Animal Friends payout issues

Mich3085

Hi all,

It’s my first post and unfortunately it’s a complaint!

My beloved cat was under the weather so I booked him in at his usual vets. He hadn’t eaten for a day and I wasn’t aware of him drinking so I was quite worried. When I got him to the vets he’d lost a considerable amount of weight and he was becoming dehydrated, so they admitted him into the hospital for fluids and tests. The costs were going to be around £500-£1000 which I was fine with as my policy covers £4000 per condition per year on a lifetime basis.

My cat spent 4 nights in hospital and was finally allowed home to make a full recovery. The vets sent the claim to animal friends directly through their pawtal.

Annoyingly Bruno was discharged from the vets when the new policy year had started so I had to pay two lots of excess, but I could deal with that. When I got the settlement they said they would only pay out up to £100 for hospitalisation and to refer to my policy wording.

This leaves a shortage of £345 on a £2100 claim.

I looked through the policy wording and couldn’t find anything so I phoned and they referred me to this passage:

1.2.1. “Level of vet fees allowed:
We reserve the right to obtain a second opinion from our vet advisor where we consider:

Vet fees charged appear greater than conventional fees charged by an attending referral practice; and/or
Treatment received may not have been required or may have been excessive when compared with treatment conventionally undertaken by an attending referral practice.”

They told me they work with ‘national average’ which go both up and down and at the moment it is £100.

I did my own research and contacted two other 24 hour vets practices and asked them for a second opinion. Both said that I’d be looking at anything from £100 to £350 for a period of 24 hours depending on the care level. My cat was in under high supervision due to his weight loss and needing to be tube fed.

I’ve raised an official complaint to animal friends about this and I’ll take it further as and when the time is right. Has anybody else had an issue like this with them? My argument is that my cat needed hospitalisation and I had no choice to take him home or opt out for a few hours, so surely they should be covering this?

Also who else would you recommend as an insurer as i want to move my boys once this is settled.

Quentin

Not straightforward changing insurer with pre existing conditions to be disclosed


If they ignore your complaint for 8 weeks or you aren't happy with the reply then you escalate to the FOS at no cost to you

nonex_2

OP do you mind me asking which policy type and level are you covered under?

animalfriends co uk/existing-customers/policy-wording/

(Sorry I'm not allowed post links)

Mich3085

Hi,

It’s a lifetime superior plus policy.

Mich3085

Some insurers accept pre existing conditions if symptom free for 2 years. So ideally I’ll move him after and hope he doesn’t have any more claims

I can move my other cat as he hasn’t had any claims.

stator

Sounds like you have a good claim, definitely pursue it to the ombudsman when they refuse your complaint.

nonex_2

I'm sure this £100 figure has been pulled out of nowhere. And in any event, even if it is the "national average" that's not what the terms say.

By this logic they would dispute half of any costs ever claimed on their policies as being more than the national average (the other half being less than the average) and people in London, for example, would never get any claim paid fully ever.

From what you've said these costs seem sensible enough and not "excessive when compared with treatment conventionally undertaken by an attending/referral practice.”

I'd pursue this point with evidence from your vets/other vets and hopefully they'll see sense without needing to involve the FOS.

nonex_2

It's also worth examining the vet invoice and speaking to the vets. Does the "hospitalisation" line item include liquid food, daily consultations etc, or other costs that the insurer is more used to seeing being itemised in more detail. They may not be comparing this cost like-for-like with similar costs at other vet practices. If so your vets could send them a letter to explain.

sheramber

Not a unique compliant about Animal Friends.

I always recommend Petplan if you can afford it. It is more expensive but they do not increase premiums because you make a claim. Premiums do increase for increased costs etc.

They will consider covering pre existing conditions if there is no recurrence and no treatment is required for two years. Confirm this with them.

Another place to look is Bought By Many who have recently introduced their own policies. They have several options available. This is not a recommendation as I have no experience of them.

Whatever company you choose make sure you read the policy document- not the summary- carefully to ensure you know exactly what you are covered for.

Many complaints arise because people are not aware of what they are and are not covered for although it is explained in the policy document.

nonex_2

As much as OP is probably tempted to move, I'd suggest they be very careful before doing so.

Sounds like Animal Friends is being a pain here but they are covering the condition on a lifetime basis. As great as Perplan are, they will still avoid paying for this condition or conditions related to it forever. It's a myth to say that they will cover a condition after 24 months. They may remove the broad named exclusion from your docs but they can still reject as pre-existing if they can prove the connection and they will.

Mich3085

My issue is the whole policy document doesn’t refer to any caps on hospitalisation costs. The clause is they reserve the right to seek a second opinion where costs seem excessive. They’re using a very general term to avoid paying out. I don’t know how I could have anticipated them not paying out in this case.