Pet insurance claim

Unamon

My dog has underlying health conditions, I manage these myself.
I switched to another provider on 21st July 2023. At the time my dog was 8 years old.  The wording of the policy is as follows: Section 7 of the policy included the following exclusion: Any pre-existing conditions or any claims costs relating to the applicable waiting period as listed in the Schedule.  “Pre-existing condition means any injury, illness or behavioural disorder that your pethad symptoms of, received treatment, medication or advice for in the last 24 months before your policy start date .”

 My dog had not been diagnosed with any new conditions in the previous 24 months, she did not have any symptoms, she had not received treatment, medication or advice so I proceeded with the policy.

 On the 16th of November 2023 (5 months after policy start date) I discussed with the vet that my dog had developed a cough, the vet diagnosed a "g3/6 new murmur.

My dog started on medication on the 17th April 2024. When she re-attended for a check-up the following week the vet has documented "grade 5/5 heart murmur. weak hind limb pulses." 

My dog was referred to a specialist and was seen the next week. Unfortunately she was diagnosed with Chronic degenerative AV valve disease, she was commenced on treatment.

I found out in June 2024 that that the insurance company had rejected my claim.

The reason they rejected the claim was because on the 21st December 2022 – 8 months before I took out the policy, during a routine health check, a vet has documented "nad except vv small murmur maximum gr 1 with no sign chf". This was never discussed with me, and I had no knowledge that a small murmur had been detected.

I have challenged this decision but the insurer still rejected the claim so I went to the ombudsman, even still the claim has been rejected.

My issues are as follows:

1. The vet never informed me that a very minor heart murmur was detected
2. I cannot disclose something I know nothing about - there is no documented evidence in my dog’s records that she has had symptoms, received treatment, medication or advice for this
3. I already had pet insurance, and if I had known a) that she had a very very minor murmur, and b) that this would be classed as an underlying health condition I would not have taken out the policy with the new insurer.
4. Not all heart murmurs lead to heart failure- at this very early stage the vet could not have possibly known that my dog had a murmur that would lead to heart failure.
5. Heart failure was only diagnosed by a Specialist vet after my dog became symptomatic, they have written the following:

Degenerative valvular disease as a condition, normally presents as a quiet murmur that can become louder over time, due to progression of the disease.  Although I cannot exclusively say that the original murmur heard was the first significant finding related to Bella's heart it would be highly likely given the disease's nature.

1. The specialist vet has clearly written that they cannot exclusively say that the original murmur heard was the first significant finding related to my dog’s heart condition.

Insurance companies happily take our money every month yet nobody ever advised me that issues like this could arise.

Surely these insurance companies should not be allowed to get away with this, I strongly believe that they should be obligated to request a copy of our pet’s records and review them to ensure that there is nothing in our pet’s records that would be considered to be an underlying condition and not eligible for insurance. Had they done, I would not have switched. I had read all the small print and only proceeded as I genuinely did not know that the vet had documented in my dogs record the she had hear a vet very minor murmur

Does anyone have any advice please I would really appreciate it. So far it has cost me thousands of pounds 

DullGreyGuy

There was a documented symptom according to your vet in the form of a a murmur 

The problem when you switch insurers for health policies (human or pet) is that what's gone before is then excluded. Whilst the vet may either have not told you or you forgot it's not relevant unfortunately, they aren't accusing you of fraud but the policy excludes pre-existing.

Whilst the symptom at the time may have been nothing or something serious and no one would have known at that time insurers protect themselves by excluding claims "relating to" pre-existing matters. 

Ultimately you have exhausted the insurance complaint process with the Ombudsman finding against you. You could complain to your vet that they recorded something without telling you and had they told you then you wouldn't have switched insurer. 

Health insurance is one to think very carefully over who you pick as its one that it becomes very risky to switch at a later time. Personally, I did the opposite and fought for 3 months to be able to stay with a provider but needing to transfer from corporate to personal policy exactly because the "and related" is so broad for our circumstances.

35har1old

DullGreyGuy said:

There was a documented symptom according to your vet in the form of a a murmur 

The problem when you switch insurers for health policies (human or pet) is that what's gone before is then excluded. Whilst the vet may either have not told you or you forgot it's not relevant unfortunately, they aren't accusing you of fraud but the policy excludes pre-existing.

Whilst the symptom at the time may have been nothing or something serious and no one would have known at that time insurers protect themselves by excluding claims "relating to" pre-existing matters. 

Ultimately you have exhausted the insurance complaint process with the Ombudsman finding against you. You could complain to your vet that they recorded something without telling you and had they told you then you wouldn't have switched insurer. 

Health insurance is one to think very carefully over who you pick as its one that it becomes very risky to switch at a later time. Personally, I did the opposite and fought for 3 months to be able to stay with a provider but needing to transfer from corporate to personal policy exactly because the "and related" is so broad for our circumstances.

Was speaking to a dog owner had heard that the dog had heart murmur the owner said it was nothing to worry about after having a discussion with the vet she was actually annoyed at the vet for mentioning it to her as it was minor issue of no great concern with no further investigation required.
To expect a insurance company to pre check a pets history is unrealistic if this was necessary the premiums would increase due to time spent corresponding with vets.
If you had car insurance would you expect them to check for driving offences before quoting 

DullGreyGuy

35har1old said:

DullGreyGuy said:

There was a documented symptom according to your vet in the form of a a murmur 

The problem when you switch insurers for health policies (human or pet) is that what's gone before is then excluded. Whilst the vet may either have not told you or you forgot it's not relevant unfortunately, they aren't accusing you of fraud but the policy excludes pre-existing.

Whilst the symptom at the time may have been nothing or something serious and no one would have known at that time insurers protect themselves by excluding claims "relating to" pre-existing matters. 

Ultimately you have exhausted the insurance complaint process with the Ombudsman finding against you. You could complain to your vet that they recorded something without telling you and had they told you then you wouldn't have switched insurer. 

Health insurance is one to think very carefully over who you pick as its one that it becomes very risky to switch at a later time. Personally, I did the opposite and fought for 3 months to be able to stay with a provider but needing to transfer from corporate to personal policy exactly because the "and related" is so broad for our circumstances.

Was speaking to a dog owner had heard that the dog had heart murmur the owner said it was nothing to worry about after having a discussion with the vet she was actually annoyed at the vet for mentioning it to her as it was minor issue of no great concern with no further investigation required.
To expect a insurance company to pre check a pets history is unrealistic if this was necessary the premiums would increase due to time spent corresponding with vets.
If you had car insurance would you expect them to check for driving offences before quoting 

Bad example because these days they can, hence they ask for your driving licence number because the DVLA has an API they can use to then get back the driving offences. 

You are however absolutely correct in that there is no central databases vets use to record pet health that  the insurer can query and even if there were it would need to be exceptionally advanced to allow a machine to understand all the observations and make decisions against it. More likely it would be like if you apply for PHI etc where a GP report is required etc. 

It works for PHI because its a 20+ year policy, for the human annual equivalent ASU its equally only checked at point of claim for the same reason, its cost prohibitive to spend £250 on reports and reviewing them each year

sheramber

You  could request a copy of your pet’s medical  record  from your vet to ensure you know exactly what is noted on them before changing insurers. 

Insurance companies only request the information if there is a claim. 

With the number of policies they issue it would not be practical to request that information when you apply and then they would have to request it again every year , in case there was new information on it. 

How many extra staff would that require and how long would it take to get the information and update the records..

Not only premiums would go up but so would vet  charges for the extra staff they would need.