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Issue with pet insurance failing to pay out.


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Hi all. Seeking some advice for my brother regarding a bill insurance should have paid.

Long story short, my brother is autistic and has long term health conditions. His service dog took ill during the pandemic, and he tried to get an appointment with his vet but he was left to wait a week. Dog started hemorrhaging and the vet refused to see him as they felt there was nothing they could do and the bleeding would stop. It did, but the dog was left severely anemic and had to be rushed to the vets the following day as he was at death's door.

Brother wasn’t allowed to go into the practice with him due to the social distancing rules (which were actually removed on the day this happened) he gets a call 30mins later, saying they’ve found a tumour and it’s in the dog’s best interests to be put to sleep before he comes round from the sedation.

My brother had 10 mins to decide what to do and was denied a chance to say goodbye to his best friend. He begged them to try and do something to save him but they wouldn't hear of it. He was absolutely devastated and as a result of what happened he made a suicide attempt in the weeks following and he’s not really recovered mentally from it. He is still deeply grieving the dog and it’s obviously impacting his health overall. He lost his job and his home as a result of his mental health crisis and is still trying to rebuild.

He had a high cost pet insurance policy with a “lifetime excess” meaning he didn’t need to pay any excess on any conditions he'd already paid an excess on. The bleeding and tumour was tied to an existing condition the dog had, and so he thought the pet insurance would pay out and he’d be done with it.

He has a bad history with this vet, who had previously shown intent to put his dog to sleep and refused to test a lump they removed for cancer as the vet claimed “it’s the least of his problems”.

Anyway, pet insurance changed their terms a few months before this happened and altered their excess policy removing the lifetime excess. No mention of this specifically in any of the documentation, so my brother was none the wiser until they rejected his claim.

Vet sends a bill. Brother raises a complaint with the insurance. They never respond. He’s too upset to deal with the issue himself, so it goes by the wayside until he’s been in therapy for a few months and he’s strong enough to face it.

He raises the issues with the ombudsman. They force him to send a lot of highly sensitive personal/medical information to validate his issues and the state he was in during the 6 month window for raising a complaint. 14 months of back and forth with the ombudsman passes and they refuse to investigate due to time barring, despite having masses of evidence to explain why he was 3 weeks outside of the window to complaint to them.

In the meantime our sister requested the dogs records and xrays from the vet and there is clearly no tumour at all and so we believe the dog may have been put down under false pretenses.

Now the vet is sending him threatening letters saying if he doesn’t pay the outstanding amount, they will send him to a debt collector.

He has no way of paying. Every penny he has is spent on essentials and I’m really concerned that this will kick off his grief again and drive him to do God knows what. He’d paid the insurance in good faith that they’d pay out when needed, and they changed the terms on him without any notification.

The vet, we’ve since discovered, has a number of complaints against them locally for very poor practices and putting dogs down when they didn't need to be. I’m going to raise a complaint with the RCVS in the coming days on my brother's behalf, but I'm not hopeful it will achieve much and in the meantime….

What can I/he do about the outstanding balance being passed to debt collectors?

As I said, he’s autistic/chronically ill, and unable to work now, and is trying to rebuild his credit, so making anything more than a token payment from his benefits is out of the question.  

What can we do when the debt collectors letter comes and/or further action is taken?  


Given my brother's circumstances, are debt collectors likely to pursue him or take court action?

Any insight or advice on this would be a big help. Thanks so much for taking the time to read.

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I think that the interesting element here is that he has been paying a regular insurance premium for a no excess policy and that the insurers have now change the terms and conditions and are attempting to withdraw that aspect of the product.

Can you tell us more about this no excess policy. You have described it as "lifetime excess". If it really is lifetime excess then the insurers would not have the right to cancel it as long as the policies properly conducted and properly and regularly renewed every year.

They would be entitled to cancel that for future policies with new customers but not for existing customers.

We need to know more about that element. Please can you put up that particular part of the terms and conditions so that we can have a look. It is on a website then maybe you can link us to that part of the terms and conditions.

I see that you haven't told us the name of the insurance company. Is there a reason for that?

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As has already been advised, depends on original terms and condition as to whether Insurers had included clause allowing them to remove lifetime excess and If so what the process was to remove it e.g., the Insurers had to provide x number of days notice or they could only take this action in certain circumstances.

 

Go ahead and make the complaint to RCVS. They should not chase debt whilst complaint is being investigated.

 

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Still waiting for the information I asked for in my earlier post please

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