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Jo C.
Jo C., Barrister
Category: Law
Satisfied Customers: 69252
Experience:  Over 5 years in practice
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We have two Irish Setters 5 & 8 years old, insured with Petplan

Customer Question

We have two Irish Setters 5 & 8 years old, insured with Petplan on a lifetime policy at £26.43 & £25.22 per month respectively. The policies were taken out in June 2007 and Jan 2009. Recently we have had a claim for an Ear Disorder with the 5 year old dog refused, with the reason stated that Ear Disorders are excluded from the policy efective 01/08/2012.On 02/04/2014 we received a further notification that Heart disorders, Ear disorders,Clinical signs of Diarrhoea, Behavioural disordersand Tumours, Warts,Cysts, Growths & Abscesses are all Excluded. The total Vet bill for the 5 year old dog's Ear Disorders amount to £885.25. The condition is now stabilised, according to the Vet.
Since the "goal posts seemed to have moved significantly" since we comenced with both dog's insurance policies, do we have legal grounds to resubmit the Ear Disorder Claim ?
I have cancelled both policies, since I believe that with all Exclusions mentioned above, we are better off putting the £51.65 per month into a savings account for any future dog's Vet bills and taking out 3rd party liability insurance only.
Submitted: 2 years ago.
Category: Law
Expert:  Jo C. replied 2 years ago.

Thank you for your question. My name is XXXXX XXXXX I will try to help with this.

Just to clarify, you have now cancelled the policy and wish to resubmit a claim?
Customer: replied 2 years ago.

Correct; I was told by the Vet to contact the local Government Ombudsman to submit the claim.I thought I would start with your service to see if this was worthwhile.

Expert:  Jo C. replied 2 years ago.
Thank you.

I think you are referring to the Financial Ombudsman

Rather than the local government ombudsman which deals with issues involving the local authority.

Whether they can move the goalposts at the end the really depends on the terms of the original policy.

Under normal circumstances it is renewed from year to year on the same terms and only if you took a new policy out with the terms change.

It would appear from what they are now excluding is that more is excluded than is actually included and therefore I can understand why you have taken the stance that you have.

Even if they are entitled to change the policy terms each year, they are only entitled to do that if they advise you and you agree.

At this stage in time you need to make a formal complaint to the insurance company (which is highly likely to fail) and ask them on what basis they are allowed to vary the policy unilaterally without you were agreeing to do so.

Assuming that the response come back is unsatisfactory, then make a complaint to the Financial Ombudsman.

The Financial Ombudsman service is not quick but it is extremely fair and if there is a reason for the claim to be upheld they will make the insurance company payout.

Can I clarify anything for you?

Jo C., Barrister
Category: Law
Satisfied Customers: 69252
Experience: Over 5 years in practice
Jo C. and other Law Specialists are ready to help you
Customer: replied 2 years ago.

Jo, a very good answer - and thanks for pointing me in the direction of the Financial Ombudsman - I also arrived at this conclusion, but only after several phome calls and much "trawling" on the net. I have made contacted them and will make a formal complaint to the insurers before going any further with the Ombudsman route.


Once again many thanks, Mike Golding

Expert:  Jo C. replied 2 years ago.
No problem and all the best.

Please remember to rate my answer.

Remember that I am always available to help with your questions. Even if I am in Court I will usually pick up a question within 12 hours. For future information, please start your question with ‘For Jo C’.

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