HI,
i am posting this topic on behalf of a good friend who at present doesnt have internet, my friend also has a boston terrier same as my self, unfortunetly she had to be admitted to the cambridge vet hospital in january due to problems with her soft palette.The symptoms she presented with were gagging and retching usually when exposed to changes of temp even though she was well wrapped up, her tongue turned blue, also she fainted on these occasions, the vet at the hospital organised numerous tests plus she took part in a brachycephalic breed test where her breathing was monitored before surgery and again six weeks later with marked improvement.sHe had her soft palette shortnened and her nostrils widened.
In september she was treated with a 7 days course of anti-boctics, after attending a local dog show where 5 cases of kennel cough were treated by the vet in the local town ,she had contracted this 3 days after attending this event.
The insurance comapny have refused to pay as they have stated that the symptoms of kennel cough are similar to the soft palette, ie retching , gagging, coughing and they believe this was what she had in sept. The dog was treated for fourteen days by the local vet without improvement on the same tablets as in sept, but she went downhill losing half a kilo and was very poor;y without the surgery i believe the little girl would have died. The local vet has written to the company stating that the treatment in sept was for kennel cough and she recoverd in a week, but still thay said the claim will not be paid out. The cover for the insurance started on the 16 september but the cough was not treated until a fortnight later, of which may friend did not claim for, the notes for treatment at the vets state kennel cough as cause for visit with the treatment for this illness being used.The dog is 2 yrs old and apart from normal innoculation she has not needed any other vets treatment .
Any suggestions?,She has sent a copy of kennel cough and brachycephalic syndrome,symptons, dignosis to company but no joy.    

I know somebody else whose insurance company are refusing to pay too! No wonder so many people do not bother to insure. They seem to want the money but not pay out when the time comes.

I'd try contacting one of the dog solicitors like Trevor Cooper. The lady I mention has contacted him through his Dog Law site for help against her insurance company.

You could try the Ombudsman.  It does seem to me that if a vet has diagnosed something they are on shaking ground in trying to say it was something else but no harm in trying from their point of view I suppose.

Hi Lesleyanne.
Firstly i'm sorry to hear about your friends girl and i hope she recovers soon. I'M afraid i had the same prob with Lillie with insurance, because the vet when she went for her first injection, and check up had put flaky skin on her records,(which was where i should've known better and bathed her in my shampoo) it was just dandruff from that.So when she was diagnosed with having allergies some 6 months later,they refused to pay for her treatment saying it was on her notes from a pup that she had a skin problem. I know it wasn't the same condition,and so did my vet, who also wrote to state this , but they wouldn't budge and stuck to saying that She had it from a pup, I appealed to no avail they said it was a pre existing condition, which it wasn't .
Have you tried the ombudsman i think that is the next stage to appeal to them? which should be on the insurance documents.I'm sorry i cant be of more help, but maybe if you contact the ombudsmen they can overturn the decision.
Marie

Hi insurance problems are very common and have got more so in recent years.

I'm having a bit of trouble following the sequence of events (bit droopy this morning!!).  Was the kennel cough episode in Sept 08 and the soft palette treatment in Jan 09?

On what basis are the insurance company refusing to pay the claim for January 09?  Are they saying the treatment was unnecessary and/or asserting misdiagnosis by the vet?  You need to start here and clarify exactly what/why they are refusing.  Their usual get-out clause is pre existing condition and if they are saying that the soft palette condition was present when the policy started (regardless of whether your friend claimed) then they are within their rights to refuse the claim.  Once you know why they are refusing make sure you find the relevant wording in the insurance documents.

Essentially, if you want to get payment, you'll need to prove that they have made an error.  Firstly I would recommend that you sit down with your friend and document the sequence of events, then clarify those with the vet.  If the issue is pre existing condition then you'll need the vet to present the case for review and a lot depends on how persuasive your vet can be and how persistent you are.  Ask for copies of all correspondence so far.  I would imagine that this is a great deal of money and if your vet is on your side they have as much interest in recovering it as you do.

I had exactly this problem with one of my dogs but the vet was extremely helpful and we got it sorted.  Several hundreds of pounds later I'm still very grateful to them.   Good luck

Hi, sorry if its a bit rambling , kennel cough episode sept 2008, soft palette jan 2009, the insurance company have said that the condition which was treated sucessfully and diagnosed by a local vet as kennel cough has the same syptoms as the condition of soft palette, they are saying the soft palette was the real reason for the cough in sept and the dog had this prior to the insurance starting but we have had history from prevouis insurance company of no claims being made. The local vet has sent a letter confirming kennel cough in sept, and no prevouis history of this or any other problems in the dog, has the dog has been seen for health checkups run freely by the vet clinic,  the hospital vet believes from the records sent to her from the local vet that she was not   presenting with soft palette in september but the kennel cough. £1500 was the bill. The condition of the dog had gone down hill in the few weeks since the initial  course of antiboctics in dec presenting with fainting and a blue tongue and gagging which the insurance say are the same or similar conditions  as kennel cough, which was not present in sept or since the pup was born. The surgeon at the vet hospital said this problem develops as the dog matures, and is going to write to the i nsurance company on her behalf stating the case, If the local vet and the top surgeon at the queens vet hospital in cambridgeshire are sayng that these conditions arent related hopefully the insurance company will pay. THe vet has said that since the credit crunch the insurance companies are not playing fair, and that because of this a few owners have had to have there pets put to sleep because they cant afford treatment. WE had to lend our friend the money as at the local vets you have to pay upfront for treatment  then insurance company reimburses, the hospital sent a claims form to insurance company which they had filled in soft palette  upper airway obstruction in box for condition claiming for , but they do  take your details of debit/credit card and if the bill isnt settled in 50 days they debit your card. We went to the hospital today for final checkup and because the little girl has taken part in a study they waivered the bill for today which was another £86.00 onto of the £1500.We will forward our case to the ombudsman but im not holding my breath.
Thanks for replies

Hi, thanks for reply have you a e-mail address or contact number for Mr Cooper.
Regards
Lesley

You can find it on line at Dog Law

www.doglaw.co.uk

I think that is right.

The insurance companies won't pay out for any condition that might have started before the insurance cover was established.   This dows make shopoiung around difficult once yiu have had to make any trip to the vett because each trip will mean a reduction in available cover were you to change insurance company.

So if you ever took the dog to a vet to have a leg checked out because tyey were limping because they had say a thorn in their pad or a pulled muscle and then you took out a new insurance policty and a couple of years later the dog developed joint problems you wouldn't be covererd for any treatment. Why? Because it once had a splinter in their pad - or did they? Maybe it was it the early indication of joint issues?

We had this with my dog. She'd had gastritus when she was a pup and to be on the safe side I'd taken her to the vet to be checked out.  It was something of nothing and I forgot all about it.  Then a couple of years later we updgraded our insurance . Then almost a year later I put in a claim because she'd eaten a sock and need an exray  to make sure there were no complications. We claimed.  The insurance company refused to pay out. They added an exclusion to the policy for any gastric related condition. Fortunatelt my vet let me pay the bill over the next 6 months.    So I now don't bother with insaurance. What's the point in payng £20 a month for peace of mind if they don't pay out when you need to claim.

There should be a clarity in the law to define each treatment and condition and outcome more clearly,  and state when the dog has fully recovered and able to be fully reinsurerd. Any exclusions should be made in advance and with agreement  with the vet. 

They are being unreasonable as they 'appear' to be ignoring the expert witness oppinion.  Had the dog failed to responed to treatment back in Sept then it would be more reasonable to draw their conclusion that the soft pallete was the cause BUT as she recovered back in sept but didn't in Dec this disproves their conclusions.

Make an appeal if that fails get in touch about making a complaint, if you send a complaint directly to the ombudsman without going through the company's complaints procedures they will just go back to the company and ask them what they're going to about it, which rightly the company will say we have no complaint lodged with us so we can do nothing.

Hi, I dont think we will now insure my two dogs as my insurance is due for renewel as my border had a problem with a chip which has fully recovered and the Boston had a ear infection once, after my friends problems it does seem they , the insurance company find any way of not paying for a claim even though u can put claim in in good faith. I dont believe there was any exclusions on the policy for her boston, Two vets , one a head vet /owner of a large practice used by numerous events for animal medical cover in lincolnshire the other  one a surgeon who teaches students from around the world at a well renowed vet hospital and the insurance claims advisor does not belive the two conditions are not related, she did  say the information is checked by a vet nurse, surely a qualified vet in these cases if there is a dispute should go through the clinical notes.No disrespect to vet nurses they do a very good job and have a good medical training.

Firstly, this really depends on the wording within the Terms & Conditions however; most insurance companies will not pay for a condition that arises with the first 14 days of cover.  So that really depends on what date is on the vet's notes to show when the symptoms of KC first became known.  I'm assuming that it is within the 14 days or before the start date given the stance the insurance company has taken.

Secondly, insurance companies will not insure a pre-existing condition.  This is what they appear to be asserting here; that the symptoms of KC and the soft palette are one and the same and it is likely that the symptoms of KC were in fact the start of symptoms with the soft palette.  Not unreasonable given that they do present themselves in similar ways.

Under pre-existing conditions in the T&C's, they usually have something like - any condition or symptoms, illness or disease that happen before the start of this insurance. 

This would mean that regardless of what the vet's diagnosis was in September 08, symptoms happened at the start/ or within 14 days of the start of the insurance - symptoms that could have been the start of the soft palette problem amd most likely were from the insurance company's perspective, given what has happened since then.    

If this is the case, then it is a difficult one to overturn.  To put weight on your friend's side, she will need to swing the balance of probabilities that the incident in September was a separate issue and not the start of the soft palette problem.  If there have been no other symptoms after the antibiotic treatment from September 2008 to December 2008, then this should help to support her case.  However, it really depends on how these soft palette problems are likely to manifest themselves in time. 

By all means, write a letter of complaint to the insurance company and ask them for their Final Reponse.  They need to do this within 8 weeks.  If the outcome is not what you would have wanted, then you can take the case to the FOS - Financial Service Ombudsman.  Just be aware of the above in the Terms and Conditions and what your friend needs to prove beyond the balance of probabilities to get the claims decision overturned.

Used to get insurance when my dogs were alot younger but now just save the same money into an account each month, seems to make more sense  as i've never claimed for some of my dogs and even the one that costs me money for hip problems it's still no more expensive than the insurance each month.

I dont believe there was any exclusions on the policy

there dosen't need ro be. They can decide to exclude conditiins after you make a claim. They don't investigate the vet history when you take out insurnce but they do once you make a claom.

It would be better if by law the insurance company had to complete vey checks before offering you their terms of insurance so that they can be clear  up front about what exclusions will be implimented were you to need to make a claim in the future. Instead ot being happy to accept monthly payment and then deciding not to pay out.

Well with the financial restrictions people are now facing it seems that pet insurance is the first luxoury item to go. Many of us are prefering to pay the £50 or so a month into savings accounnts to help us out if we need it rather then then throw it away.  When you look at what they acutally are going to pay out - normally somewhere between £2000 - £5000  it isn't really all that much compared to house or car insurance where we pay much less but when we need to we can claim vastly more back.

> It would be better if by law the insurance company had to complete vey checks before offering you their terms of insurance so that they can be clear  up front about what exclusions will be implimented were you to need to make a claim in the future. Instead ot being happy to accept monthly payment and then deciding not to pay out.

That is totally unreasonable just imagine the extra premiums they'd add to the policy if they had to check every animals medical history possibly with several vets prior to accepting them as a client.  It is the responsibility of you to disclose any and all previous problems that may lead to an problem or claim,  without honesty from you then there is indeed a risk they won't pay out on a claim later.  In some circumstances you can reclaim your premiums, just can't remember what they are at the min ------ old age lol.

hat is totally unreasonable just imagine the extra premiums they'd add to the policy if they had to check every animals medical history possibly with several vets prior to accepting them as a client.  It is the responsibility of you to disclose any and all previous problems that may lead to an problem or claim,  without honesty from you then there is indeed a risk they won't pay out on a claim later.  In some circumstances you can reclaim your premiums, just can't remember what they are at the min ------ old age lol.

We aren't vets or insurance experts. We are clients. And we can't always remember every little trip we made to the vet or what we asked at the yearly check up etc.

You can be honest and forgetful. Forgetfulness or ignorance is not dishonesty.

I wouldn't have suspected that having the runs as a puppy and being on the safe side asking the vet to check if the pup is okay and the next day the pup is perfectly fine so you forget all about it. Then to provide a better cover for the dogs I updated to a better policy with the same company and then made a claim a couple of years later because I was worried the dog ate something like a sock and has an obstruction an the vet keps the dog in to be safe has an exray done and the dog is fine - well how is it dishonest not to link the two!  Because my dog dosent actually have a gut/intestine condition!  How can eating a sock be related to an upset tummy two years earlier when the dog was fine!

And heaps of people get caught the same way.

If the dog is healthy it is actually dishonest for the insurance company to take money and then decide a healthy dog has something wrong with it that it dosen't have.

They take our money and it is already more expensive then any other like for like insurance. If they have to add the cost of a phone call or fax to our vet or email ( which is free ) then it is cheaper then charging us £100's of £££ and giving us noting back in return.

> Secondly, insurance companies will not insure a pre-existing condition.  This is what they appear to be asserting here; that the symptoms of KC and the soft palette are one and the same and it is likely that the symptoms of KC were in fact the start of symptoms with the soft palette.  Not unreasonable given that they do present themselves in similar ways.

It can also depend on the type of cover you have too. I've got a 'covered for life' policy in which on-going condidtion can be claimed for repeatedly. Other policies will not cover a condition that the dog has previously been treated for. So it may not be beacuse the condition was pre-exisiting (as in, before the policy started), but because it has allready beed treated. ??

>Other policies will not cover a condition that the dog has previously been treated for. So it may not be because the condition was pre-existing (as in, before the policy started), but because it has already been treated.

I'm not sure of what you mean here; and I'm not convinced that would be a fair term in insurance principles to exclude recurring conditions indefinitely in today's market.  Most pet insurance policies are standard.  They either cover for life with a set amount reinstated each year regardless of conditions or cover a condition for life up to a set amount, or cover a condition up to a set amount within a certain timeframe i.e.12 month period. 

I don't know of any insurance companies that would do not insure a reoccurring condition providing the maximum amount or time has not expired.   Such a policy would not have any real meaningful value on the market anyhow. 

I can't imagine the OP falls into that category as the policy had just been opened in September which coincides with the first condition requiring treatment and the second 3 months later with no known illnesses before that.