Insurance Claim Dispute - where do I go from here?

Okell

@SWadventurer -  so:

(1) What level of cover did you select and have you exceeded it?

(2)  What reason under their T&Cs did the insurer give for refusing the claim?  I assume they gave a reason and if they didn't you would've asked them why?

sheramber

If your policy has a vet fee kimitmof £4000 and you have already claimed for £4000 then you will not be covered for any further costs until the new policy year when your vet fee limit will be reinstated.

What level of vet fees did you slect for your policy?

How much have you already claimed in this policy year?

SWadventurer

Okell said:

@SWadventurer -  so:

(1) What level of cover did you select and have you exceeded it?

(2)  What reason under their T&Cs did the insurer give for refusing the claim?  I assume they gave a reason and if they didn't you would've asked them why?

I haven't exceeded the max vet fees limit (£4k) in this policy year (far from it) and they have not offered any reason for refusing it which is why I'm so frustrated and have followed-up with an email to the FOS - and yes, I've asked them for a reason. They have written back this afternoon to say they are fully investigating it and offering a call tomorrow - I really hope I get some clarity!  

born_again

SWadventurer said:

Okell said:

@SWadventurer -  so:

(1) What level of cover did you select and have you exceeded it?

(2)  What reason under their T&Cs did the insurer give for refusing the claim?  I assume they gave a reason and if they didn't you would've asked them why?

I haven't exceeded the max vet fees limit (£4k) in this policy year (far from it) and they have not offered any reason for refusing it which is why I'm so frustrated and have followed-up with an email to the FOS - and yes, I've asked them for a reason. They have written back this afternoon to say they are fully investigating it and offering a call tomorrow - I really hope I get some clarity!  

So how much of the £4K have they paid out this policy year? Given

, and while Napo paid part of the claim for her x-rays and medication at the time, 

SWadventurer

sheramber said:

If your policy has a vet fee kimitmof £4000 and you have already claimed for £4000 then you will not be covered for any further costs until the new policy year when your vet fee limit will be reinstated.

What level of vet fees did you slect for your policy?

How much have you already claimed in this policy year?

Thanks @sheramber - it was £4k vet fees and I have claimed £1250 in this policy year. They have emailed to say they are investigating and I'm hoping to have a call tomorrow with them. Being denied a claim for medication for an approved condition on a lifetime policy which happened during the policy year makes no sense.  

SWadventurer

DullGreyGuy said:

SWadventurer said:

I’m seeking advice on an insurance claim issue. Two years ago, I took out Lifetime premium insurance for my dog with Napo Pet Insurance. Last year, she was diagnosed with arthritis (a new condition), and while Napo paid part of the claim for her x-rays and medication at the time, they’ve now denied a claim for her ongoing medication for her arthritis. Despite referencing my lifetime policy, which I believe covers this, Napo refused to pay and suggested I contact the Financial Ombudsman if dissatisfied. With my policy renewal approaching, I feel frustrated and suspicious of their timing. Any advice on next steps?

On what grounds did they refuse the claim?

eddddy said:

Aylesbury_Duck said:

Are you confident you're right?  Napo must be confident in their position if they're referred you to the ombudsman.

If you make a complaint to a regulated financial institution, and they reject the complaint - it's a regulatory requirement that they tell you that you can contact the ombudsman to challenge their decision.

I suspect it might be the same if they reject a claim.

So rather than being an indication of confidence, it's likely that they are just doing what the rules require them to do.

Only complaints but it sounds like they've treated the OPs dissatisfaction as a complaint hence have sent a final response and highlighted the ombudsman service as required

@dullgreyguy they haven't given me a reason for denying the claim - which is why I'm frustrated and have written to the FOS. It seems illogical to deny medication claims for an approved condition - which they approved this policy year - unless I submit all receipts for medication I've purchased within the first three months of diagnosis. It therefore implies that going forward, and with my lifetime policy, I would need to have my dog re-diagnosed with arthritis every new policy year, and purchase all of her arthritis medication within three months. 

SWadventurer

born_again said:

SWadventurer said:

Okell said:

@SWadventurer -  so:

(1) What level of cover did you select and have you exceeded it?

(2)  What reason under their T&Cs did the insurer give for refusing the claim?  I assume they gave a reason and if they didn't you would've asked them why?

I haven't exceeded the max vet fees limit (£4k) in this policy year (far from it) and they have not offered any reason for refusing it which is why I'm so frustrated and have followed-up with an email to the FOS - and yes, I've asked them for a reason. They have written back this afternoon to say they are fully investigating it and offering a call tomorrow - I really hope I get some clarity!  

So how much of the £4K have they paid out this policy year? Given

, and while Napo paid part of the claim for her x-rays and medication at the time, 

£1250 (minus policy excess and less 20% for co-payment because she's 9 years of age), so in reality, I've received £716 of that.