Pet Protect Insurance Thieves

[Putupon]

Hi everyone,

Recently my dog had problems with his cruciate ligament which he had to see the vet for. As this was not going to be a quick fix I decided to go through my insurance. This is Pet Protect. They said cruciate injury was capped at £750.00. We went on with the treatment and things didn't get better however my vets put a bill through which was settled. Minus my £100 excess and 20% contribution to Veterinary fees. This was all good so far. The policy was auto renewed in March which meant all the limits were reset.
After this time my dogs cruciate ligament ruptured and needed surgery. As this was a rupture and not an injury I did not think the previous limit would apply.
When my vet submitted their interim, invoice for £2,100.00 to Pet Protect, they only paid £750.00 of this.
When I questioned this they stated it was in the T&Cs which I had agreed to by auto renewal. They said they had made this change in 2015. THey also made reference to my telephone conversation which I mentioned earlier.

So there's the back ground.
My questions are; Is it fair and reasonable to cap an operation that normally costs between £2,000 -£3,000?
Also is it fair and reasonable for a lay person to know the cost of this operation. Therefore, making an informed choice. I assumed any cap would at least cover the average cost of the dealing with the issue.

I am in the process of putting these thoughts to Pet protect to see what they say, but I thought I would see what the eagle eyes of the legal beagles had to say about it.

Thanks in advance for all your help.

[des8]

Before I comment on this could you please give full details of the policy you have as Pet Protect have many different products.

As cruciate ligament rupture in dogs is normally caused by degeneration and not injury can you also post up the exact wording of your vet's invoice.
PP defines injury as " Physical damage or trauma caused by an accident "
An accident is defined as: "A sudden and unexpected event brought about by an external influence which is not an illness but which results in an injury"

Also exact wording of their rejection of claim would be useful.

If you have only had this in phone calls, we will need to get something in writing.

[Putupon]

Thanks Des8,

To be honest I have not seen the invoice. I will get a copy of this today and get all the information up to you ASAP

[Putupon]

OK,

I've been to the vets and got a copy of the invoice. However, this just states what has been used and what has been carried out. Along with the invoice the would have sent a full medical history.

The insurance I have with Pet Protect is a lifetime premium.

Also they have not rejected the claim, they have paid out at their capped rate of £750.00. However this isn't a third of the interim bill which came in at £2,113.07 for the interim invoice. The current bill which includes follow up X-rays and check up is £1068.34. This includes the payment of £750.00 from Pet Protect and a payment from me of £350.00.

I still have at least another check up appointment to go and this may not be the end of it.

None of this includes all the hydro-therapy my dog has had to under take. Which I am currently paying on and ad hoc basis as Pet Protect have stated this would all be under the treatment for the cruciate. Which (all together now) is capped at £750.00

My point and I think the only leg I may have to stand on, is that Pet Protects T&Cs are not fair or reasonable.

What do you the collective legal brains think?

Happy to supply any m ore information if required. Although I don't think going into the medical history will be of any use as the claim has been accepted just capped (Rather unfairly in my opinion).

Thanks again for all your help.

[des8]

Having had more time to look at the policy wording, it quite clearly states that excluded are costs "more than £750 per period of insurance for claims resulting from cruciate ligament rupture, tear or damage"
Why did you think the limit, which you knew about from your first claim, would not apply to the second incident?
Why do you think those exclusions are unfair?.

It depends on the extent of the injury as to how much it will cost to correct it.
I think you will find it will be held that it is for the pet owner to find out how much a particular course of treatment will cost, and then decide how to fund it eg by insurance, pet charity, own funds.
It would be unwise to assume any policy limit would be sufficient to cover any particular course of treatment.

Unless you can plead ever so nicely for an ex gratia payment I doubt you have much chance.

[FergusonJes]

I would have liked my parents to allow me to buy a pet but they definitely do not accept.