Appealing petplan insurance
Debsmel
Posts: 1 Newbie
Paddy a cavalier king Charles spaniel has some serious issues one of which is pituitary dwarfism and will be on thyroid medication for life. Petplan have contacted us saying they will not pay the claim which is many thousands as there were clinical signs within the 14 day exclusion period.
Paddy was taken to the vet during this period for his second vaccination. Two weeks later (which was 8 days outside the exclusion period so technically covered) he was taken to vets as he had diahhorea, the vet gave him antibiotics and suggested he be wormed again as it may be due to parasites. The insurance company are saying the vet noted he hadn't gained weight in that 2 week period which partially falls into the exclusion period so they are saying this is a clinical sign of pituitary dwarfism. He had diahhorea for 2 days of course he hadn't gained weight! We didn't claim for that visit and signs of him having a potentially underlying condition didn't appear for another month and 6 weeks later after a referral to vet hospital and organ biopsies and lots of consultants scratching their heads they finally tested him for thyroid and dwarfism.
He is/was small but so were his litter mates and his mum was also small it's not like he was obviously smaller when he was bought. They originally settled the first claim for treatment at local vets but since receiving the second claim which is for many thousands from the small animal Hospital they are now saying they paid the first claim in error but as it was their fault won't be asking us to repay that was for £115.00. But won't be paying the second claim as he showed clinical signs of pituitary dwarfism in the exclusion period
Has anyone challenged petplan or gone to an ombudsman that can offer any advice
Paddy was taken to the vet during this period for his second vaccination. Two weeks later (which was 8 days outside the exclusion period so technically covered) he was taken to vets as he had diahhorea, the vet gave him antibiotics and suggested he be wormed again as it may be due to parasites. The insurance company are saying the vet noted he hadn't gained weight in that 2 week period which partially falls into the exclusion period so they are saying this is a clinical sign of pituitary dwarfism. He had diahhorea for 2 days of course he hadn't gained weight! We didn't claim for that visit and signs of him having a potentially underlying condition didn't appear for another month and 6 weeks later after a referral to vet hospital and organ biopsies and lots of consultants scratching their heads they finally tested him for thyroid and dwarfism.
He is/was small but so were his litter mates and his mum was also small it's not like he was obviously smaller when he was bought. They originally settled the first claim for treatment at local vets but since receiving the second claim which is for many thousands from the small animal Hospital they are now saying they paid the first claim in error but as it was their fault won't be asking us to repay that was for £115.00. But won't be paying the second claim as he showed clinical signs of pituitary dwarfism in the exclusion period
Has anyone challenged petplan or gone to an ombudsman that can offer any advice
0
Comments
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In the first instance I would speak to your Vet. They should be able to tell you if Petplan have a legitimate get out or not, and should be able to provide evidence to assist any appeal if that is appropriate.0
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First, talk to your vet about whether he can say that the not gaining weight was not due to the dwarfism.
If he can confirm that to Petplan that may be enough.
Exclusions apply to anything that showed signs , not when actually diagnosed so the timing of the first signs is crucial.
The free insurance that many breeders give is invaluable for this as you are covered for the first 4 weeks and are able to continue the insurance with no exclusion period.
If you are unhappy about Petplan's answer then follow the complaint procedure set out in your policy document.
Submit your complaint in writing, stating that it s a complaint.
If you still are unhappy or they don't reply within 8 eight weeks, then you can contact the Financial Ombudsman, who will review the case.0
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