Dispute with pet insurance company

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 Jamie Wakeham 18 Jul 2021

I've posted about our rescue dog before: to cut a long story short, the Dogs' Trust thought she was a bit timid, and once we'd taken her on it emerged that she was in fact very damaged indeed.  Probably a failed gun dog, and utterly crippled by fear of anything vaguely gunshot-like. 

We've had a long 18 month journey, and with the help of a vet behaviourist we are slowly making progress.  She is now emerging outside of the house to have a look around the back garden; six months ago I didn't think she'd ever even get that far.

She's on a complex cocktail of drugs, and at the moment her daily meds bill is about £8.  A year ago I had a discussion with our insurer (who I will leave nameless for the time being).  Our cover is for £7000pa, with that limit resetting at every annual renewal, but there were also explicit limits of £1000 for alternative therapy and of six months for behavioural therapy.

I had to ring them - they simply weren't replying to emails.  I spoke with a very helpful person who completely assured me that any drug that came by prescription from my vet was a medical issue, and therefore came out of the recurring £7000pa limit.  I explicitly checked that these ongoing drugs would not fall foul of either the £1000 or the six month limitations.

I now wish I had recorded that conversation.  I've just put in a claim for a little short of £4000 for the last twelve months, and they have paid out £148.  Their position is that, as they class this as a behavioural problem, the six months started on the day we first discussed her issue with our vet.  In effect, when I made that phone call and was assured that they would cover any drug with a prescription, I was already only a couple of weeks from the cover being lifted.

Needless to say I am not too chuffed about this!  We might not have gone down the route we have, if we'd known that our insurance was not going to pay out; our attitude has very much been 'forget the cost, it's all going on the insurance anyway'.

I have written back to them to ask that they dig up the recording of my phone call (they do say that they record everything) and review it, and then re-assess my claim.  I'd appreciate any ideas of what to do next.  I'm thinking of sending an SAR to the insurer, to see if that will allow me to obtain a copy of the recording, and assuming it is as clear as I remember it to be, taking the case to an ombudsman?

All advice gratefully received!

In reply to Jamie Wakeham:

<vet hat firmly off>

you should be able to get a copy of the recording under Freedom of information or GDPR.

beyond that I imagine it depends on the fine print of the policy - good luck!

 Yanis Nayu 18 Jul 2021
In reply to Dr.S at work:

I think FOI only applies to public bodies. Happy to be corrected!

 elsewhere 18 Jul 2021
In reply to Yanis Nayu:

You're right.

OP can get recording under GDPR rather than FoI.

Post edited at 19:27
 Jamie Wakeham 18 Jul 2021
In reply to Jamie Wakeham:

Cheers, all.  Yes, a Subject Access Request made under GDPR. If they have retained a copy of the recording, that should flush it out.

The policy wording is fairly simple; We will pay up to a total of £7,000 every year for claims in this section. Veterinary treatment: If a vet recommends treatment or medication for your pet, we will pay those costs.... Behavioural treatment: If your pet is diagnosed with a behavioural condition by a vet, we will pay its treatment costs for up to 6 months after diagnosis.

They do not specify anywhere precisely what they consider to be a behavioural condition.  What I am very unsure about is what happens if - as seems to be the case - one of their staff gives me incorrect advice about whether my claim is are going to be covered.  

In reply to Jamie Wakeham:

From your description it sounds to me that the treatment being given is for an ongoing (and probably pre-existing) behavioural problem and so may not be covered at all under the policy T&C's, but certainly not past the 6 months unless an underlying medical issue is involved (which would be similar with most insurers).

However you have committed to treatment decisions following incorrect assurances given by the insurer and they should pay for their mistake (at least up to any limit they put on timing of claim submission - some insurers would insist on claims submitted every month or so rather than at the end of a year). 

General advice would have to be to get any correspondence in writing /email, and to make claims early and frequently so any problems can be picked up before large bills have arisen.

Since this problem stems from issues before you took the dog on have you discussed treatment / costs with the Dogs Trust?

In reply to Jamie Wakeham:

You can obtain your recording via a dSAR request. If one exists.

You have taken exactly the steps I would recommend (I work in insurance). depending on the outcome of reviewing the case, then Ombudsman would be the next option.

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