Was Rita’s pet insurance provider right to reject her medical costs claim? And was her dog’s illness a pre-existing condition or not?
What happened
Rita’s dog, Bella, got sick but her pet insurer declined her claim for treatment costs.
It told her that the illness was a pre-existing condition, pointing out that her dog had suffered with several bouts of sickness before the policy started. Rita said the previous episodes were unrelated and had been treated before the policy began, so were unconnected to this claim.
Rita complained about the claim being declined, and unhappy with her insurer’s response, brought her complaint to us.
What we said
We looked at Bella’s veterinary notes and thought it was clear that there was no connection between her recent sickness and her past episodes. We didn’t agree with the insurer’s decision that the problem was pre-existing.
We took this information to the insurer. It told us that if it had known about Bella’s past issues when Rita applied for the policy, it would have added a ‘digestive problems exclusion’ to the policy. The insurer’s underwriting guidance confirmed that this was true.
We then asked the insurer for a copy of the online application. Looking over this, we saw that there was a question about the pet’s medical history. Rita could have mentioned Bella’s past sickness at this point.
In the end, we agreed with Rita that the condition wasn’t pre-existing and the claim shouldn’t have been declined on that basis. But we still couldn’t uphold her complaint because she hadn’t mentioned all of Bella’s medical history when taking out the policy.
We said it was fair for her insurer to add ‘digestive problems exclusion’ to the policy and decline the claim.