Ask the expert: Direct Line refuses to pay claim

Paula contacted me after Direct Line pet insurance eventually refused to pay her claim even though they had agreed to it over the phone.

Hello,

I am having a problem with Direct Line Pet Insurance and their refusal to pay out for an operation on my dog. I hope that you can help me with this problem as I am not faced with a massive vet bill that I believe my insurance carrier should help me with.

I have a 18 month old chihuahua called Lenny. On the 08/07/2010 we took him to our vets to get his booster shots. At that time he was not covered. During that visit the vet noted that one of his testicles had not yet dropped, but probably would in the next 6 months. He was 2 months old. Obviously no way of knowing what would happen and no indication of any pre exsiting conditions.

I took out a policy with direct line pet insurance on the 25/01/2011.

On the 09/08/2011 He was due another booster and his testicles were checked. They noted that it would be safer if he was castrated, as it had not fallen and was not going to fall of its own accord.

He was booked in for surgery on the 11/10/2011.

Initially the vet entered his leg, thinking his testicle was there. It was not. She then went into his abdomen and found it there. Only found during the operation itself.

on the same date I thought I would try to see if my insurance would cover this, as I was unsure. I spoke to a operator called Natalie. After explaining Lenny’s situation she informed me that I would be able to claim on my insurance as his condition was abnormal. I went ahead with the claim.

On the 14/12/2011 I recieved a phone call in which they stated that Lenny’s condition was pre-existing and as such I could not claim on my policy.

It is very frustrating as I was led to believe this would be covered. How they can say that at 2 months old this condition was pre-determined is outrageous. I understand that only one testicle had dropped at that first visit, however, the vet said there was a likelihood it would fall on its own. And even if it didnt, who was to say this would end up stuck somewhere as dangerous as his abdomen. The vet had to go inside him to find out where it was.

I am angry at the company, I pay my policy and for what? I hope beyond hope that you can help me with this. I have a huge vet bill waiting to be paid, and since direct line said they would pay, I have not put anything aside for. I am so worried about how I am going to pay it and would appreciate any help you can give me.

Thank you ever so much for all of your help.

Hi Paula,

Direct Line defines pre existing conditions as ‘Any condition or symptoms, or signs of injury, illness or disease, that happen or exist in any form before the start of this insurance‘. Therefore the fact that the testicule hadn’t dropped can be interpreted as a sign of a potential condition and that’s enough for Direct Line to refuse to pay the claim.

I agree, it’s very difficult to prove that your pet was suffering from a condition at the time. If your vet can confirm that the testicle issue is normal and simply part of the pet’s growing up then you could try and put a formal complaint into Direct Line. If so, please follow the instructions given in the terms and conditions.

You should also include the fact that you were told the claim would be covered as confirmed by the Operator. Include the exact date of the call so they can retrieve it and listen back to it if needed. If they admitted liability on the call you have a case. Direct Line may say they can’t guarantee claim liability over the phone but please check your terms and conditions as the one I have read on the website may be slightly different.

You should also mention the fact that Direct Line were told to recently review the wording of their pet insurance policy as it was deemed unclear by the FSA. It didn’t clarify exactly what would be covered or not. You should make this a strong point in your complaint letter and also mention that you’re ready to take the issue to the Ombudsman and FSA if needed.

I hope this helps. Please let me know if you have any more questions and let me know how you get on.

Thanks

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