Tesco Pet Insurance, Not fit for purpose

TimmyeH

Hi Team MSE,

After a 16week process of trying to make a claim for my dog's Right Leg's cruciate ligament, Tesco/ RSA have decided not to pay out.

They claim that Because my Dog's left leg had the same Injury 18+months previously this is now classed as a Disease/condition and therefore not covered.

I have submitted statements from my Vet and xrays of the effected leg from 18 months ago and there is no sign of ware or disease or condition that would suggest there is an issue with my dog.

It seems to me that they are choosing to interoperate  the term "underlying Condition" to their advantage and have no regard for my Vets knowledge of such injury. as well as the specialist who operated on him.

So in Basic terms. Injure One Leg..... The other three are not Covered as this is classed as Historical?

I have gone through the complaints procedure as per their guide lines and I now have 6 months to go to the Ombudsman.

At this stage all I can say is Buyer be ware, Tesco use an Underwriter and therefore have a layer of blame to hide behind.

I'm Circa £2600 out of pocket , But on the flip Side my dog has made a full recovery.

I'd also like to add that there seems to be a rise in Insurance firms carrying out this same practice so be careful folks.

Sandtree

It would be interesting to know what "the injury" is/the cause? From what you are saying it sounds like something thats "just happened" for no apparent reason and therefore is being put down to an underlying issue as evidenced by the previous occurrence (even if it was the other side)

elsien

Did they add any exclusions to the policy after the last injury - it would be helpful to see what the wording is.

TimmyeH

Sandtree said:

It would be interesting to know what "the injury" is/the cause? From what you are saying it sounds like something thats "just happened" for no apparent reason and therefore is being put down to an underlying issue as evidenced by the previous occurrence (even if it was the other side)

Basically My dog Injured his Left Cruciate Ligament in early 2018, a one off injury that needed surgery to fix. At that time both legs were x ray'd and examined as a matter of course. At this stage only the Left leg was injured. The Right leg showed no signs of Disease of condition that could be related.  fast forward to March 2020 then the right leg suffers the same injury....

So based on this they state as per T&C's that this in not covered as it is an underlying condition.

"Your Policy" won't insure: Any changes that you or your Vet notice in your Pets health or behavior before your cover start date or any condition, illness or Injury that you have been advised before the cover start date may lead to further illness or treatments. , They will consider these to be a pre-existing condition or illness and they will not be covered.

******

Pretty standard stuff, but An injury is not a "condition" or "Disease" . I understand that if an injury is of a type that then needs ongoing treatment/medication etc then that could be classed as a condition. But if an Injury is fixed by surgery and is 100% successful and needs no other treatment/medication then surely it should be treated as a genuine one off claim.

If then the Same injury happens to the other leg purely because of bad luck then surely should be regarded as a separate claim.

Whats more annoying, I have had a renewal quote from the same company and nowhere in the schedule/T&C's do they give a detailed exemption list knowing my dogs history.

Sandtree

The look backwards states condition, illness or injury and the look forward states illness or treatment therefore an injury not being a condition or disease isnt an issue with the wording.

You still havent said what the injury was/what the cause was? If he was hit by a car one time and run over by a motorcyclist another I think you'd be in a very different position to if on both occasions the ligament "just went".

There are strong parallels between Pet and ASU, the budget version of income protection, in that you have nebulous wording around pre-existing and the test of how it applies only occurs at the point of claim. For people there is another version of income protection where full medical history is taken before a quotes given and you're told up front exactly what will and wont be covered... unfortunately its cost prohibitive to do the same in Pet.

sheramber

 It is standard practice to consider  cruciate problems in both legs as one condition.
Rupture of the  cruciate ligament is  considered one  condition  caused by  an  inherent weakness, which affects both legs.
If a dog ruptures one ligament  there is a 60% chance of it rupturing the other one at a later date  because of the weakness and while the dog  recovers from the first one the other leg takes the strain of   supporting the dog. That is why careful rehabilitation is necessary.
This was explained to me by the orthopaedic specialist who operated on my dog

TimmyeH

Thanks Sheramber, I think this is what they are basing their decision on as He wasn't Hit by a car etc. It was caused by him running around etc. I shall be cancelling my policy and put it down to my lack of understanding of what insurance is. I feel totally conned. But hey ho. time to move on.

TimmyeH

Sandtree said:

The look backwards states condition, illness or injury and the look forward states illness or treatment therefore an injury not being a condition or disease isnt an issue with the wording.

You still havent said what the injury was/what the cause was? If he was hit by a car one time and run over by a motorcyclist another I think you'd be in a very different position to if on both occasions the ligament "just went".

There are strong parallels between Pet and ASU, the budget version of income protection, in that you have nebulous wording around pre-existing and the test of how it applies only occurs at the point of claim. For people there is another version of income protection where full medical history is taken before a quotes given and you're told up front exactly what will and wont be covered... unfortunately its cost prohibitive to do the same in Pet.

The Injury was caused by him running around with other dogs.

TimmyeH

I shall be taking this to the ombudsman as I still think their exclusion explanation is open to interpretation depending on your views of "injury" One experts view can be different to an other's etc. If your dog breaks/injures one leg, does that mean the other three are not covered? And if knowing my dogs history why is there not a more clear exemption statement in the renewal policy, again, knowing my dogs full history.   

Sandtree

You are in your right to take it to the FOS once you've had your final response letter (or 8 weeks have passed and one hasnt been received).

"Breaking a leg" is too vague... an obvious and significant external force is applied (eg hit by car) then most likely the other 3 are still fully covered, if the bone spontaneously breaks with no obvious external cause then serious questions of bone strength etc have to be raised and potentially other three wont be covered.

Pet insurance like PPI/ASU is a fairly budget product; in the case of humans there is the option to step up to a higher quality product where cover is fully confirmed at the point of sale/renewal but the cost for setting up a policy runs into the hundreds of pounds which unsurprisingly is reflected in the premiums... how much more would you be willing to pay to get that certainty?

ZaSa1418

Yes take it to the ombudsman, they will probably suggest arbitration. Do you have any arbitration wordings in your policy?