Insurance definition of an injury?

knightstyle

Our dog has had a small lump on her ear and we showed it to our vet a few years ago, they tested a sample and said it was best to leave it but if it got bigger it might need to be removed.

Recently it quickly got bigger and seemed inflamed so we told the vet to remove it, all done and we paid just over £1000.

We put a claim in to our insurance and they refused it as the opp. was more than 365 days since the lump was first noticed, but it is only a month since the lump became inflamed/septic.

Is this right? Relevent part of policy attached.

elsien

I guess that’s down to the definition of clinical signs of an illness. I would probably put a complaint in and argue no treatment was required at the time it was first noted and it be becoming inflamed was a new step.

MyRealNameToo

https://forums.moneysavingexpert.com/discussion/6653934/insurance-definition-of-an-injury

What was the diagnosis of the lump? Agree with the other poster that it's more likely the clinical symptoms unless it was caused by an embodied foreign object or such.

sheramber

out of interest what insurance company?

Their argument could be that it would have been a less invasive procedure to remove it when small , than when bigger.

Ask your vet to confirm to them that the lump did not require removal when first examined and it would not have been in the dog’s best interest to operate at that time.

If you still get refused you can follow the complaint procedure detailed in your policy document.

MyRealNameToo

https://forums.moneysavingexpert.com/discussion/comment/81871297#Comment_81871297

The clause also only applies to non-lifetime policies so it will depend also on if they only offer time limited cover or also max benefit cover. Time limited cover typically starts ticking when the illness starts not the treatment.

born_again

Going by the title, has there been any injury that caused the small lump in the 1st place?

What sort of policy do you have?

If just annual one & not lifetime, then was the lump declared to the insurance co on renewal?

knightstyle

Thanks, it is not a lifetime policy, that is too expensive for us. The lump was small, marble size for several years but suddenly got bigger and more red.

So is a small lump an illness or injury as defined by the policy? having a lump is quite common with dogs and most are just left alone and do not suddenly grow.

This is the company.

www.pet-insurance.co.uk is a trading name of The Equine and Livestock Insurance Company Limited registered office: Thorpe Underwood Hall, Ouseburn, York, YO26 9SS 

Alderbank

…So is a small lump an illness or injury as defined by the policy? having a lump is quite common with dogs and most are just left alone and do not suddenly grow…?

Legally, definition of an injury is not so much the medical description as about who has caused it. To be an injury it must result from the actions (acts) or inaction (omissions) of another party.

So a lump would be classed as an injury if for instance it resulted from someone hitting your dog with a stick, or another dog biting him, or if it was caused by a minor scratch which you could have treated with simple first-aid but you did not so it developed into an infection which needed veterinary treatment.

eskbanker

So is a small lump an illness or injury as defined by the policy?

You've only shared a small extract from the policy document and the full terms aren't readily apparent from a quick online search, but rather than just focusing on the exclusion clause that you've highlighted, it'll probably be worth examining exactly what is covered, i.e. is it just illness and injury, or other medical risks too? If the latter, is there a specific clause that you are hoping to rely on?

MyRealNameToo

https://forums.moneysavingexpert.com/discussion/comment/81871601#Comment_81871601

So is it Max Time or Max Benefit? The former is a cheapest

First of all… what's the cause of the lump? You'd need a diagnosis on if it's a lipoma or mast cell tumour etc.

Then you need to look at the definitions in your policy book, if things are defined then you fall back to plain English. Some things are definitely going to be an injury or illness under plain English; there are maybe one or two which are more in a grey area and could be argued.

born_again

https://forums.moneysavingexpert.com/discussion/comment/81871601#Comment_81871601

So was the lump declared on the policy, given not a lifetime one & it had been to the vet for treatment on it?