Insurance definition of an injury?

Ergates

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

I suggest you speak to you vet for starters. Can you vet tell you what the lump was and/or what caused it to appear in the first place? And/or what caused it to become red and inflamed.

sheramber

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

I guessed they would be involved. They have a reputation for finding any possible way to avoid paying out.

Cheap is cheap for a reason.

visidigi

Question - did you claim on your insurance when the lump originally turned up? e.g. for the consultation etc?

Or has the Vet, in filing their side of the claim declared the original consultation and then the surgery over 365 days?

pinkshoes

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

On the basis their policy says:

"Any costs incurred 365 days after the occurrence of an injury to the insured pet, or after the insured pet displayed clinical signs of an illness"

I would then reply to them saying that your dog did not show any signs of an illness until a few days ago when they got an infection which required treating, therefore as per the wording of their policy, you are entitled to claim.

A lump on a dog is neither an illness nor an injury. It is a lump. Our dog has lumps. Had them for years. They're common in dogs, particularly older ones. Our previous dog had lumps. And the one before that!

Ergates

I think it would come down to what the illness was that needed treatment and what the clinical signs of it where.

i.e.: was the lump becoming inflamed a progression of the original appearance of the lump. (stage 1: lump appears. Stage 2: lump gets inflamed).

OR: was inflammation unrelated to the original appearance. i.e. the original lump was just a benign lump, nothing more - it would have sat there for the rest of the dogs life not doing anything. Then, in an unrelated incident, it became infected and became inflamed.

These are the types of questions only the OPs vet can answer.

MyRealNameToo

https://forums.moneysavingexpert.com/discussion/comment/81872135#Comment_81872135

Have you seen the diagnosis? The OP hasn't stated if the lump was just fat lumps, cancer, foreign object… there are a vast array of causes of lumps and a significant proportion are caused by injury or illness

knightstyle

Thanks for comments, the lump was not caused by an injury, foreign object etc. I think I will use the sentence from Pinkshoes and see how they react before taking it further.

pinkshoes

https://forums.moneysavingexpert.com/discussion/comment/81872749#Comment_81872749

I'm not sure how that is irrelevant.

The insurance company are saying they will not pay out because it was more than 365 days since the lump was noticed, but the lump noticed over 365 years ago was not an injury or illness or anything of concern.

It would be cruel to put a dog through anaesthetic/surgery to remove a lump that isn't infected, hence it wasn't done years ago. Very sensible. This infection is a NEW thing. The infection has not been there over 365 days, therefore the insurance should pay.

@knightstyle I'm curious if the insurance would therefore pay out for the removal of a lump that poses no potential harm or risk? Because they are implying that they should/would have done so given they're saying they won't now. Otherwise this would be an unfair term…

sheramber

According to the policy document

llness - physical disease, sickness, infection or failure

which is not caused by injury.

The lump comes under illness as a physical disease not caused by injury.


If the lump hadn’t been there it would not have got infected so the infection is directly related to the lump.

eskbanker

The insurance company are saying they will not pay out because it was more than 365 days since the lump was noticed, but the lump noticed over 365 years ago was not an injury or illness or anything of concern.

What's that in dog years? 🤔