before taking out the insurance.

if the OP had continued with the Petplan insurance then they would have been covered as she had already had a month's free cover so no exclusion period.

It is always prudent to take out cover immediately you have your pet, whether you are offered a free period or not. The free period is not really worth it if you do not continue with it.
If the OP had insured with Argos from the beginning they would have been covered.

Changing your pet insurance company has to be carefully considered if there has been any query about the pet's condition whether treatment was given or not. If it is mentioned in the medical history it is pre existing condition.

Soot2006

The vet will need to certify that the limp from 6th January was a little injury that cannot in any way be associated to the HD. i.e. it was a sprain, it was a different leg than the first HD symptoms, it cannot be part of the HD symptoms, etc .... Is this the case?


If there is a any possibility of that first limp being linked then I'm afraid this is probably not going to resolve in your favour.



I've just been through an insurance decline for pre-existing condition that my vet had to fight for me; thankfully they did in the end accept the vet letter that stated there was absolutely no chance of the two conditions being linked.



Unfortunately many pet insurance have 10-14 days exclusion at the start, when you're normally only covered for liability and accidents/injuries but not for illness or internal conditions. The idea being that you can't insure an unwell animal and then immediately claim for that condition.



Good luck to you and your pup x

garth549

sheramber wrote: »

that is the way pet insurance works.

The first 10 ( sometimes 14) days of the policy are excluded for any condition or illness arising during that time. This is to prevent someone for taking out insurance after they find out their pet is ill.

It could be that an owner takes their pet to the vet because it is limping,
The vet indicated a sprain but it might be more than that . However, he would treat as a sprain first to see if it resolved.

On hearing this the owner decided to take out insurance in case it was something more serious.

The exclusion period is to prevent this happening.

Usually they will cover injury from an accident ( but not all policies do) as that could not be known about before taking out the insurance.

if the OP had continued with the Petplan insurance then they would have been covered as she had already had a month's free cover so no exclusion period.

It is always prudent to take out cover immediately you have your pet, whether you are offered a free period or not. The free period is not really worth it if you do not continue with it.
If the OP had insured with Argos from the beginning they would have been covered.

Changing your pet insurance company has to be carefully considered if there has been any query about the pet's condition whether treatment was given or not. If it is mentioned in the medical history it is pre existing condition.

Thanks, useful to know! Still seems massively unfair as the policy was taken out 3 weeks in advance. You could understand an exclusion where you couldn't claim for a new condition within x number of days of buying the policy, but not when you're buying 3 weeks in advance. It doesn't make sense (well apart from giving a technicality to reject claims for!).

So if you shopped around and switched to a new insurer you'd always have a period where you'd effectively not be covered for new conditions? (assuming the start date of the new policy was the end date of the lapsed one)

Quentin

The date of purchase is irrelevant. You can buy insurance policies weeks/months before the policy starts

For (what should be) obvious reasons any qualifying period for being on cover starts from the policy start date, not the date of purchase.

stator

When it comes to pets, switching insurance isn't always a good idea.
The levels of cover vary so much, you can't really just do a price comparison