Ask the expert: Pet insurance company refuses to pay out claim
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?
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.