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Any insurance experts?



Triggaaar

Well-known member
Oct 24, 2005
49,989
Goldstone
I made a claim on pet insurance. My pet hadn't been seen by a vet for a couple of years, so they're trying to get out of the claim saying that the pet should have been seen more often.

My thought is that if they're not going to provide cover, then they should refund the premiums we're paying. Should that be the case?

Thanks
 


D

Deleted User X18H

Guest
Not so much an expert but genius .

If the terms and conditions of your policy state that a condition precedent to liability is that you take your pet to a vet for regular check ups. Then if you do not comply with this your claim will be repudiated. And possible the policy voided

The perils your pet is covered against may lessened with regular check ups. Why you think they should refund your premiums when you have been indemnified until this oversight came to light is beyond me.

Perhaps the world has gone mad.
 


drew

Drew
Oct 3, 2006
23,007
Burgess Hill
I made a claim on pet insurance. My pet hadn't been seen by a vet for a couple of years, so they're trying to get out of the claim saying that the pet should have been seen more often.

My thought is that if they're not going to provide cover, then they should refund the premiums we're paying. Should that be the case?

Thanks

You need to check the policy wording. If it is a condition of the policy that the pet is checked by a vet at least once a year then you're on a sticky wicket although there may be an argument if the illness is something that could have occurred irrespective of any vet visit. Without knowing what sort of pet it is, does it require annual inoculations?

As for the last part of your post, if it is a condition of the policy that the pet is checked by a vet annually then the onus is on you to comply with that condition.
 


dejavuatbtn

Well-known member
Aug 4, 2010
7,128
Henfield
Ah, good old terms and conditions. Whilst it may not have been specified on the initial paperwork and application form, I would imagine that there will be something in the policy conditions about having an animal checked out at periodic (yearly) intervals. If it isn't in the original application form and booklet etc, you should have a case for the policy at least being voided as you didn't get what you thought you were getting (no consensus ad idem).
 


drew

Drew
Oct 3, 2006
23,007
Burgess Hill
Not so much an expert but genius .

If the terms and conditions of your policy state that a condition precedent to liability is that you take your pet to a vet, then if you do not comply with this your claim will be repudiated.

The perils your pet is covered against may lessened with regular check ups.


Don't you mean 'The perils your pet is covered against may be lessened without regular check ups'!
 




D

Deleted User X18H

Guest
Don't you mean 'The perils your pet is covered against may be lessened without regular check ups'!

No. If you take you CAT to the VET to have it LOOKED at. The VET might notice a problem. Then the likelihood of an insured peril becoming prevalent will be lessened.
 


studio150

Well-known member
Jul 30, 2011
29,553
On the Border
I made a claim on pet insurance. My pet hadn't been seen by a vet for a couple of years, so they're trying to get out of the claim saying that the pet should have been seen more often.

My thought is that if they're not going to provide cover, then they should refund the premiums we're paying. Should that be the case?

Thanks

What does your policy wording say about vet visits. If the Insurance company are refusing to pay the claim, I assume that your policy either has an exclusion or a condition that mentions the need to visit the vet at regular intervals, and the Insurance Company has referred to this when declining the claim.
If they have not, then I would suggest you read the policy and see if there is such an exclusion or condition. If not, it would be worth while speaking to your insurer again and asking why they are declining the claim on this basis, as there does not appear to be any policy requirement to do so. The claim should be assessed on the basis of the policy cover, and if not in the wording the Insurer should have specifically mentioned the need to visit the vet.
If this does not move the claim forward that the next step would be to make a formal complaint in that you believe the Insurer is not correctly applying the cover that you brought.

Once you have a final letter declining the claim if there is no mention in the policy wording then speck to the FOS.

If there is a clear exclusion or condition in the policy, then this is clearly stated and you are no entitled to any refund of premium as you should have complied with the requirements.
 


Triggaaar

Well-known member
Oct 24, 2005
49,989
Goldstone
As for the last part of your post, if it is a condition of the policy that the pet is checked by a vet annually then the onus is on you to comply with that condition.
Yes, it would be. I haven't complied with that condition, so they're not providing cover. So if they're not providing cover, surely I shouldn't be paying for cover.
 




D

Deleted User X18H

Guest
What does your policy wording say about vet visits. If the Insurance company are refusing to pay the claim, I assume that your policy either has an exclusion or a condition that mentions the need to visit the vet at regular intervals, and the Insurance Company has referred to this when declining the claim.
If they have not, then I would suggest you read the policy and see if there is such an exclusion or condition. If not, it would be worth while speaking to your insurer again and asking why they are declining the claim on this basis, as there does not appear to be any policy requirement to do so. The claim should be assessed on the basis of the policy cover, and if not in the wording the Insurer should have specifically mentioned the need to visit the vet.
If this does not move the claim forward that the next step would be to make a formal complaint in that you believe the Insurer is not correctly applying the cover that you brought.

Once you have a final letter declining the claim if there is no mention in the policy wording then speck to the FOS.

If there is a clear exclusion or condition in the policy, then this is clearly stated and you are no entitled to any refund of premium as you should have complied with the requirements.

Speak to the FOS speak to the FOS!! It's blokes like you who are costing the industry millions. It costs the insurer £550 a pop if a complaint goes to the FOS. It's makes me sick.

Just bloody lump it or read the conditions.

HB&B Cert Cii
 




D

Deleted User X18H

Guest
Yes, it would be. I haven't complied with that condition, so they're not providing cover. So if they're not providing cover, surely I shouldn't be paying for cover.
Yes you should. You have accepted an insurance contract and its terms and conditions. The insurer had acted in good faith throughout. And had offered indemnity without prejudice.

So every time a claim is declined insurers should refund premiums should they?

Look up risk transfer mechanism. And don't come back until you have.
 






warmleyseagull

Well-known member
Apr 17, 2011
4,201
Beaminster, Dorset
Yes, it would be. I haven't complied with that condition, so they're not providing cover. So if they're not providing cover, surely I shouldn't be paying for cover.

Er, all insurance has conditions attached, ever bought travel insurance that says you have to disclose pre existing conditions, for example? You pay for cover on the basis that you read and comply so the premium is kept to a reasonable level. If you dont want to comply with the condition, then, yes, dont pay for cover but dont complain because you have paid and havent read.
 


Triggaaar

Well-known member
Oct 24, 2005
49,989
Goldstone
Yes you should. You have accepted an insurance contract and its terms and conditions. The insurer had acted in good faith throughout. And had offered indemnity without prejudice.
But they haven't offered indemnity have they. They're saying I'm not covered for anything, there is no indemnity.

So every time a claim is declined insurers should refund premiums should they?
If no claims could be covered, then yes.

Look up risk transfer mechanism. And don't come back until you have.
:lol:
 




studio150

Well-known member
Jul 30, 2011
29,553
On the Border
Speak to the FOS speak to the FOS!! It's blokes like you who are costing the industry millions. It costs the insurer £550 a pop if a complaint goes to the FOS. It's makes me sick.

Just bloody lump it or read the conditions.

HB&B Cert Cii

But if the condition of visiting the vet on a regular basis is not in the policy wording, then as a retail policy, the Insurer has not provided a policy wording that is clear and therefore one that the FOS should be aware. Of course the Insurer could always pay the claim, if they know that they would lose the FOS complaint, and update their policy wording to ensure that it is written in plain and clear English.
 


AmexRuislip

Trainee Spy 🕵️‍♂️
Feb 2, 2014
33,727
Ruislip
Speak to the FOS speak to the FOS!! It's blokes like you who are costing the industry millions. It costs the insurer £550 a pop if a complaint goes to the FOS. It's makes me sick.

Just bloody lump it or read the conditions.

HB&B Cert Cii

There is nothing wrong in speaking to FOS, if you feel that you have been wronged in any case involving money.
I have recently had two successful cases in claiming on PPI'S.
It pays to fight back. :)
 


Triggaaar

Well-known member
Oct 24, 2005
49,989
Goldstone
Ah, good old terms and conditions. Whilst it may not have been specified on the initial paperwork and application form, I would imagine that there will be something in the policy conditions about having an animal checked out at periodic (yearly) intervals. If it isn't in the original application form and booklet etc, you should have a case for the policy at least being voided as you didn't get what you thought you were getting (no consensus ad idem).
It wasn't on the application form, and it wasn't on the policy either. But it was on a new policy when the policy was automatically renewed. It's not on the current policy either, it was only there in the year I made the claim.
 






studio150

Well-known member
Jul 30, 2011
29,553
On the Border
It wasn't on the application form, and it wasn't on the policy either. But it was on a new policy when the policy was automatically renewed. It's not on the current policy either, it was only there in the year I made the claim.

When the different policy wording was issued to you, was the change in cover pointed out to you, as the Insurer has a duty to bring changes to your attention.
 


Triggaaar

Well-known member
Oct 24, 2005
49,989
Goldstone
When the different policy wording was issued to you, was the change in cover pointed out to you, as the Insurer has a duty to bring changes to your attention.
No it certainly wasn't. I think the Financial Ombudsman might be on my side:

"In 1984, Mr K took out index-linked household buildings and contents insurance. This included cover for his personal possessions, which were valued at £9,150 in total. He renewed the insurance every year. However, when he was burgled in 2001, the firm rejected most of his claim. It said that some of the personal possessions that had been stolen were worth more than £500 each and that such items were not covered unless they were insured separately.

Mr K was very surprised by this. He said he had no reason to think these possessions were not covered, as they were items of jewellery that his wife had owned since he first took out the insurance in 1984. He pointed out that the firm's promotional literature stated "New for Old Replacement means exactly that" and that it promised "Reimbursement in full at today's prices, whatever the original cost". The literature also said that index-linking "automatically takes account of inflation when assessing claims and renewal premiums". Since none of the stolen items of jewellery had been worth more than £500 in 1984, he considered that they should all still be covered.

The firm based its rejection of the claim on the renewal notices that, since 1991, had stated, "any item worth more than £500 is not insured at all unless specified". The firm said that Mr K should have noticed this and made sure that each item of expensive jewellery was individually specified.
complaint upheld
We considered that the firm's decision to exclude all personal possessions worth more than £500 constituted an unusual and onerous policy term. And such policy terms should be clearly drawn to the attention of policyholders. It is not sufficient for firms merely to print them on the renewal notice without giving policyholders any explanation or notice of the change"
 



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