What to do next if your pet insurance claim been refused?

Posted Jan 31, 2019.
As with many types of insurance, it can be extremely frustrating if the insurer of your beloved pet refuses to pay out on a claim. As pet owners, we want the best care possible for our animal friends but with the advances in veterinary technology and capability leading to ever higher treatment costs, having insurance that won’t pay can result in significant financial outlay for owners.

Pet claim checklist

If you have had a pet insurance claim turned down, before making a formal complaint, see the checklist below:

1. Read the Policy Wording – insurers have to be very clear with their policy wordings compared with a few years ago, when many clauses and exclusions were hidden in the ‘small print’.  You should always read the policy wording before taking out insurance. It is vital that you understand the terms and conditions of your cover and double check anything that is unclear with your insurer. Don’t assume the meaning of certain terms based on their everyday use or your previous experience with another insurer.

2. Check you cover start date – most pet insurance policies will exclude claims for an initial period of time – often the first 14 days - to prevent people taking out insurance after a problem has been diagnosed. 

3. Does the policy cover pre-existing conditions? - Most policies do not cover pets with pre-existing conditions. However, it’s important to fully understand how your  insurer defines existing conditions – it may mean an exclusion for  any injury or illness experienced during the two years before a policy is taken out, together with any related conditions. Chronic illnesses are usually never covered by new policies.

4. Is your pet the right age for the cover in place? - Insurers will typically have minimum and maximum age limits for pets to qualify for cover. As pets age, cover restrictions may apply and premiums are likely to increase, often quite significantly.

5. Basic treatments may be excluded - There are usually certain basic / routine treatments that most insurers will not cover, including vaccinations, spaying, neutering and pregnancy-related issues. 

6. Does your policy have a 12 month claim limit? - The 12-month limit is very common in pet insurance policies, depending on the level of cover you originally selected and the premium you paid. It refers to the time period you can claim for a specific condition under annual pet insurance policies. Insurers may use different names to describe these types of policies, for example "Basic", "Economy", "Essential", or "Bronze", so it's important to check.

What can you do next to contest a disputed claim?

Having checked your policy wording, if you still believe that your pet insurance claim has been unfairly refused the first step is to make a formal complaint through your insurer. If this is rejected, you can then take your claim to the Financial Ombudsman Service. 

If you need legal advice regarding your disputed claim, contact our experienced specialist lawyers at Bakers Solicitors for advice with a friendly and personal approach. You can contact us by email, arrange a free consultation online or ring us on FREE on 0800 731 7284.