PET INSURANCE CLAIM

[persha50]

Hi - hope you can help as usually get amazing advice but not on this subject.

One of my pets is insured with E&L (I have had 9 dogs registered with them), she had a slipped disk last year in August 2018 which was treated by a referral to a specialist. All paid except for a shortfall of £250 (in addition to excess which I paid).

1) Her policy is for 365 days but when I renewed her policy in October 2018 they did not put an exclusion on for back/spine injury (there were exclusion for other conditions).  So it was renewed 2 months after treatment.  Because she did not have an exclusion on her renewed policy would that mean that she would be covered till October 2020.

 

2) Can the consultant refuse to see an animal due to money still being owed.  I owed the consultant the shortfall as have not been able to work due to health reasons and have been in constant contact with them since September 2018 regarding this. 

They did not give me the option of paying cash just that they refused to see her which they also contacted my vet about (he did the referral) revealing to him that I still owed them money.  Prior to this as I knew she needed to be seen I got a payday loan, called them paid the arrears asked them to make the appointment which they said they would only to be called back 10 minutes later telling me they refused to see my dog. 

Once I complained they agreed to see her provide I paid cash. 

 

She has a slipped disk so cannot walk, is in severe pain which we were struggling to manage, had not eaten in over a week, had no sign of improvement the only other options would be to have her put down which I am not prepared to do.

 

So any advice on is she should still be covdered till Oct 2020 due them not having given me an exclusion notice.

Are they able to refuse to seen an animal without giving an option

 

It looks like she may need surgery as there has been no improvement in nearly 4 weeks, I can bet, steal and borrow to get money to pay but very concerned will not get it back from the insurance company.

Stay safe

Sharon

[BankFodder]

Which veterinary practice are you dealing with?

[honeybee13]

Hi. I'm sorry that your pet is suffering.

 

I'm not sure I've followed everything in your post but I would say a consultant or specialist you owe money to wouldn't have to treat your pet if you owe them money.

 

Please say if this is the situation.

 

HB

[unclebulgaria67]

I don't understand the post either in regard to the policy renewal and dates quoted.

 

Please re-post in date order, so we can hopefully understand.

 

 

[persha50]

Hi dates reposted:

 

My policy is for treatment 365 days from start of injury, when my policies are renewed an exclusion notice is put on the policy to say what specific injury is not covered.

 

Aug 2018 - dog developed spine injury (slipped disk), was treated by vet and specialist.  Claim was paid by insurance company.

Oct 2018 - policy renewed but no exclusion mentioned.

Oct 2019 - policy renewed but no exclusion mentioned

April 2020 - dog has developed another spinal injury which is more severe than previous one in Aug 2018.

 

Contacted insurance company to say she has another spinal injury and if they would be able to do a pre-approved claim form as needed referral to specialist which needed surgery as conservative treatment no working and she is in severe pain.

 

They said she is not covered as policy is for 365 days but I told them that there is no exclusion on the policy stating she is not covered for spinal injury.  I have 9 dogs insured with them an all of them who have been treated for major medical conditions have had an exclusion placed on their policy.  I usually receive a letter prior to the renewal date stating the exclusion and the date its effective.  This has not happened with her policy HOWEVER about an hour or so after speaking to them I received an exclusion notice from them saying that from October 2020  she will not be covered for back or spine injury.

 

My arguement is that because they have not put the exclusion on her policy when they renewed it in October 2019 they are still liable to pay for treatment.  I know its a lot to ask but financially we cannot afford to pay for her treatment especially with the COVID19 situation and if insurance does not pay the only other option is to have her put down due the how much pain she is in, she is nearly 9 years old and is a rescued chihuahua so very special to us, especially as I lost one in March this year due to a heart failure.

 

Any advice would be appreciated as I am getting desperate trying to help her.

 

Sharon

 

[unclebulgaria67]

Agree with your analysis, that you have the Insurance cover as stated in the renewal documents issued to you October 2019.

 

The Insurers cannot refuse you a claim based on an error they have made in not adding an exclusion.  The exclusion they have applied is only effective from October 2020.

 

Contact the Insurers on Monday by phone ( record call if you can) and ask to speak to the Claims Manager.  Get their name and email address, so you can follow the telephone call up in writing.  Ask them to register a complaint and advise them you will follow up with FOS or County Court, if this claim is not honoured in line with the Insurance contract they issued in October 2019.

 

 

 

 

[persha50]

Hi thanks for reply.  Their arguement though is that my policy only covers 365 day from date of treatment, and this is over 365 days HOWEVER I am attaching a copy of their standard exclusion notice which I understand to say its not set in stone and is negotiable.

I would not normally have an issue but with her being so poorly and struggling and having no income at the moment I need to do something as my poor little dog is struggling. 

 

Thanks again for advice really appreciate it.

Carli.pdf

Edited May 2, 2020 by persha50

[unclebulgaria67]

Are they saying that they only covered the treated condition in August 2018 for 365 days after the treatment was first carried out ?

 

So from August/September 2019 they would not pay for any further treatments ?

 

The exclusion letter you attatched is a change to the policy from renewal in October 2020.

 

Have you received a letter from the Insurers rejecting a recent claim ?

[persha50]

Hi - yes thats what would normally happen with the policy HOWEVER prior to poilcy renewal I would get an exclusion notice which they did not issue until 24/04/20.  This letter should've been issued prior to my renewal in October 2019 and an exclusion placed on my policy which did not happen.

Having other dogs insured with them they have done that with the others after treating conditions such as heart disease, spine issues (on another dog) and conditions treated by previous vet (I have 8 dogs registered at the moment).

I received the letter about an hour after speaking to them and saying that there was no exclusion notice on my policy despite having had treatment in 2018 and challenging their decision.

My understanding of the wording in the exclusion the letter says that it is negotiable.

Yes I have received an email saying they do not accept liability.

[unclebulgaria67]

You need to go back to them as advised earlier.  Make a complaint and insist they honour the contract.

 

They CANNOT make any backdated change to your Insurance contract.

 

You DO have the cover as shown in your renewal documents issued in October 2019.

 

 

[unclebulgaria67]

When they originally accepted your claim in August 2018, did they warn you that the condition and anything related would only be covered for 365 days ?

 

Is there any clause in the policies issued in October 2017, October 2018 or October 2019, that specifically states that if you have claimed or have any claim accepted for a condition, that any treatment would be restricted to 365 days ?

[persha50]

Hi -

There was no warning issued after her treatment in 2018 to say she would only be covered for 365 for treated related to her slipped disk.,

There is a section in the policies which make reference to 365 days.   I have attached the most current page.  Its Section 1 - Exclusion 7 on the right hand column. BUT nothing that says relating to her back injury.

Policy - clause.pdf

[unclebulgaria67]

 

"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."

 

The Insurers argument is that the costs you are now trying to claim are more that 365 days after the injury or illness ?

 

Is that what they told you in writing, that they are not liable for your claim, because of this clause ?

 

If they have not clearly explained this, you need to go back to them.

 

Unfortunately, I think the Insurers may technically be correct.  But you need them to confirm in writing exactly why they are not liable for your claim.

 

In the meantime have you contacted the nearest PDSA surgery .

 

https://www.pdsa.org.uk/

[persha50]

Hi - yes they have said that in an email, for the claim my vet put in for her first consultant and xray to find out what was wrong with her as did not think it was a slipped disk again as she has been as right as rain.

 

However when I phoned to see about getting a prepayment letter as she need to be seen by specialist, they told me the same thing over the phone but I asked if that was the case why was no exclusion notice put on the policy since 2018.  She spoke to manager and they said that if we can prove that its in a different area then they will cover it.

My vet says he thinks its T12 & T13 (previous one was T11 &T12) but this cannot be confirmed without an MRI.

 

My arguement is that no exclusion notice has been issued despite 2 renewals.  Also not sure if section 19 on policy is relevent which says any conditions on the exclusion.

 

Normally I don't think it would be an issue but my poor dog is in agony and we have tried everything.  I don't mind her loosing use of her back legs and not being able to walk provided she is not in pain and putting her down is not an option.