Vet Claim Handeling Question

[Bigglesw]

Hello

 

We recently made a claim on our pet insurance for some lumps to be removed from our 10 y/o dog. The bill was £640 and we had an excess of £80. That's all OK.

 

We submitted the claim with our vet filling in the technical bits of the form and the claim has bee processed and payment issued.

 

We were expecting a check for £560, but no. They have sent 4 cheques amounting to £260 claiming that as there were 3 different types of lump, Cyst, Melanoma and Lypoma this is 3 separate conditions each being a separate condition and therefore being 3 claims and 3 excesses. Even then the maths don't work out.

 

Surely this can't be right. It was 1 operation, and 1 consultation, and one bill. Had we have not paid for histology no one would have been the wiser, but of course this is not in the dogs best long term interest. If we had had these lumps removed in separate operations there would have been significantly greater expenses for things such as pre & post op consultations, aesthetic, medication etc, but again this would not be in the dogs best interest.

 

How should I fight this? The company is Direct line.

 

Thanks in advance.

 

Kevin

[honeybee13]

Hello there. I hope your furry friend is improving.

 

Do you have the policy wording about claims and does it mention separate conditions at all?

 

HB

[Bigglesw]

Hi

 

The dog is doing just fine thanks.

 

I am going to go through it tonight.

 

It does however gall me that if we had not had the histology done, or claimed for it then this would be treated as 1 item "lumps removed"

 

I just strongly feel this is a very wrong approach and even if it is in the wording it is a VERY significant item and attention should be brourght to it lest it be considered unfair / reasonable terms.

 

We have 2 dogs and have paid out 42 p/m for 10 years and this is the first claim we've made. Thats over £5000 in premiums. I know this is a typical statement and I know the underwriters job is to save the insurance co. as much as possible but this really is taking the micky.

 

Even our vet had never heard of this happening.

 

Kevin

[Bigglesw]

Bump Anyone?

[honeybee13]

Hello again. If you're going to argue with an insurance company, then my approach is always to use their policy wording against them. Please can you post the relevant bits of your policy about claims?

 

HB

[Bigglesw]

Hi

 

I have already sent a letter of complaint. My key point in it is if we had not had histology it would have been a bil saying something along the lines of "lump removal".

 

This is their full policy

 

http://www.directline.com/pet/P1013_0110_web_copy.pdf

 

This is the key facts summery.

 

http://www.directline.com/pet/page02.htm

 

Thanks.

 

Kevin

[honeybee13]

Hello again and thank you for taking the time to post this info.

 

I think I'm up against the limits of my knowledge, but I wonder if they're trying to hide behind their definition of 'different diseases' in the claims section of the policy document. I imagine what your poor dog had wasn't any sort of pre-existing condition?

 

Depending on what the guys say, it could be a case of waiting for a reply to your letter and arguing it from there, but at least we have the policy terms to refer to now.

 

My best, HB

[Bigglesw]

I got a phone call today from an underwriter agreeing to pay in full as one claim. However their reasoning for dividing the claim into 4 is so we can claim again if one or more of the listed types of lump come back.

 

Heres the bit I don't get. If we go for the full settlement the current lump types are only covered for a year after the surgery if they need revising or come back. After this time we would not be able to claim at all for them as they would then be classed as a pre-existing condition. If we go with their proposed settlement the lump types will be covered for life and we wouldn't have to lose our excess again.

 

Surely pre-existing would be at the time the policy was taken out, i.e. when each one was 8 weeks old. There has been no lapse of missed payments. Does this policy renew each year or is it an ongoing policy with annual revised payments

 

I need to speak to my vet about this. Seems like a climb down to me dressed on bullsh*te

 

Kevin

Edited November 12, 2010 by Bigglesw
to add a missed sentance.

[hightail]

If you have a policy which gives ongoing cover then I don't understand their argument UNLESS you have one which has a cover limit per condition rather than a limit per year in which case I understand what they're saying. Even so £640 shouldn't be anywhere near your limit. I would be interested in knowing their reasoning on this. I honestly don't understand how they can exclude 'lumps' as a pre-existing condition but not exclude named lumps.