Ask The Expert: Unfair pet insurance exclusion, what can I do?

Sally contacted me this week after she felt her pet insurance company unfairly imposed an exclusion on her policy. Was it really unfair and if so, what could Sally do? If you too have queries or questions, just ask the pet insurance expert.

 

I feel I have had an exclusion put on my insurance unfairly as I merely asked if the item would be covered, but made no claim before or after (vet had suggested an allergy test). Can I get this lifted?

My two 5-year-old basset hounds are inclined to scratch, particularly in the summer. I give them piriton and a good quality, hypoallergenic diet/treats. They are also kept up-to-date with Frontline and Drontal, and the house is regularly sprayed with Zodiac.

This summer the itching got so bad the Piriton wasn’t working and they were keeping me awake at night. The vet, although he couldn’t find any fleas on them, concluded that was the problem. He gave them prednisone and advised giving Frontline more often (every 3-4 weeks). Once the medication wore off, the scratching started again. We returned to the vet (another in the same practice) who quite reasonably said she was unhappy to keep prescribing steroids and the cause needed to be investigated. She said an allergy test would cost £250 per dog and any serum, £174.

I emailed my insurer to ask if the cost of the test would be covered (I had paid all vet costs up to this point). The reply said as it was a pre-existing condition (ie they had scrated in the summer and I hadn’t told them) so they would not cover it. They then promptly put an exclusion on their policies. I felt this was unfair as every dog scratches and when I first took them to the vet I wasn’t expecting it to become an insurance issue.

This is one of the reasons I am currently considering changing my insurer and am looking at buying ‘lifetime’ insurance for them.

 

Hi Sally,

Thanks for contacting me. I had a look at the terms and conditions. Here are some interesting points:

Under ‘Conditions of settling claims’: “We cannot accept any liability for a claim if this form has not been returned to us as soon as possible and at most within 90 days of the incident occurring“.

This means that you have 3 months to report any health problem you have noticed. This is very different from 3 months from the treatment date which would make more sense. If you can find the exact date you phoned your insurer, the first date you noticed the dogs scratching and the first time you visited the vet for this, then that would help challenge the exclusion they have imposed.

Under the general conditions, it also says: “1. How to claim; On discovering any accident, illness, loss, destruction or damage giving rise or likely to give rise to a claim under the policy, you must give full details as soon as possible to our head office. This can be done in writing, by phone, fax or email.”

This means that you should report an accident or illness as soon as you see the first signs, even if you haven’t seen a vet yet. We can argue that scratching is neither an illness nor an accident. However, since it got worse and your vet prescribed Piriton and a special diet, then it should have been reported, probably within the 90 days mentioned above.

Your pet insurance company has a bad reputation and this proves it yet again. But what can you do?

I would still put the claim to them though, sending it via recorded delivery and then contact the Financial Ombudsman to complain.

I would also look for another provider but be aware that anything that relates to your dogs scratching will be excluded from your new policy. If you want to do the allergy test in anyway I would do it now and try to claim it back from your current insurer.

I hope this helps and let me know if there’s anything else I can do for you.