Lula-Belle v M&S Pet Insurance

[Lula-belle]

This thread is worrying. To be fair I was already worried as I'm with M&S Premier and haven't been happy with them in the past over their definitions.

 

In light of everything happening with Halifax/Lloyds etc. I'm quite anxious about my policy so I have been reading through the T&Cs. I've come across an exclusion I don't completely understand so I'm hoping for some help.

 

I have M&S premier cover for both my dogs (provided by Royal & Sun Alliance) which was taken out as 'lifetime cover' in 2007 and 2008 (I have documentation stating this). In December 2010, my renewal details stopped mentioning the term 'lifetime cover' but equally don't state that it isn't. The new term used is 'long term'.

 

Premiums for my 6 yr old girl:

£136.68 for 2008-2009

£167.88 for 2009-2010

£222.72 for 2010-2011 (one claim made Feb 2011 for £1182.74 less excess for OCD)

£335.88 for 2011-2012

 

Premiums for my 4 yr old boy:

£214.08 for 2008-2009 (one claim made Feb-Jun 2009 for 381.14 less excess for infected dew claw)

£275.88 for 2009-2010

£359.88 for 2010-2011

£407.88 for 2011-2012

 

I bought the policy because it was lifetime cover and at the time, the cover was comparable to Petplan but less expensive and covered both complementary therapy and holiday cancellation. I also believed M&S would be a brand I could trust, particularly as there were a lot of lesser known providers around at the time. I have already had problem with them on the complementary therapy front as their definition of 'hydrotherapy' is different to most. Also, I believed their holiday cancellation would cover holiday anywhere but it turn out it's just Europe. We don't go away often but when we do, it's further afield so that wont be covered.

 

Anyway, on my 2010-2011 renewal, there was an enclosed sheet 'M&S Pet Insurance - Important changes to your policy booklet'. On this is a 'New Exclusion' which states 'The cost of any veterinary treatment if a claim has not been made within 12 months of your pet receiving it first treatment.'

 

My question is - what does that mean? At the time I thought it meant that if my dog was ill and I didn't put a claim in within 12 months, then they would not pay that particular claim. However, I'm now worried it means something else - i.e. that if they have been diagnosed with an illness or condition, which may not need any treatment at the time, but could possibly need it years down the line, then that is not covered because the treatment was not within 12 months of the first diagnosis or treatment.

 

If the latter, my dogs may well not even be covered... one has a lump that my vet thinks is probably nothing (but wont guarantee it and wants to monitor it). The other dog has a joint condition (OCD) in her back legs which I currently buy supplements for online. She also has painkillers if needed. I don't claim for either of these as the cost isn't as much as the excess. They did say either may need operating on at a later date though.

 

I'm really hoping this makes sense as I'm not finding it the easiest thing to explain. I'd really appreciate your thoughts.

[citizenB]

Anyway, on my 2010-2011 renewal, there was an enclosed sheet 'M&S Pet Insurance - Important changes to your policy booklet'. On this is a 'New Exclusion' which states 'The cost of any veterinary treatment if a claim has not been made within 12 months of your pet receiving it first treatment.'

 

My question is - what does that mean? At the time I thought it meant that if my dog was ill and I didn't put a claim in within 12 months, then they would not pay that particular claim. However, I'm now worried it means something else - i.e. that if they have been diagnosed with an illness or condition, which may not need any treatment at the time, but could possibly need it years down the line, then that is not covered because the treatment was not within 12 months of the first diagnosis or treatment.

 

If the latter, my dogs may well not even be covered... one has a lump that my vet thinks is probably nothing (but wont guarantee it and wants to monitor it). The other dog has a joint condition (OCD) in her back legs which I currently buy supplements for online. She also has painkillers if needed. I don't claim for either of these as the cost isn't as much as the excess. They did say either may need operating on at a later date though.

 

I'm really hoping this makes sense as I'm not finding it the easiest thing to explain. I'd really appreciate your thoughts.

 

 

Hi Lula-belle. Yes, I have that "Important Change" notice as well.

 

I believe it means that if a diagnosis is made say on 1st January 2012 but that no treatment for that condition is made within a year, then it will be classed as a "new condition" if your pet then requires treatment from January 1st 2013.

 

It would be very worrying though if it was then excluded as having been diagnosed previously ?

 

It might be worth contacting M&S helpline to get clarification.. I have to admit, they are usually pretty helpful.

[Lula-belle]

Thanks CitizenB... that's 3 possible definitions between the two of us so it's definitely ambiguous. I'm reluctant to speak to M&S as I've found it hard work whenever I've called the general line, they've just not had the knowledge to deal with the query and I get passed from pillar to post, with numerous different answers so I never know what to believe (they wouldn't confirm in writing). I ended up speaking to the chief exec's secretary (surprised they put me right through) when I had some problems over the OCD payout/terms. I was hoping someone may have some legal experience to explain the meaning....

[Lula-belle]

I just gave them a call and was put through to the claim department. They wont put what they said in writing but did say that it's a recorded line and for me to take a note of time/date/who I spoke to as it could be retrieved if needed. I'm still not 100% convinced because I still think it's ambiguous in its wording. The recorded line business doesn't reassure me either as I was sold the policy on the basis that hydrotherapy was covered for any problem (whereas the policy document says otherwise) and when I asked them to trace my call to their sales people, they couldn't find it!

Anyway, the lady I spoke to basically said that claims for anything suspected/diagnosed needed to be in within 12 months for them to be covered otherwise they would not pay. She gave me an example which said, if a dog gets diabetes but the owner doesn't claim for treatment for 2 years, they wont cover the treatment. With reference to my two, she said that my girl's OCD is on their records so will be covered. With my boy, I mentioned the lump on his side and said that the vet wasn't worried and that they did a needle biospy and weren't worried by the results. I said it came to about £40 or something so obviously I didn't put a claim in as it was less than the excess. I asked what would happen if it became something to worry about and she said it would be covered. I don't understand to be honest as the test for it was over 12 months ago so according to her diabetes example, to me I'm still not convinced they would cover treatment. Very confused to say the least.

[citizenB]

Alanty, if you look on the threads dealing with Halifax/LTSB policies specifically, I think there are draft letters in the threads.

 

Lula Belle - If you are still unsure, then I would suggest you write to M&S. You should send the letter either recorded or special delivery.. JIC you need at some point to take action.

 

Refer to your telephone conversation of today, advise that you are still unclear and request a properly detailed explanation of the clause.

[BankFodder]

Lula-belle

Please will you start your own thread about this.

Sounds as if M&S are gearing up to shaft you

[citizenB]

New thread for Lula-belle as requested

[BankFodder]

If you are going to phone them then you should record the call yourself. To expect that they will be prepared to supply you with a recording is pretty optimistic.

 

Try it and prove me wrong