Ask the expert: Pet insurance company refuses to pay out claim
October 13, 2010 by Webmaster
Filed under Ask The Expert
Nicola contacted me last week after Tesco refused to pay out her pet insurance claim even though they first said they would.
My dog had a cruciate ligament operation done on her right leg back in December 2009. I put in a direct claim to Tesco’s who paid out with no problems.
Several months down the line after a walk I noticed a limp in my dogs other leg. She visited the vets and was given some anti inflams. After the prescription had run out and with full cage rest I took her back to the vets as it had not improved. She was given an x-ray and like before found to have another cruciate tear.
I was concerned I wouldn’t be insured for another operation so before I booked her in for one I called the claims helpline. I mentioned the previous operation and explained that if I’m not covered there would be no option but to put the dog to sleep. It was not finacially possible for me.
The claims lady said as long as its not cruciate diesease I was covered for up to £2,500 as it was a different limb. Reassured I was covered, I booked the operation. It’s been now 7-8 weeks & I have just learned Tesco’s are not paying out?????
Are they allowed to give me the go ahead then decline it?
Hi Nicola,
I’m very sorry to hear about Tesco not willing to pay out.
I feel they have misled you and left you out of pocket. This is not acceptable and I would give them a serious call again on 0845 300 22 00 and tell them to provide you with a record of the conversation you had with them before the operation. They should be keeping records of all calls so should be able to trace it back.
Hopefully, this should be clear evidence that you’ve been misled and they should agree to pay out. If they refuse to give you this information, you can tell them that you have a right to request all the information both Tesco and UKI (underwriter) hold about you – it’s in your terms and conditions.
Their T&Cs also say:
- Wherever possible you must contact us before you pay or agree to pay any costs for which you may want to claim. – you’ve done that
- You have not told us about the condition within three months of your pet’s first treatment for the condition – did you do that, as it may be one of the reason they’ll use to reject the claim
If you can’t get anywhere, you can also go to the Financial Ombudsman after you’ve officially complained – simply follow the procedure in your terms and conditions. When you start talking about going to the Ombudsman, their stance might change quickly.
Let me know how it goes.
Get the latest deals and offers on pet related products.
Hi Nicola,
You are not alone, I am having the same trouble with Tesco, they are refusing to pay out for my dogs second cruciate repair TPLO, I just don’t know what to do, am only on a small pension.
Any advise please.
Wendy
Hi Wendy,
Sorry to hear about that. Why are Tesco refusing to pay? Tell me more about when the first cruciate operation was and when the second one was, including whether it was on the same leg, and I may be able to help or at least provide some useful information.
Hi
Just wondering how the two above got on with their insurance situation.
I have several pets insured with Tesco and they have just told me they are not paying out on a recent claim.
Around the end of Nov 2010 I noticed a large lump on my dogs chest area and within 60 mins I was at the Vets to get it checked out.
The Vets said they had to remove it and do tests so the operation was booked in for a short time later.
I contacted Tesco Pet Insurance and explained that we had just found alump and it was being removed and that I would need to claim and they said fine and would send out the relevant claim form.
No the claim for has been sent in Tesco are not paying out as they say that in the Vets notes it says the lump was present for 3 – 4 years.
This is not the case.
I went back to the Vets and questioned this and they sent a fax to Tesco insurane saying that they had seen my dog several times over the previous 10 months and that the dog had been checked many times and at no time was any lump found in the past. They also stated in their fax that they had checked with our previous Vets notes and there is no mention of any lump.
In the fax it also stated that maybe there was a mis-understanding of information and that is why the original Vets notes had 3 – 4 years noted in them.
Tesco Insurance rang me yesterday and said they were still not paying out and there was nothing I could do.
I asked about the notes and the fax and pointed out that the notes were obviously incorrect and that the Vets fax had sugested it. Tesco Insurance said the notes could now not be altered /corrected as this would be Fraud.
I explained that this could not be Fraud if the original notes were incorrect and asked the person to explain her understanding of Fraud… she could not.
So, I have now been told by Tesco to take the matter up with my Vets as its not their concern anymore.
My Vets are saying thay they will not refund my payment and that there is little I can do.
I am currently £407.00 (after paying the excess) out of pocket.
Can anyone point me in the right direction to try and get my money back from either the Insurance ot the Vets?
Thanks
Hi,
I have just found this post, as I have a claim that has just been refused by Tesco for 2nd cruciate TPLO surgery, the left leg went december 2010, and we have just had her right leg done, they paid the first £2300, and have now said that they will not pay the second £2300 as it is past 12 months from the original claim, even though the vet wrote me a letter stating that they were not connected, so should be a separate condition? Maybe they don’t understand the difference between left and right? any advice appreciated.
They’re simply trying to get out of paying the claim, basically arguing that the condition was pre-existing and that the fact it affected the other leg doesn’t matter.
You have to look through your terms and conditions and double check whether it says something along the lines of ‘bilateral conditions are considered as one condition’. Bilateral conditions can be defined as a condition which may affect duplicate body parts on both sides of the body (e.g. Ears, eyes, knees, cruciate ligaments).
If there’s nothing specified then you should formally put in a complaint and escalate to the Ombudsman if required.
Good luck!
Same thing here with healthy pets. Right ligament Dec 09. Paid out. Left leg Aug 11. Refusing to pay. Watch this space i am awaiting their letter in response to my vets letter which said it was 2 seperate treatments as to why they are refusing.
I have my dog insured with Animal Friends. They are refusing to pay out for a joint infection on her leg, because she has a skin condition. Which I have been told by my vet that it is not connected. So far I have written 2 letters disputing Animal Friends not paying out. But have had no reply. I have just contacted them on line letting them know that if they do not respond I will cancel the policy and look for a more suitable one. I am totally fed up with paying out insurance policies for this and that. I have never made a claim for anything. I have made 2 claims on pet insurance with Tesco’s who did pay out.