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Pet Insurance, Exclusions applied mid policy.

cheeseman002
Posts: 2 Newbie

Hi all
Newbie here !
We took out pet insurance with Animal Friends for our new pup 2 years ago.
During the first year he unfortunately had some problems with a condition called Ataxia ( he had symptoms similar to a stroke). This resulted in significant vet costs including a couple of visits to out of hours vets. Animal Friends at this point covered the majority of the costs, with me paying the extras costs due to vet fee limits etc. which I was happy to do. He also had an out of hours vet visit where they believed he had a foreign object in his stomach, luckily x-rays showed nothing found. Animal Friends covered the majority of the costs.
We then renewed the policy for year 2 and they applied the following restrictions, Ataxia and Abdominal pain. We accepted these restrictions as it was a time limited policy and he had recovered well from Ataxia ( going from a pup/dog we were syringing water into his mouth to keep him going, who could hardly walk to an 18 month old bounding around the park playing with other dogs)
Sadly on his 2nd Birthday he woke up coughing really badly, we took him to the vets in the morning where he believed it was related to his heart and recommended a heart scan. He had a heart scan the following day and was diagnosed with final stage heart failure, which was untreatable. We had a few more days with him before it was clear we couldn't let him suffer anymore, and took that very difficult decision.
We left the vet costs for initial diagnosis and the heart scan with the vets as they can claim direct to Animal Friends. The vet put the claim through as "condition, cough". Animal Friends rejected the claim for all costs after reviewing his veterinary records and finding the word "cough" mentioned in them and placed a new exclusion mid policy for "cough". I presumed they used some sort of word search of previous records! We believed the cough we had mentioned in previous voluntary check ups was due to his large and rather saggy neck (Bulldog breed) We took the vets advice and raised his food and water station which improved his cough. The vets also put a claim in for his euthanasia which was also rejected for "condition cough" I find the "condition cough" very vague.
I have started a complaints procedure on the grounds of adding an exclusion mid policy despite the fact they had access to his full medical records at the point of purchase of the second year renewal and stated I believed I had been mis sold a policy.
I also requested all my data through a GDPR request.
I also completed a death benefit form which they offer to cover some of the cost paid for our pet, which has a box asking if we have proof of purchase, I clearly stated no. they replied with an email asking for proof of purchase and attached a pdf letter addressed to our now (4 week) dead dog! I asked for this fact to be added to our ongoing complaint.
Any thoughts would be appreciated !
Thanks Gavin.

We took out pet insurance with Animal Friends for our new pup 2 years ago.
During the first year he unfortunately had some problems with a condition called Ataxia ( he had symptoms similar to a stroke). This resulted in significant vet costs including a couple of visits to out of hours vets. Animal Friends at this point covered the majority of the costs, with me paying the extras costs due to vet fee limits etc. which I was happy to do. He also had an out of hours vet visit where they believed he had a foreign object in his stomach, luckily x-rays showed nothing found. Animal Friends covered the majority of the costs.
We then renewed the policy for year 2 and they applied the following restrictions, Ataxia and Abdominal pain. We accepted these restrictions as it was a time limited policy and he had recovered well from Ataxia ( going from a pup/dog we were syringing water into his mouth to keep him going, who could hardly walk to an 18 month old bounding around the park playing with other dogs)
Sadly on his 2nd Birthday he woke up coughing really badly, we took him to the vets in the morning where he believed it was related to his heart and recommended a heart scan. He had a heart scan the following day and was diagnosed with final stage heart failure, which was untreatable. We had a few more days with him before it was clear we couldn't let him suffer anymore, and took that very difficult decision.
We left the vet costs for initial diagnosis and the heart scan with the vets as they can claim direct to Animal Friends. The vet put the claim through as "condition, cough". Animal Friends rejected the claim for all costs after reviewing his veterinary records and finding the word "cough" mentioned in them and placed a new exclusion mid policy for "cough". I presumed they used some sort of word search of previous records! We believed the cough we had mentioned in previous voluntary check ups was due to his large and rather saggy neck (Bulldog breed) We took the vets advice and raised his food and water station which improved his cough. The vets also put a claim in for his euthanasia which was also rejected for "condition cough" I find the "condition cough" very vague.
I have started a complaints procedure on the grounds of adding an exclusion mid policy despite the fact they had access to his full medical records at the point of purchase of the second year renewal and stated I believed I had been mis sold a policy.
I also requested all my data through a GDPR request.
I also completed a death benefit form which they offer to cover some of the cost paid for our pet, which has a box asking if we have proof of purchase, I clearly stated no. they replied with an email asking for proof of purchase and attached a pdf letter addressed to our now (4 week) dead dog! I asked for this fact to be added to our ongoing complaint.
Any thoughts would be appreciated !
Thanks Gavin.
0
Comments
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was the policy a 12 month policy only?
If so, a condition is only covered for 12 months from first occurance. In that case cover for the 'cough' would run out after 12 months from the initial visit.
Have you asked your vet why they claimed for a cogh rather than heart failure?1 -
In principle health related insurance can be written in one of two ways, irrespective if it applies to humans or other animals.
The cheap way is to exclude all pre-existing conditions, allow prospective policyholders to declare pre-existing conditions and make a case by case decision on each one and anything not declared remains excluded.
The expensive way is to get the full medical records up front, reports from doctors/vets etc and then make the decision to explicitly exclude anything you dont want to cover and anything else is covered (unless a general exclusion). Its great because it gives both parties more certainty but given reports cost a couple of hundred etc means is limited to long term policies
Adding an explicit exclusion just makes life easier for everyone as a low trained member of staff can quickly see coughs are excluded so if you call and say the animal has a cough it's a quick answer. It doesnt actually change anything though as without it they get the vets records and still decline the claim as they had a pre-existing condition of a cough.
Have to say that I have never done pet claims so dont know what the vet is explicitly asked, it could be that they ask what the animal first presented with or it could be their diagnosis but sounds more a question to your vet why they said it was a claim for a cough rather than heart failure.0 -
From my experience the claim form just states the condition dignosed.
the vet also send a copy of the pet's medical history.
The insurance company can then check back the medical history.
If you have a lifetime policy that renews the vet fees maximum every year then there is no problem with previous claims for the same condition or something that can be related to it.
if there is a limit on the maximum amount that can be claimed for each condition then previous claims for the condition will be taken into account.
If it is 12 month limit policy then cover only lasts from 12 months from first arising.
A consultation about something, whether treatment is given or not, is taken into account.
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sheramber said:was the policy a 12 month policy only?
If so, a condition is only covered for 12 months from first occurance. In that case cover for the 'cough' would run out after 12 months from the initial visit.
Have you asked your vet why they claimed for a cogh rather than heart failure?
Yes it was a 12 month policy and renewed as a 12 month policy for the second year.
Exclusions were applied from the start of the second year for Ataxia and Abdominal pain.
At no point in year one had he be seen by the vet for the condition "cough" nor did he receive any treatment for "condition cough"
The cough the insurance company refer to in their rejection of our claim relates to voluntary visits to the vet for check-ups for previous health issues, in which we mentioned coughing but believed it to be related to eating and drinking.
After requesting a GDPR it was clear that Animal friends had full access to his vet reports from year one. So I wonder why they didn't apply a restriction for "cough" at the start of the policy? Or are all pet owners required to request and keep detailed reports of every vet visit ?
I'm not sure why the vet used "condition cough" but can only assume that was what we said when asking for an appointment the day before his diagnosis.0 -
As I said anything you have mentioned to the vet and is noted in the medical records, whether treatment is given or not , becomes a pre existing condition from that date.I would suggest you go back to the vet and ask them to confirm to the insurance company that the diagnosis was heart related and was not connected in any way to the previous cough.
It I’ll be up to the vet whether he will confirm it is not connected to the previous cough.
There is the possibility that the original episode of coughing was an early indication of the heart problem.0 -
cheeseman002 said:Yes it was a 12 month policy and renewed as a 12 month policy for the second year.
Pet insurance can be written in one of three ways:
1) Time limited - cheapest option, a condition is covered for a set period of time since first diagnosis and/or until the policy limit is exhausted, which ever happens first. Most of these policies the time limit is 12 months but it can be different
2) Maximum benefit - is the middle ground option, it will have a maximum payout for a single condition and will keep paying out no matter how long it takes to hit the max, so could be within a policy year of over 5-6 years depending on the limit and how much is claimed each time
3) Lifetime - is the top tier, you have an annual limit thats refreshed each and every year you renew.
So the question wasnt how long did the policy last for, all three of the options above is normally a 12 month contract, but if you had the budget option of a 12 month time limited policy. It sounds like you did which would mean you were only covered for "coughs" for 12 months from the date of the original diagnosis for a cough. After that the condition is barred irrespective of if you claimed or not nor how much you claimed.0
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