Hi all…

.I need advice on a pet insurance claim matter….apologies for the long post.

My sister took her cat to the vets (July 2016) when he started dropping his food

…this was a few weeks after she had insured him initially

….but a couple of days after she noticed the problem.

The vets said he had lumps on the inside of his cheeks but his teeth and gums were fine.

They gave him a course of antibiotics.

These had little effect so she took him back a week later.

The vets then said that he most probably had an immune system condition whereby they ‘reject’ their own teeth and that they wanted to do biopsies on the cheek lumps.

A week later she took him into the vets for the recommended biopsies and they also mentioned that he may need to have several teeth extracted as a long term solution.

She was aware and advised the vets that the insurance did not cover teeth and gums so she would have to pay for the extractions etc.

She paid the bill and submitted the claim form via the vets.

She received a letter from the insurance company refusing the claim

and after enquiring she discovered the vets had submitted all the bill – including extractions!

The insurance company said to submit another claim form

– so she did

– minus anything to do with teeth etc.

It was then refused again as the vets had stated the condition as Gingivastomatitis – ie gums?

The insurance company then said to submit another claim omitting anything mentioning Gingiva

– so ‘stomatitis’

– an immune system problem…which her vets did.

They refused it again

– even though the vet had submitted a letter in support of her claim.

She took it through their complaints procedure

...which took several weeks

...and they refused it again

– for the previous reasons

– stating that it was teeth and gums

– but also the vets have stated on a question which asks when the owner first noticed symptoms

– 7 days

– which takes it into the exclusion period.

She has spoken to the vets and clearly they have misunderstood/made an error in stating this…

.the person who deals with the insurance claims confirmed that nowhere in the notes does it state 7 days…

possibly the vet has stated the timeframe between initial consultation and subsequent consultation??

The question on the claim form clearly states "how long before seeing the pet did the owner state they noticed symptoms?" - to which they have written a 7 in the box

- but failed to complete the date box at the side of it.

Where does this leave her now?

- as if she escalates it to the ombudsman

– the vets have automatically invalidated the claim by stating this.

Every time she calls the vets she isn't getting any answers/action.

The lady who deals with insurance claims was on holiday for 2 weeks then the vet who completed the claim form is now on holiday for 2 weeks.

I was discussing with her the possibility of sending an official complaints letter to the vets

- in order for it to be formally recorded

- as all discussions have taken place verbally so far.

Additionally, maybe looking at holding the vets responsible for voiding the claim? (without the teeth/gums matter)

- and seeking recompense from them?

Any thoughts would be most welcome.

Thanks Foxy

I'm sorry, but your solid block of text is just too difficult to read.

Please would you edit it or post it again this time properly spaced in paragraph et cetera.

Presented as it is, it will simply put people off giving you the help that you need

Hi Bankfodder I did edit my post into paragraphs but it doesn't appear to have worked! I will try again. Edited to add - the edit post option doesn't appear to be available for my original post?? Thanks Foxy

done for you

Not something i have dealt with, but i understand a lot of pet claims are refused, particularly when a condition has presented itself soon after taking out Insurance.

Can please state the dates that are relevant.

Start date of policy -

Exclusion period stated in policy -

Date of first contacting the Vets about this problem -

And confirm which Insurers and name of product e.g Animal friends pet plus

The date in contacting the Vets is most relevant, as this is the date recorded of the problem being noticed and Vets being notified. If this is within the exclusion period and any treatments excluded by policy, there is no cover.

For background information, it would also help to know the age of the pet and whether your friend had a previous insurance policy. Unfortunately, Insurers do sometimes find that people take out Insurance when they think their pet will need treatment by Vets. They buy the policy, then wait until the exclusion period has has passed before contacting Vets. This might not be relevant here, but it might inform your friend of what might be in the mind of Insurers, when a claim is made close to inception/exclusion period. Insurance does not cover conditions known before the Insurance was taken out.

Not something i have dealt with, but i understand a lot of pet claims are refused, particularly when a condition has presented itself soon after taking out Insurance.

 

Can please state the dates that are relevant.

 

Start date of policy -

 

Exclusion period stated in policy -

 

Date of first contacting the Vets about this problem -

 

And confirm which Insurers and name of product e.g Animal friends pet plus

 

The date in contacting the Vets is most relevant, as this is the date recorded of the problem being noticed and Vets being notified. If this is within the exclusion period and any treatments excluded by policy, there is no cover.

 

For background information, it would also help to know the age of the pet and whether your friend had a previous insurance policy. Unfortunately, Insurers do sometimes find that people take out Insurance when they think their pet will need treatment by Vets. They buy the policy, then wait until the exclusion period has has passed before contacting Vets. This might not be relevant here, but it might inform your friend of what might be in the mind of Insurers, when a claim is made close to inception/exclusion period. Insurance does not cover conditions known before the Insurance was taken out.

Thanks for your reply UncleBulgaria The policy was taken out on 21st June 2016 - 14 days exclusion period - Animal friends . Yes she did have another policy for her other cat (for about 2 years) but cancelled it and went elsewhere on principal when this happened. She contacted the vets the day previous to taking him in when she noticed he was dropping his food. His first visit was the 8th July 2016. He is around 8 years old I think - she took him in from being a stray - neighbours moved and left him - but she knew him from a kitten so this is why she knows his age. He showed no symptoms previous to her calling the vets. The vets have automatically invalidated the claim by writing the wrong information on the claim form though - should she pursue them for the money?? Where does she stand? Thanks Foxy

done for you

Thanks DX

Thanks for your reply UncleBulgaria The policy was taken out on 21st June 2016 - 14 days exclusion period - Animal friends . Yes she did have another policy for her other cat (for about 2 years) but cancelled it and went elsewhere on principal when this happened. She contacted the vets the day previous to taking him in when she noticed he was dropping his food. His first visit was the 8th July 2016. He is around 8 years old I think - she took him in from being a stray - neighbours moved and left him - but she knew him from a kitten so this is why she knows his age. He showed no symptoms previous to her calling the vets. The vets have automatically invalidated the claim by writing the wrong information on the claim form though - should she pursue them for the money?? Where does she stand? Thanks Foxy

I can see why the Insurers are having a problem with this claim. It is for the reasons explained, taking out Insurance and then making a claim so quickly after the exclusion period. I note you say your friend had previous Insurance on another cat, but not this particular cat that had the problem.

Did the Vets have a problem with the Insurance claim and what has been completed was meant not to be helpful ? They deal with Pet Insurances on a daily basis and they know what is covered/not covered. If the Vets have made a mistake and the claim was valid, then your friend needs to make a complaint to the Vets, asking them to write a full letter explaining the full circumstances to the Insurance Company. Perhaps with full information in a letter from the Vet, the Insurers can consider the claim again.

My vets charge for processing a claim - around £7. If your friend's vet does then I'd say this puts a professional duty on them to get it right and you stand more of a chance of getting things sorted by putting in a complaint to them and hoping for a goodwill gesture. If they do it as a favour then it is a more murky situation with the cover being taken out so soon before treatment with a cat of this age. Although the cat hadn't shown symptoms earlier there's little doubt the insurers can argue it was a pre-existing condition.

Thanks for your replies. I appreciate the view on the claim being after the exclusion period, however, the vets were aware that teeth/gums were excluded and she knew she would be covering the extractions. My sister has actually paid all the bill as the vets don't do direct claims with Animal Friends. It has not helped matters as the vets submitted the full claim on the first claim form - extractions ..everything! The vet also sent in a letter of support in December 2016 - which when she spoke to AF they claimed not to have received. The vets sent her a copy and submitted it again to AF. I believe she is writing a formal letter to the vets requesting their proposals on how to rectify the matter. I suppose we will have to see what happens.???? Foxy