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Managing Expectations: Complaints Regarding Pet Insurance

Apr 25, 2019

The Association of British Insurers (ABI) has announced annual figures on pet insurance coverage and claims, revealing that the average claim rose by 5% to £793. 

Pet insurance provides owners and vets with access to treatment which may not otherwise be affordable. 

Veterinary care and treatment options are now as sophisticated as those available to humans (or sometimes, more so). Without an Animal NHS, cost and affordability has to be a factor in decision-making. 

In the heat of the emotion, it is understandable that as owner’s, we can feel that ‘money is no object’ when our beloved family pets need care. Insurance is not a blank cheque but insurance can provide more choice when costs are covered or a contribution available.

In our experience at the VCMS mediating complaints, there are some areas where clear understanding and good communication will help owners and practices: 

1. Be aware that there are different types of cover. Not all policies are equal. Excess payments and cover will vary dramatically. For example, some policies will cover a condition for life and others for only one year, or cover will be capped for each condition. 

Life policies which cover an animal for their entire life offer the most extensive cover when compared to most annual policies; 

2. Insurance is a matter between the owner and insurance company. When making a claim under the policy, whether the practice completes and submits the form or receives payment directly from the insurer, the veterinary practice are assisting by providing information etc. but they are not a party to the insurance. They are not responsible for the cover or whether the claim is accepted by the insurer.

Some policies charge an excess (first £x of each claim are paid by the owner), and some cover a percentage of the veterinary fees. 

As owners it is important that we know the type of cover we have. The veterinary practice cannot change the type of cover we have in place. We must remember they did not choose the policy for us. The practice also cannot adjust their fees to fit the policy we have. 

Practice: Give a clear estimate and help the owner to decide on the best care plan based on risk and benefit. 
Owner:  Responsible for the fees of the care plan agreed. 
Insurer:  Contributes to the cost of those fees based on the policy and the type of cover. Insurance claim is paid to the practice or the owner. 

3. Pre-authorisation is often a requirement by insurers, but even when it is not required, it is sensible for the insurer to be consulted. 

Knowing any issue in advance helps everyone concerned. 

4. Insurers will review the animal’s veterinary history to see if the claim involves a pre-existing condition or injury which pre dates the insurance. 

There are occasions where the insurer will identify previous symptoms which may or may not be linked to the current condition or injury. 

If the insurer queries or rejects the claim, and you disagree that the earlier symptoms are related, it is worth speaking with the practice to ask for their advice on whether there is a link. A practice cannot be asked to ‘amend’ a clinical history. 

It is also worth remembering that earlier symptoms may be related, particularly where there is a developing situation. At the time of the earlier treatment, the full story was not known to the vet or the owner. We are now looking back with 20/20 hindsight. 

If owners and practices can discuss the insurer’s assessment calmly and constructively, the decision can be explained and understood, or there may be grounds to raise a query with the insurer. Further explanation i.e. confirmation that the earlier symptoms were connected with an unrelated condition or reaction, can help an insurer to review their decision that a claim will not be covered.

Calm and clear conversations are helpful as a collaboration may help to explain to the insurer why their view on the claim should be reconsidered. 

From a practice perspective, it is also useful to help owners to understand what you can and can't do in terms of monitoring total fees, timescales for claims being submitted and how cover may be apportioned where two practices are involved. 

Owners may believe that practices are 'keeping track' when treatment is provided over a long period of time. Owners will also expect that insurance claims are submitted in a timely fashion so the available or remaining cover is up to date and known. 

It can be difficult where an owner's insurance cover is exhausted by the diagnostics, leaving no available cover for treatment. If a practice is able to have a conversation with the owner to help them make proportionate and sensible decisions on how to approach diagnosis and a care plan, then complaints may be avoided. 

In reality, this is about a team approach to decision making and clearly managing expectations and the available insurance cover to avoid any nasty shocks for either party.



Independent mediation for veterinary professionals and their clients