The previous thread has been archived here: https://www.ukclimbing.com/forums/off_belay/dispute_with_pet_insurance_comp...
The TL;DR is that our rescue dog, who we got in Feb 2020, has turned out to be extraordinarily afraid of noise, and was diagnosed as noise phobic in the summer of 2020. Our vet has put her onto meds that cost about £8/day, even buying through online pharmacies. Our insurance company is now refusing to pay out in full, citing a six month limit on behavioural therapy.
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. 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.
I made one claim which was paid without problems. It was becoming clear that this was probably a life long condition, so I sent several emails trying to determine their precise definition of 'behavioural' issues but never got a reply. Eventually I called them to clarify exactly what would be covered. I've now got the recording of that conversation back after an SAR:
- JLW: A quick question: she has been formally diagnosed as being noise phobic and the vet has put her onto what I'm afraid are some pretty bloody expensive drugs. What we need to know is do you count a noise phobia as a 'behavioral issue' because that's going to change how much you will pay out.
- BBM: Umm... a very very good question that I've not actually had before... umm... I think the way we would look at it is, if it was prescribed by a vet, and the vet are able to prescribe this medication, diagnosed by a vet, then we would consider it as vet fees. The only way we would consider it as... the complementary... is if you were actually referred to a behaviourist and the behaviourist was the one sort of doing the treatment and whatnot, but if it's been diagnosed and prescribed by a vet then it would come out of the vet fees.
- JLW: Oh, OK - fine. So in that case it sounds like we're OK to continue with this.
- BBM: Yes - I mean, what I'll do for you is - I'm pretty sure that's right but I will follow it up and just ask the question to a few people at my end just in case I get any different information. And if -
- JLW: Sure.
- BBM - if it turns out that it does then I will give you a call back and let you know. But I am pretty sure that, yeah, it will come out of vet fees.
- JLW: Fine. OK, that's great news, because that means that she is going to be able to continue to get this medication. The other quick question is - at the moment, we're getting this medication direct from the vet; I can see that I can get it probably about half the price by purchasing the prescriptions from the vet and buying from an online pharmacy. Do you particularly want me to do that?
- BBM: We are happy to cover it from an online pharmacy as long as you provide the invoice for it, as we know it's been prescribed by a vet so as long as they can provide that and you provide the invoice we are happy for you to purchase it online.
- JLW: Fine - it makes sense for me to do that, I think, just it's going to knock the claims down by about half, and that's going to leave more in the kitty if anything ever goes wrong.
- BBM: Yeah, exactly, yeah, and I find that - a lot of people find that it is a lot cheaper online; that's something that happens and people do do quite a lot especially for a long term medication. That's absolutely fine. As long as there's invoices for everything then that's not a problem.
- JLW: Marvellous stuff - that's great. Thanks very much for your help.
Having been given this information, I racked up almost a whole year's worth of medical bills. Their rules are that claims have to be made within a year, and as the policy excess for each claim was not insignificant I chose to let it build up into one big claim.
It now emerges that, at the time of that phone conversation, we had barely two weeks of cover left under their six month limit. This was not mentioned (I am kicking myself for not explicitly bringing it up). That phone call left us firmly under the impression that all her med bills would be coming out of the recurring £7000pa vet fees fund, and as a result we did not hold back on the cost - whatever our vet suggested, we bought without hesitation.
When the claim (for almost £4000) went in, they paid out the £150 that had been incurred in those last few weeks and rejected the rest. I complained.
They admit that their employee mis-described our cover and give us £50 to apologise: "I wish to firstly apologise for the inaccurate information provided, as you should have been made aware that although the advice and medication originated from your vet, as this was treating a behavioural condition these claims would be subject to the 6 month timeframe. It follows that I have upheld your complaint as we were not transparent and clear when providing your policy coverage and limitations..."
They then go on to assert that, because their original policy document and subsequent letters contain their wording that behavioural issues are only covered for six months, they are correct not to pay out further.
My position is that I clarified whether this was 'behavioural' or 'medical', and was told the latter, and went on to make significant choices in her treatment based upon that incorrect advice. At that point in time if we'd correctly been told that this dog would cost us, personally, £3-4k in uninsured medical bills per year, probably for the rest other life, we would have returned her to the Dogs' Trust.
Now we are another year down the line and she is completely devoted to us (and us to her) so there is no question of giving her up - I honestly think euthanasia would be kinder.
Any thoughts? I think I need to take this to the ombudsman but I have no idea of my chances.
Post edited at 15:30
