Pet insurance problem

ellymoo

I took out pet insurance in September. One of the things I had to answer was:

"has X been currently suffering from [anything, I presume] or has your pet been examined or treated by a vet?"

Poor English, but I took it to mean "is your pet currently suffering from something [for which they have] been examined or treated by a vet?"

I ticked "no" because he wasn't ill nor had he been examined by/treated by a vet 'currently' (he wasn't under any investigation). He last went to the vet in July for his jabs. He had some teeth removed, and a heart scan, in November 2023, so I knew nothing dental or heart-related would be covered by the policy.

The documents came through and one of the things I apparently stated was 
"Your pet is not currently undergoing treatment or ["has", I presume, is missing] ever been examined or treated by a vet".

I didn't state this, though. If you tick "no" to "is he currrently ill?" that's one thing, but by ticking "no" to "he has [n]ever been treated by a vet" you're saying he has been treated by a vet. If they'd put the word "ever" in the initial question it would have looked totally different.

I'm now trying to claim on this policy and am really worried that I have shot myself in the foot as it looks now like I said he had never been examined or treated by a vet, which is obviously insanity as surely no animal exists which hasn't ever been examined or treated by a vet - even if you get a puppy that's the first thing you do, surely? 

I could just be over-thinking it and panicking, and I am going to give them a call in the morning but I wasn't expecting this policy to cover any pre-existing conditions so this didn't make me blink. Now I'm blinking all over the place!

Any advice gratefully received. I read through the documents at the time but was distracted by them not including a vet call service which they had said they offered when I took the policy out. I rang them about this and they said they were setting it up as they were changing providers so I stuck with them (obviously a mistake). Also I thought that I had answered the question correctly and it's now only that I'm paranoid that I am worried.

ellymoo

ETA I had a look through my documents and the terms say I must:

Take reasonable steps to maintain the health of Your Pet, and prevent it from Accident, Injury or Illness. This includes ensuring that Your Pet undertakes yearly dental and medical examinations, and that any recommended treatment is undertaken immediately following diagnosis, and that Your pet is vaccinated.  

So they tell you that you MUST take your pet to a vet. 

I signed up for this on MSE (that was a mistake) - MSE ask you if you want to be covered for pre-existing conditions (I've just gone through the quote process again) and I said "no" . Not sure what they've processed that as.

DullGreyGuy

ellymoo said:

I took out pet insurance in September. One of the things I had to answer was:

"has X been currently suffering from [anything, I presume] or has your pet been examined or treated by a vet?"

Poor English, but I took it to mean "is your pet currently suffering from something [for which they have] been examined or treated by a vet?"

I ticked "no" because he wasn't ill nor had he been examined by/treated by a vet 'currently' (he wasn't under any investigation). He last went to the vet in July for his jabs. He had some teeth removed, and a heart scan, in November 2023, so I knew nothing dental or heart-related would be covered by the policy.

The documents came through and one of the things I apparently stated was 
"Your pet is not currently undergoing treatment or ["has", I presume, is missing] ever been examined or treated by a vet".

I didn't state this, though. If you tick "no" to "is he currrently ill?" that's one thing, but by ticking "no" to "he has [n]ever been treated by a vet" you're saying he has been treated by a vet. If they'd put the word "ever" in the initial question it would have looked totally different.

I'm now trying to claim on this policy and am really worried that I have shot myself in the foot as it looks now like I said he had never been examined or treated by a vet, which is obviously insanity as surely no animal exists which hasn't ever been examined or treated by a vet - even if you get a puppy that's the first thing you do, surely? 

I could just be over-thinking it and panicking, and I am going to give them a call in the morning but I wasn't expecting this policy to cover any pre-existing conditions so this didn't make me blink. Now I'm blinking all over the place!

Any advice gratefully received. I read through the documents at the time but was distracted by them not including a vet call service which they had said they offered when I took the policy out. I rang them about this and they said they were setting it up as they were changing providers so I stuck with them (obviously a mistake). Also I thought that I had answered the question correctly and it's now only that I'm paranoid that I am worried.

So when the schedule arrived with your answer not being what you believed you were answering what did you do? Call them to correct it?

Who did you buy from? Did the question have helper text?

Ultimately there is nothing you can do now until they make a decision on this claim. If they do decline the claim or void the policy then come back with what they have said. 

TELLIT01

You need to contact the insurer as that second part of the statement you showed clearly states 'been examined or treated', not 'currently'.

ellymoo

Thanks both - I had confirmation from a live chat individual that I was covered, given the fact that you have to have your pet vaccinated in order to get insurance means you must have visited a vet at some point. But I didn't trust that. So I put in an official complaint about the poorly worded clause. To be fair to them, they called me back within a couple of days and admitted that the wording was bad. The agent confirmed that I was covered for any illnesses which arose after the policy started, and that the clause refers to pre-existing conditions. He also said they are stopping insuring pets.

My concern now is that they will look at a "fatty lump" found in 2022 (deemed harmless) and claim it is the cyst discovered in 2025 (which needed removal) but I will cross that bridge when I come to it. The bill is £1300 so I do not expect this to be easy.

ellymoo

Quick update - the insurance have paid most of the claim, thank heavens. I am very surprised, and relieved! I'm used to assuming insurance companies won't pay out.

DullGreyGuy

ellymoo said:

Quick update - the insurance have paid most of the claim, thank heavens. I am very surprised, and relieved! I'm used to assuming insurance companies won't pay out.

Obviously I work in insurance so some will say I am biased... insurers by and large payout what they have committed to payout on, generally with a reasonable balance of investigation and speed.  Many problems are caused by the policyholder, often by buying on price and not actually getting the cover they needed/wanted. Obviously sometimes insurers do mess up but the rate of complaints -v- volumes of claims should tell you they are the exception rather than the norm. 

Glad its all sorted for you

ellymoo

Thank you, that is reassuring. How would I see rate of complaints v volume of claims in general? More of us need to know this statistic as it's something which really worries me, and this jaundiced view may stop people taking it out.

The only problem now is the speed of payout. I was told 10-14 working days, but nothing has come through so far and when I queried this I was told that was a guideline only. So I asked what timescale they actually work towards and was told they didn't have one. They said they'd take it up with their accounts team who are offline and take up to 5 days to reply. Heaven knows when I'm going to get the money - how can it be impossible for them to work to a specific timescale?

twopenny

Can't offer you a speedy pay out but on the subject of claims being rejected I can agree with Dullgreyguy.
I've answered lots of travel rants over the years about insurance not paying out. They've not read the terms, not read what to do when an incident occurs and scream when they aren't covered.
Most buy cheap and don't ensure it covers what they are doing.

I think you've done well nothing and remembering exactly what you took out.
Yes the slack business of not having precise time for claims and payments is often the case these days. Business is so far removed from its customers they can do this.
The times when you could turn up on their doorstep and they had to look you in the eye and do something business is happy to get rid of.

DullGreyGuy

ellymoo said:

Thank you, that is reassuring. How would I see rate of complaints v volume of claims in general? More of us need to know this statistic as it's something which really worries me, and this jaundiced view may stop people taking it out.

It varies significantly by product, if you look at Car insurance there are circa 2.4 million claims a year and the ombudsman receives 3,940 complaints in total about Car insurance in Q1 this year. About 75% of complaints are about claims so 0.49% or just under 1 in 200 of claims end up at the ombudsman despite the fact we are brought up to think you should always reject the first offer and insurers are there to screw you over. 

Home insurance will be higher, many people dont understand house insurance so phone to make a claim when water is coming through the roof for it to then be rejected because its a maintenance issue and they cannot point to a particular event (eg a storm) that caused the damage. 

Pet I can't say I've had much dealings with from a claims perspective, the ABI states there are 1.8m claims a year and the ombudsman in the same period as above had 502 new complaints registered which would put it at 0.08%

It's also probably worth noting that in both cases the ombudsman only upheld 1/3 of the cases so in the other 66.7% of cases it agreed that the insurer hadn't treated the customer unfairly. Arguably it's more than this because partial uphold (eg where the ombudsman says the insurers decision was right but they were too slow to get to it) count towards the 33% of upholds.