animal insurance won't pay out (what's my rights?)

56
Found 22nd Feb 2016
Hi I took out dog insurance for my dalmatian a few months back when I got him. A few weeks ago I noticed he had blood in his wee so long story short he went to the vets and come out with £1500 bill. The vets sorted out the insurance paperwork for me. On the insurance it states they will only pay up to £1000 and I need to pay the remaining plus 20% of the total bill to the insurance. but now the insurance has been in touch with me and told me because the booster injections have not been kept up in previous years they will not cover me for any amount. I already have to pay £100 excess as well.

When I signed up to the insurance online they never asked if I had documents for booster injections so am really heartbroken I now have to pay £1500 as well as the £100 excess and the £280 for the insurance which in words is no good. I took insurance out for the reason I don't have a lot of money and wanted to cover myself in the future.

Can anyone help and guide me to if there is something I can do. The insurance is called Animal Friends. Thank you
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56 Comments
that's awful insurance company's are evil
read the small print it is your own fault
Always read the small print is the only advice i can offer.
Insurance will try and wiggle out of most claims but then the boosters should have been kept upto date.

It's alot of money and very harsh, I don't know what to suggest other than checking all the small print, I know they pretty much all insist that the dogs jabs are upto date etc.

I hope you can sort it out because it's too harsh a lesson, Maybe even suggest they give you your premium back?, That's unlikely.

If you missed a jab will any other insurance pay out in the future?.

Would the jabs have protected your dog against the condition?.
adamsxi

read the small print it is your own fault



Beaten to it although i withheld sticking the boot in.
It seems lots of insurers don't cover without vaccinations. Have you got the policy to hand? You need to read through it thoroughly if it states it in writing, you have had it. If not, I would seek
independent advice and look for literature about "over vaccinating" and put that argument to them.
I don't understand why you would have to pay the excess if they aren't paying the claim? at least cancel the insurance now and try and get back some of the premium you have paid
Banned
take them to the insurance ombudsman for being unreasonable

financial-ombudsman.org.uk/
Edited by: "YouDontWantToKnow" 22nd Feb 2016
when you applied did you have to give his age as well as the date you got him? I take it the boosters in question are one that were missed before you got him? insurers are only supposed to sell policies which are suitable for the purchaser, I would claim that by not asking for any booster details when purchasing, and you having no control over his history prior to you getting him, that you were misold the policy, that may get you the full premium you paid back
YouDontWantToKnow

take them to the insurance ombudsman for being unreasonable



why? If the T&Cs of the policy say the animal must have regular and up to date vaccinations then that is it - done and dusted!

For as long as I have had animal insurance, vaccinations have been a contractual requirement, and many now say that you must take up any extra treatments such as dental work that the vet recommends and is not covered by the insurance.

The only way to get out of this is to prove the dog did have up to date vaccinations.

EliTom
Yeah but the boosters missed were out of the ops control, and had been missed prior to the insurance being taken, so the policy sold was not fit for the op, this should have been flagged by the insurance company prior to sale, by way of a question asking if any boosters had been missed
sparxuk

Yeah but the boosters missed were out of the ops control, and had been … Yeah but the boosters missed were out of the ops control, and had been missed prior to the insurance being taken, so the policy sold was not fit for the op, this should have been flagged by the insurance company prior to sale, by way of a question asking if any boosters had been missed



to be ethical yes - but how many businesses are totally ethical now ?

But the policy holder also has a responsibility to read the T&Cs

when you tick that box to say you have read the T&Cs that is what it means - you have read and therefore agree to what you are entering into.

Another example of .... don't tick the box without reading ..... this applies especially to insurance policies

In some cases you can negotiate this out if for example you have taken a rescue dog and agree to get it vaccinated asap, but this must be done by exception after reading the T&Cs.

EliTom
I'm with more than for my Labrador insurance and he's kept up to date with booster but he doesn't have kennel cough one, asked if he needs to have it to keep insurance valid said no they just wouldn't put him in kennels if needed or treat him it.
Try asking if not having the jabs caused the illness, this can sometimes get them to back track on their decision.
Banned
elitom

why?



Because unless it was a pre-existing illness or the current owner didnt look after the dog they will win.

The small print is there to catch out fraudsters not to wiggle out of genuine claims. Even insurance companies have a duty to be reasonable in litigation regardless of clauses.

Also it will not cost a penny to contest it.
Edited by: "YouDontWantToKnow" 22nd Feb 2016
I guess it would be handy to know if the op had the dog vaccinated once they got it.
richje100

I'm with more than for my Labrador insurance and he's kept up to date … I'm with more than for my Labrador insurance and he's kept up to date with booster but he doesn't have kennel cough one, asked if he needs to have it to keep insurance valid said no they just wouldn't put him in kennels if needed or treat him it.Try asking if not having the jabs caused the illness, this can sometimes get them to back track on their decision.




yes it cancan do but these exceptions to the T&Cs need to be negotiated before any claim is ever made

for example I have two cats which I took on when a friend was emigrating and we could not find one of their booster records so I explained this to the insurer and they then accepted their first vaccine certs plus the boosters I had got done when I got them - and I got this statement in writing from the insurers before I continued with the policy.

I am also guessing that Animal Friends Insurance was the cheapest the OP could get - and as with all insurance the market is made more competitive by such sire as gocompatre etc so the market have to reduce premiums to be competitive, and as a result they make the T&Cs tighter / enforce them more rigidly in order to manage the risks and balance the books

EliTom
elitom

to be ethical yes - but how many businesses are totally ethical now ?But … to be ethical yes - but how many businesses are totally ethical now ?But the policy holder also has a responsibility to read the T&Cswhen you tick that box to say you have read the T&Cs that is what it means - you have read and therefore agree to what you are entering into.Another example of .... don't tick the box without reading ..... this applies especially to insurance policiesIn some cases you can negotiate this out if for example you have taken a rescue dog and agree to get it vaccinated asap, but this must be done by exception after reading the T&Cs. EliTom



Very few businesses are ethical now in fact very few people are which is why we live in the dump that we live in

I feel very sorry for the op they have basically been ripped off so id definitley try the ombidsman
YouDontWantToKnow

Because unless it was a pre-existing illness or the current owner didnt … Because unless it was a pre-existing illness or the current owner didnt look after the dog they will win. The small print is there to catch out fraudsters not to wiggle out of genuine claims. Even insurance companies have a duty to be reasonable in litigation regardless of clauses.Also it will not cost a penny to contest it.




that is possible if the current owner did have the dog vaccinated as soon as possible and can show that they have no record of the dog's history, but these facts must be disclosed when the policy is taken out! It is the policy holders responsibility to disclose all material facts .

If this were a major insurer like PetPlan or MoreThan there would be more hope - but my guess is Animal Friends is a budget insurer and will enforce the policy document T&Cs

but you are correct - more info from OP is needed

EliTom
When I had a claim refused by Petpals insurance, I took it to the Financial Ombudsman and they had to pay up, it doesn't cost anything to try so always worth a go
123batman321

Very few businesses are ethical now in fact very few people are which is … Very few businesses are ethical now in fact very few people are which is why we live in the dump that we live inI feel very sorry for the op they have basically been ripped off so id definitley try the ombidsman




No OP has not been ripped off

3 questions to OP

1. did you read the T&Cs before ticking the box to say you agreed? - honest answer please !

2. Did you know the dog's veterinary history?

3. Did you get the dog's booster vaccinations done as soon as possible after taking ownership?

or - are you the first owner of said dog?

only with answers to these questions can we give you more definitive answers

EliTom
Edited by: "elitom" 22nd Feb 2016
I would try to claim back the premiums paid if the insurance wasn't fit for purpose (i.e. they didn't ask about boosters before you signed up). There will be no excess to pay if you aren't going through the insurance. Perhaps look at pdsa vets in future if you are on a very low income, as I believe they subsidise costs if you meet the criteria.
Banned
elitom

It is the policy holders responsibility to disclose all material facts … It is the policy holders responsibility to disclose all material facts .EliTom




All known reasonable material facts that are relevant to the claim. There is a difference.

IE if the OP failed to declare a broken leg the insurance company cannot refuse to payout for lung cancer. The insurance company cannot/shouldnt refuse to pay out when undisclosed information is irrelevant to the claim. And that is pretty much proven.
YouDontWantToKnow

All known reasonable material facts that are relevant to the claim. There … All known reasonable material facts that are relevant to the claim. There is a difference. :)IE if the OP failed to declare a broken leg the insurance company cannot refuse to payout for lung cancer. The insurance company cannot/shouldnt refuse to pay out when undisclosed information is irrelevant to the claim. And that is pretty much proven.



Both of you actually have a point. The OP should have certainly read the terms and conditions when taking out the policy, however although they may not have fully complied it should be determined if the treatment would have been prevented by having the booster injections.

If it entails that the booster injections in fact wouldn't have made a difference I would perhaps try and pursue a claim. At the end of the day you should have checked the policy however in my opinion they should still be forced to pay out if it is confirmed that they would have not made a difference.

An example would be that if you have an accident in a motor vehicle and you have undeclared mods, the insurance company will normally overlook them (although it will only be replaced for standard parts) providing they was not a deciding factor in the claim i.e. it was not the fault of the modified part which caused the accident ect....

Anyhow that's just my opinion.


Edited by: "joshp" 22nd Feb 2016
YouDontWantToKnow

All known reasonable material facts that are relevant to the claim. There … All known reasonable material facts that are relevant to the claim. There is a difference. :)IE if the OP failed to declare a broken leg the insurance company cannot refuse to payout for lung cancer. The insurance company cannot/shouldnt refuse to pay out when undisclosed information is irrelevant to the claim. And that is pretty much proven.




I have just check the Animal Friends website and took a look at the T&Cs - Policy Wording


from Animal Friends T&Cs

Section 9
General Conditions
9.1.7 You must ensure that your pet is vaccinated against distemper, hepatitis,
leptospirosis, parvovirus and kennel cough for dogs, and feline infections
such as feline infectious enteritis, feline leukaemia and cat flu for cats. You
must also agree to have your pet vaccinated against any other disease a vet
feels is necessary. You must keep your pet’s vaccinations up to date, as
recommended by your vet.

Section 10
General Exclusions
10.13 We shall not be liable under this policy unless you have complied with all the terms,
conditions and endorsements of this policy.

which parts of the above can be ignored in this case

EliTom
joshp

Both of you actually have a point. The OP should have certainly read the … Both of you actually have a point. The OP should have certainly read the terms and conditions when taking out the policy, however although they may not have fully complied it should be determined if the treatment would have been prevented by having the booster injections. If it entails that the booster injections in fact wouldn't have made a difference I would perhaps try and pursue a claim. At the end of the day you should have checked the policy however in my opinion they should still be forced to pay out if and only if, it is confirmed that they would have not made a difference. An example would be that if you have an accident on a motor vehicle and you have undeclared mods, the insurance company will normally overlook them (although it will only be replaced for standard parts) providing they was not a deciding factor in the claim i.e. it was not the fault of the modified part which caused the claim .Anyhow that's just my opinion.




that would have been the case years ago before the insurance industry got so competitive as a result of so many comparison sites. Now a days they have to manage their risks and still make a profit whilst making premiums more competitive.

I am totally sure that if a car had an undisclosed modification and it is a condition in the policy wording that any mod must be declared then the insurer would be within their rights to disllow the any claim

EliTom
Banned
joshp

Both of you actually have a point. The OP should have certainly read the … Both of you actually have a point. The OP should have certainly read the terms and conditions when taking out the policy, however although they may not have fully complied it should be determined if the treatment would have been prevented by having the booster injections. If it entails that the booster injections in fact wouldn't have made a difference I would perhaps try and pursue a claim. At the end of the day you should have checked the policy however in my opinion they should still be forced to pay out if it is confirmed that they would have not made a difference. An example would be that if you have an accident on a motor vehicle and you have undeclared mods, the insurance company will normally overlook them (although it will only be replaced for standard parts) providing they was not a deciding factor in the claim i.e. it was not the fault of the modified part which caused the claim .Anyhow that's just my opinion.




^^^^^ this

& that is exactly how The Ombudsman will look at this case or any other case
Can I ask what was wrong with your dog in the end and would having boosters made and difference ?
Banned
elitom

that would have been the case years ago EliTom




Its still the case.

If your house is flooded but you didnt declare a massive oak tree is less than the stipulated 15 meters away NO insurance company would be able to get away with not paying out regardless of tree clauses.
agree - jt is worth a shot with the Ombudsman - but without more information as suggested in my earlier post, the outcome could be very dubious

EliTom
elitom

No OP has not been ripped off3 questions to OP1. did you read the T&Cs … No OP has not been ripped off3 questions to OP1. did you read the T&Cs before ticking the box to say you agreed? - honest answer please !2. Did you know the dog's veterinary history?3. Did you get the dog's booster vaccinations done as soon as possible after taking ownership?or - are you the first owner of said dog?only with answers to these questions can we give you more definitive answers EliTom



Legally the insurance comp has probably do e nothing wrong i agree

But name me a big company that doesnt advertise themselves as being the messiah then hide a million get out clauses in the small print

We live in a society that its acceptable to tell massive lies as longs you hide said lies in 25 pages of small print. Its not really fair 1500 might not be that much to you or i but ive been in a position where that amount would pretty much be game over lol
123batman321

Legally the insurance comp has probably do e nothing wrong i agreeBut … Legally the insurance comp has probably do e nothing wrong i agreeBut name me a big company that doesnt advertise themselves as being the messiah then hide a million get out clauses in the small printWe live in a society that its acceptable to tell massive lies as longs you hide said lies in 25 pages of small print. Its not really fair 1500 might not be that much to you or i but ive been in a position where that amount would pretty much be game over lol




Exactly - the insurer has complied with the policy - the policyholder it would appear has not ...

how far should the insurer bend the rules - if at all?

EliTom
If the terms and conditions state that your animals vaccinations must be up to date then I'm not sure you'll have much wiggle room. Several policies don't require the vaccines but won't cover you for any related illnesses. Speak to your vet they may be able to set up a payment plan for the amount owed.
Original Poster
OK il try and be as honest as I can as I want honest answers back.

I did go for the cheapest insurance at the time as this is what I could Bearley afford.

I didn't read all the t&c's word by word so I hold my hands up this is my fault. However the boosters wouldn't have effected the dogs treatment. My dog had a kidney stone 3cm in size so no booster would have prevented this.

I have not had a booster done no.

The story is my and my husband split up around 7years ago he kept everything and I've been trying to get the dog back since. He lost his job last year and managed to persuade him for the dog back as it would save him money. Now when we first got the dog as a puppy some 10 years ago all is papers was in my name. Now because I have not had him for 7 years since divorced in the insurance eyes it's always been my name on his papers even though the house address has changed on vet records for me. So I think I have just come to a total loss as In the insurance eyes it looks like I have owned the dog/I'm my possession since a puppy and not kept up with jabs. Would I still be able to go with the fact that jabs wouldn't have helped to prevent this emergency operation to remote the stone he had? What steps can I take.
No insurance company would hold you to vaccinations when you did not legally own the dog. They would if you did not hold a historic record for the dog insist that you have vaccinated them since the dog came into your possession and kept them up to date.

So if you have had vaccinations done when the dog was yours and since kept them up to date then this would be your defense against their judgement. If they still will not concede then you will need to lodge an appeal with the ombudsman. You will need to obtain proof, a sworn statement from your ex husband, copies of divorce papers and a letter of explanation should suffice. Make sure you send a copy of the evidence to your insurers too.

I have just read your last post and see you have not kept the boosters up to date, sorry but you stand zero chance of fighting this. The insurers will argue that the vaccinations contribute to your dogs overall health, no defense.

Additionally an insurer will state that they would have refused insurance when you applied if you stated you would not be vaccinating. They would use this as a indicator as to the level of risk attached to insuring you.

Speak to your vet and explain and ask them if you can repay costs monthly at a agreed rate you can afford. Most will be amenable , as most would have had clients with your problem.


Edited by: "Argoj" 22nd Feb 2016
elitom

Exactly - the insurer has complied with the policy - the policyholder it … Exactly - the insurer has complied with the policy - the policyholder it would appear has not ...how far should the insurer bend the rules - if at all?EliTom



I agree in a way but lets face it these bigger companies rely on the fact people dont understand their very cleverly written small print

Also they know your average person cant afford to challenge them legally. Id love to see the day where people simply pull the plug and stop spending a penny with big companies.


tovtm

OK il try and be as honest as I can as I want honest answers back. I did … OK il try and be as honest as I can as I want honest answers back. I did go for the cheapest insurance at the time as this is what I could Bearley afford. I didn't read all the t&c's word by word so I hold my hands up this is my fault. However the boosters wouldn't have effected the dogs treatment. My dog had a kidney stone 3cm in size so no booster would have prevented this. I have not had a booster done no. The story is my and my husband split up around 7years ago he kept everything and I've been trying to get the dog back since. He lost his job last year and managed to persuade him for the dog back as it would save him money. Now when we first got the dog as a puppy some 10 years ago all is papers was in my name. Now because I have not had him for 7 years since divorced in the insurance eyes it's always been my name on his papers even though the house address has changed on vet records for me. So I think I have just come to a total loss as In the insurance eyes it looks like I have owned the dog/I'm my possession since a puppy and not kept up with jabs. Would I still be able to go with the fact that jabs wouldn't have helped to prevent this emergency operation to remote the stone he had? What steps can I take.



Its not right but to put it bluntly your screwed from what youve said. Basically in the eyes of the insurance and the law youve been the legal owner since the dogs been insured
tovtm

OK il try and be as honest as I can as I want honest answers back. I did … OK il try and be as honest as I can as I want honest answers back. I did go for the cheapest insurance at the time as this is what I could Bearley afford. I didn't read all the t&c's word by word so I hold my hands up this is my fault. However the boosters wouldn't have effected the dogs treatment. My dog had a kidney stone 3cm in size so no booster would have prevented this. I have not had a booster done no. The story is my and my husband split up around 7years ago he kept everything and I've been trying to get the dog back since. He lost his job last year and managed to persuade him for the dog back as it would save him money. Now when we first got the dog as a puppy some 10 years ago all is papers was in my name. Now because I have not had him for 7 years since divorced in the insurance eyes it's always been my name on his papers even though the house address has changed on vet records for me. So I think I have just come to a total loss as In the insurance eyes it looks like I have owned the dog/I'm my possession since a puppy and not kept up with jabs. Would I still be able to go with the fact that jabs wouldn't have helped to prevent this emergency operation to remote the stone he had? What steps can I take.




I am now confused!

you say in your first post that you took out insurance a few months back but in your last post you say ... Now because I have not had him for 7 years since divorced in the insurance eyes it's (the dog) always been my name on his papers .... and you cannot state that the dog has been vaccinated in the last 7 years ...... these are all material facts that would have effected the insurers decision / premium calculation.

Either some info is still missing or you have just a bad set of circumstances and are expecting the insurer to pick up the pieces

EliTom
Horrible position to be in , but I know from looking into cat insurance in the past for our feline that I couldn't get cover for her as a poor immune system means she can't tolerate the vaccine jabs. I assume this is standard on most policies still, she is 10 and although I believe some policies now cover unvaccinated animals faqs.churchill.com/hel…ine for example it really is a case of choosing the cover you need and complying with the terms. There's never any harm in questioning the insurance company , but as you didn't comply with the conditions I wouldn't hold out much hope regrettably .
Argoj

I have just read your last post and see you have not kept the boosters up … I have just read your last post and see you have not kept the boosters up to date, sorry but you stand zero chance of fighting this. The insurers will argue that the vaccinations contribute to your dogs overall health, no defense.Additionally an insurer will state that they would have refused insurance when you applied if you stated you would not be vaccinating. They would use this as a indicator as to the level of risk attached to insuring you. .



This is exactly the case!

Insurance is about insurance the unplanned - not a general maintenance plan. Therefore your responsibility is to keep your animal in good health and maintain it's wellbeing. This requires regular check ups at a vet to keep on top of known risks. One of the ways an insurer can enforce this is to insist on vaccinations, not only to reduce the risk by protecting the animal from common ailments, but to demonstrate that the owner is looking after the animal in a good way .

Therefore in the terms of the policy and the spirit of the contract the argument that vaccinations would not prevent a kidney stone are not valid, and the Insurance Ombudsman will not support you.

But as it's free to appeal - then why not try and find out!

EliTom
tovtm

OK il try and be as honest as I can as I want honest answers back. I did … OK il try and be as honest as I can as I want honest answers back. I did go for the cheapest insurance at the time as this is what I could Bearley afford. I didn't read all the t&c's word by word so I hold my hands up this is my fault. However the boosters wouldn't have effected the dogs treatment. My dog had a kidney stone 3cm in size so no booster would have prevented this. I have not had a booster done no. The story is my and my husband split up around 7years ago he kept everything and I've been trying to get the dog back since. He lost his job last year and managed to persuade him for the dog back as it would save him money. Now when we first got the dog as a puppy some 10 years ago all is papers was in my name. Now because I have not had him for 7 years since divorced in the insurance eyes it's always been my name on his papers even though the house address has changed on vet records for me. So I think I have just come to a total loss as In the insurance eyes it looks like I have owned the dog/I'm my possession since a puppy and not kept up with jabs. Would I still be able to go with the fact that jabs wouldn't have helped to prevent this emergency operation to remote the stone he had? What steps can I take.



sorry but having read all that, I don't think you've got much chance, you didn't get him vaccinated once he came back into your possession, so you have broken the terms of the insurance.

I thought he was a new dog to you and you had him vaccinated yourself, but they were refusing due to him not having them in the past, but it seems now that they are refusing because you still haven't had him vaccinated.

I would suggest getting his jabs asap, for the dogs sake, as well as yours as you have found out the hard way
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