Life long impact of Pet insurance rejection

Mikmonken

In short i made the mistake after 1 year of changing from my Puppy's previous insurer to Napo (underwritten by C&G) the quote was a bargain.

Anyway during the policy period with Napo, my Pup started showing some signs of behavioural issues, and the vet and our trainer recommended to tests, bloods, pain tests etc and the vet prescribed Reconcile.  the next stage was a referral to a vet behaviourist.

I submitted a claim, Napo took 6 weeks of back and forth before they rejected stating that he had once shown signs of being nervous and therefore already had a behavioural issue and wasn't covered by the life long policy for behavioural issues.

it just so happened that at the same time Napo weren't sending out renewal quotes so aa day before my claim was rejected i got a quote for 3 times my original premium, based on the outstanding claim.  Once the claim was rejected i chose not to continue.

Anyway skipping forward several months, this has been to the Ombudsman who have suggested Napo reconsider my claim, which they have duly done and now settled the claim.

and here lies the issue, my Puppy is 2 so I now have to potentially fund ongoing prescription costs along with any Vet behaviourist work etc.

Which brings me to my question I suppose, estimating that lifelong costs for this particular diagnosis being upwards of £10k and I now might be in the wrong forum forum for it, should i consider going through the small claims court to recover future impact, in light of the fact that Napo have now agreed and processed the claim, they say the ombudsman overturned their decision but they actually asked them to reconsider.

And as a lesson learnt from me, if you take out a life long insurance for you pet, it's best to stick with it and not be wooed by lower premiums else where.

DullGreyGuy

The ombudsman is bound to make decisions based on fairness, which considers the law, industry practice etc. 

Courts are bound to make decision purely on the law. As a consequence you are vastly more likely to get a favourable outcome from the ombudsman than from the courts. So if you are going to try for something more then it should be via the ombudsman. 

Ultimately you've made the decision to switch to another insurer knowing that this condition will then be excluded as pre-existing. The ombudsman nor the courts are going to say the current insurer must continue paying for the condition because the ombudsman later changed the decision. The realistic best you could hope for is that they allow you to reinstate your policy with them and consider it continuous cover in relation to conditions but again thats an ombudsman type outcome not court. 

Mikmonken

Thank you. Yes your right, but i made the switch due to Napo refusing the claim and I had i asked them to extend during the complain period which was refused. so ultimately faced with a scenario where i would have had to take up insurance at 3 time the price without the same cover (pending being able to escalate to the ombudsman which was nearly 2 months after the cover would have finished).  So yes I did make the decision to switch but in Napos eyes his future cover would not be covered.

Interestingly I have asked them to reinstate my cover with no break, so will wait to see what they come back with, although i'm not taking bets.

DullGreyGuy

Mikmonken said:

 i asked them to extend during the complain period which was refused. so ultimately faced with a scenario where i would have had to take up insurance at 3 time the price without the same cover (pending being able to escalate to the ombudsman which was nearly 2 months after the cover would have finished).  So yes I did make the decision to switch but in Napos eyes his future cover would not be covered.

Interestingly I have asked them to reinstate my cover with no break, so will wait to see what they come back with, although i'm not taking bets.

I've worked in insurance for more years than I care to mention, I used to work in claims and have worked in strategy and change for many years since. 

For many years we used to do offers like, pay for 9 months and get 12 months cover. Our MD however wanted to do pay for 12 months and get 15 or 18 months cover. In principle not a big difference financially but moving your renewal date could be considered useful. IT took 3 months, they came back quoting £20m to change our systems to enable this promotion with a 3% confidence factor that they had found all the places where the systems were hardcoded to assume a policy was 12 months in duration in one way or another. 

Being able to do a short term extension is not necessarily as simple as changing a date and even more so if they arent intending to do so as freebie. In most cases you take a punt, you either stay with the firm and hope the ombudsman corrects their action or you decide your money is better spent elsewhere. Even if the ombudsman were to require them to offer continued cover they won't comment on pricing. There is a reason why some think its better to buy from PetPlan who won't rate based on claims experience but are notably higher per month for a healthy animal