Ask the expert: pet insurance and pre-existing condition for my dog

Tracey contacted me last week as her pet insurance claim was rejected because it was considered as ‘pre existing’.

I hope you can give me some advice.

I have a 5 year old German Shepherd dog who has recently been diagnosed with Hip dysplasia and bad arthritis in both hind legs and knees. Problems have only arisen this year when he had to have xrays for lameness, which is when we were told of the condition. Having already paid out hundreds of pounds for this, we then had to have further tests when he suddenly could not walk on one leg. We were told he had damaged the cruciate ligament and would need surgery by a specialist which will cost in the region of £3000.

He has been insured for the past year and a half, but the company have since told me that they consider his condition pre-existing and will not pay out for anything. It is the first time i have claimed anything with them and i was not aware of any condition when i took out the policy.

I reluctantly accept that there is probably nothing i can do about this and will have to pay for treatment. But being only 24 and recently out of university it is a lot of money that i can barely afford. I am guessing it will be an ongoing condition and that it is highly likely problems will arise with his other leg, so is it really any use paying out for insurance when it will not help for this? Do any companies cover pre-existing conditions like this? Would it be better to take out a lifetime policy with another company for the future? I wasn’t aware of ‘lifetime’ policies when i originally insured him, otherwise i would obviously have taken it out in the first place.

I would appreciate any advice you could offer me as i am struggling financially but will not let my pet suffer.
Thanks

Hi Tracey,

I had a look at the terms and conditions of your policy and could notice the following important information:

• We will not cover any treatment for a condition if you have not told us about the condition within three months of your pet’s first treatment for the condition;

This means that if your dog had the x-rays on the lameness at least 3 months before you contacted your company to make a claim on it, then they would most likely say it is ‘pre existing’ or not cover it at all. Does that make sense?

That’s the only reason I can see for why they would refuse to cover it. I would advise that you contact them again, complaining that they didn’t make it clear when you bought your policy that you had to declare any condition within 3 months of first treatment and see what they say. If nothing changes, I would suggest you make an official complaint, follow the procedure stated in the Terms and Conditions and then escalate to the Financial Ombudsman on the basis that your company didn’t make the claim procedure clear enough. For instance, under section ‘Veterinary Fees – Claims conditions’, it doesn’t mention anything about this 3 month notice period.

I don’t want to raise your hopes on winning this one but you may have more luck with the Ombudsman.

I cannot comment on whether this will be ongoing and affect the other leg, refer to your vet for this. If that’s the case, then you may not want to carry on paying the insurance but bear in mind that any other condition your dog will suffer in the future will also need to be paid for by yourself. No companies provide cover for pre existing conditions but for the future, you’re right in considering a lifetime pet insurance.

Maybe a way of managing the costs in the short term is to borrow money from friends or maybe take a loan? Your vet may also offer a 0% loan scheme offered by Axa, see http://www.pethealthplans.co.uk/vet/whyofferloans.htm

I hope this has been of help. Let me know if you have any more queries and keep me updated.