British Dogs Have Trouble with Health Insurance Claims
Thanks to the Guardian Unlimited for this article.
Even dogs get tied up by insurance claims
The ombudsman is being asked to sort out a growing number of pet cover disputes
Sunday November 11 2007
Herbie was diagnosed with arthritis two years ago. A medical policy that he had in place covered payments for his condition and the insurers paid out 4,000 for treatment. However, they then refused to pay any more - saying that he had been diagnosed with arthritis before his policy was taken out.
'What's new?' you might ask. 'Insurers are frequently denying cover for this type of reason.' The difference here, however, is that Herbie is a dog. It seems that dogs and humans are facing increasingly similar issues in terms of the complexity of their disputes with insurers. In fact, pet disputes are possibly more complicated in that the policyholders cannot testify directly, but have to rely on the evidence of vets, veterinary nurses and owners.
In Herbie's case, his veterinary nurse had inadvertently landed him in difficulty, noting erroneously on his records that his arthritis had been diagnosed eight months earlier than it actually had been. When his owners took the case to the Financial Ombudsman Service, they won - and Herbie emerged victorious (and less arthritic).
Complaints to the ombudsman over pet insurance are soaring (up 18 per cent so far in 2007-08 and up 23 per cent in 2006-07) - largely because pet cover is the fastest growing sector of insurance sales. If they continue at this rate, pet complaints for the current 12-month period will pass 300 by March.
Common problems seen by the ombudsman include:
Some policies have annual limits on the amount of individual and cumulative claims. If these are not clearly spelt out in the documentation, the ombudsman may well find for the pet owner.
Removal of an area of cover when the policy is renewed.
Dental and homeopathic treatment cover are examples of areas removed from some policies recently. The ombudsman has found in favour of owners when they have not been notified of the change, 'particularly when a pet is undergoing treatment'.
Disputes over whether a particular treatment or operation would be effective.
Disagreements over whether alternative treatments, such as hydrotherapy, are covered under individual policies.
Veterinary treatment is becoming more sophisticated - and, therefore, increasingly expensive. Fees can quickly add up to several thousands of pounds.
Recent Ombudsman cases have involved a 2,000 dispute over a sick kitten, a 4,000 vet's bill to treat a horse with colic and a 12,000 personal accident claim over a parrot which had crashed into the toys in its cage and died (this was turned down by the ombudsman as the 'policy did not provide personal accident cover and... this type of insurance was only available for human beings').
It will be no surprise that we British live up to our stereotypical fondness for our pets. The pet insurance team at the ombudsman service is now used to dealing with distraught owners and warns that such claims can be 'very emotive'.