Pet Insurance Claim Rejected

TamRichardson · 2 October 2019 at 8:38PM

Hi all,

Looking for some advice around a pet insurance claim I made that was rejected.

I'd had Pet Insurance with Sainsbury's Bank since 2014 without making any claims. I changed provider in June this year to Animal Friends as they were cheaper. I took my (indoor) cat for a routine check up in April where the vet said he had lost weight. I wasn't concerned as in December last year we moved house and also had a baby so there was a lot going on and a new addition to the family so assumed the weight loss was probably stress related. Had to go through various testing and it turns out he is hypoglycemic, so is now on a special diet.

I got the vet to fill out the paperwork needed and sent the claim to Animal Friends. They replied, see below. What rights do I have in the way of an appeal given nether myself or the vet were worried at the initial weight loss given the house move and new baby, and were going to monitor it? Thanks for any help or advice.

"Archie’s clinical history has been reviewed as part of the assessment of your claim and the following has been noted:
30/04/2019 - "otherwise weight loss ++"
25/06/2019 - INCEPTION
01/08/2019 - "in good health overall tho continued weight loss", "calcium elevated"
We refer you to the Vet Fees section of your policy wording:
1.3 Exclusions – the following are excluded from cover:
1.3.1 Any pre-existing condition or claim for costs relating to an injury or illness that relates to or results from an accident, injury, illness or clinical signs your pet had before the commencement date;

The information provided confirms that the condition being claimed was first noted on 30/04/2019, prior to the inception
of your policy."

stator · 3 October 2019 at 9:24AM

If you want to appeal you first appeal to Animal Friends, if they reject you, you can appeal to the ombudsman.
To be honest though, If the weight loss is associated with the condition you are claiming for, according to their terms and conditions; they have every right to refuse your claim.

That's the major danger with changing pet insurance

sheramber · 3 October 2019 at 10:01AM

Yes, anything that can be related to a pre exisitng condition, even if no treatment was given, is excluded.

You can try appealing it and get a final letter then refer it to the ombudsman- follow the complaints procedure in your policy document.

As said already it is one of the drawbacks of changing insurance company if your pet has had any previous vet consultation.

TamRichardson · 6 October 2019 at 9:15AM

Hi guys, sorry haven’t been able to reply sooner. Thanks for your replies. I’ll use the Animal Friends Appeal process and potentially contact the ombudsman. Will also see if the vet can give me any backing that the weight loss identified in April (in the context of a recent house move and new baby) there was no way of knowing at that point if there was an underlying condition or if it was stress related.

I’ll also contact Sainsbury’s Bank as if the condition was first identified in April I was still insured by them then. Although given the tests and fees happened after I changed provider I can imagine they aren’t going to be receptive to my claim. In my mind it will probably come down to help from the ombudsman as to who should accept the claim as I’ve been covered the whole time regardless of when the illness was first identified and when the testing began.

Cheers

Trina90 · 6 October 2019 at 9:31AM

My cat had a urine infection before he was diagnosed with the fatal feline disease, FIP. When I put in my claim with Petplan, they tried to argue that he was showing symptoms before my cover started (I wasn't covered when he had the urine infection). All I had to do was get the vet to write that a urine infection is a completely different condition and not a symptom of the disease that he later contracted, then Petplan coughed up.

Pet Insurance Claim Rejected

Comments

Categories

Get our FREE Weekly email full of deals & guides - and it’s spam-free