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UK Solicitor John
UK Solicitor John, Solicitor
Category: Law
Satisfied Customers: 317
Experience:  8 years legal experience
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I have a question to an insurance dispute. Farnham near

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Hello, I have a question to an insurance dispute.
JA: Where are you? It matters because laws vary by location.
Customer: Farnham near London
JA: What steps have you taken so far?
Customer: None
JA: Anything else you want the Lawyer to know before I connect you?
Customer: I create a summary of the background of the case I could share this with you in case this is beneficial

Hello welcome to Just Answer. Please provide your background information so I can see if I can assist you.

Customer: replied 12 days ago.
Background

The matter is related to an insurance claim against my previous dog’s (Luis) health insurance.

Timeline

22/05/2018
Commencement date of insurance.
No pre-existing conditions asked or declared.
(Policy document: “20180522 Animalfriends policy schedule.pdf”)

03/01/2019
Claim related to joint problems. Animalfriends asked about Luis medical history in Germany, which was then provided.

The medical history has two entries, which Animalfriends uses later for stating an exclusion:
In 2012 Luis had diarrhea, and in 2015 he vomited. His vomiting was treated with anti-inflammatory medication, and the vet noted that if his vomiting does not improve he should come in for further checks. He did improve and did not need further treatment.

(Medical history file: “20190301 Germany vet - translated.docx”, original document in German: “20190301 Germany vet - original.jpeg”)

11/10/2019
Luis has been admitted to the vet due to vomiting. After ultrasound it was discovered that there is something in the stomach. It was decided to proceed to cut open the stomach and the vet discovered that the inside of the stomach and intestines were full of cancer and that nothing could be done. Luis had to be put down.

The insurance declined the authorisation for treatment as it claims it is a pre-existing condition. Also, the insurance puts in a retrospective exclusion to everything related to the digestive system.
(Insurance response letter: “20191011 Animalfriends - declined preauthorisation.pdf”). Following this, the insurance also refused payment for the treatments.

My position on the matter:
In 2015 Luis suffered from vomiting. The insurance states that this is a pre-existing condition related to the cancer that occured four years later.

Firstly, vomiting is not related to the occurrence of cancer four years later. Therefore the cancer is not related to this pre-existing condition.
Secondly, the insurance could have applied the exclusion in January 2019, when it found out about the condition. However, the exclusion was only applied once I tried to claim for the cancer treatment. If the insurance had applied the exclusion from the date it found out about the condition, I would have had the chance to look for alternative insurance cover. This treats me unfairly as a customer, as the insurance gave me no choice to make alternative arrangements, and left me with an insurance product that was useless for me. Furthermore, on 23rd of April 2019, with renewal of my insurance, I have been mis sold an insurance product.

Could you please let me know your opinion on this matter. How are the chances of success if legal action is taken against the insurance?

Many thanks,
Kai

Hello Kai, I will be honest with you. I have read your background and I am sorry to hear about your dog. I am a dog owner myself. But your chances of success will ultimately depend on the defence the insurance company uses.

From what you have stated it doesn’t appear the cancer was related to any pre-existing condition and the insurance company is doing all it can not to pay. But I say this from your point of view in that they may have a different argument. The only way this can be decided is through investigatory actions.

However, you have a good chance of success based on what you have stated. If you do decide to take legal action, you need to keep in mind it isn’t about allegations and what you think happened, it is all about evidence and what you can show to prove. You have a good chance as any by taking legal action and I suggest you do. I just cannot guarantee anything because I am unsure what the insurance company will say in mitigation, but you must certainly try as you have nothing to lose in that a firm will take this matter on, on a no win no fee basis. I do wish you all the best. Kind regards, John.

I hope you have found my answer useful. I would be grateful if you could take a brief moment to provide me with a positive rating before you leave the site. This way JA credits me for my time in helping you. Please remember to return to the site if you require anymore assistance. Thank you in advance.

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