Hi folks,

I've a Golden Retriever, Ollie who is around two and half years old. He suffers from anxiety and the vet has given him various treatments including Selgian and the use of a DAP (Dog Appeasing Pheromone) Diffuser (like a glade plug-in but full of female pheromone).

Ollie is now off the Selgian and the DAP works a treat. Petplan had been great and had met the cost of the treatment, including the DAP. They have recently denied my claims saying that they paid for it previously outside their terms and conditions and shouldn't have. That it is a complimentary therapy etc etc..

My question is has anyone else had a similar experience, what happened? Did you have any joy?

Anyone a legal expert - i would have thought this is breech of contract? They have paid for previoulsy and therefore set a precedent... i'm no expert in UK law. Any ideas?

At the moment my Vet is writing to them but they have indicated that their final decision is that they won't pay. So I then need to take them to the FSA - has anyone experience of this? Were you successful?

Any information or advice anyone could offer would be great.

Thanks
Tim

I think that before you can complain to the FSA you need to complain to the company and reach deadlock - when I complained they asked me for a letter of deadlock and then took the case on, however that was a year ago and it's still ongoing.........
Try writing a formal complaint to the chief executive, mark the envelope private and confidential and set out the facts, (it has worked for me before when departmental manager was fobbing me off) I would play heavily on the fact that they've paid for it before so have set a precedent.
I'm not legally trained (just assertive :) :) :) ) so perhaps someone with legal training will be along..........

Hi Poppynurse

Thanks for the advice.  I'm doing that at the moment - and they have to reply within the next few days with their final decision.  I spoke with the case manager and she has explained that the final decision is likely to be that they won't continue to pay.

I've sent you a PM, Tim.

Presumably you have the policy in which the terms of payment are clearly delineated.

Before you throw your teddy out of the pram I would read it extremely carefully................ and of course, any updates you may have recieved.

IME most people with insurance cover of any sort do not bother to read updates to their policy etc etc etc.......

tohme. thanks, i think.

The policy wording has not changed since when they paid for it previously.  There has been absolutely no change to the policy and trust me I have been through it with a fine tooth comb. 

The issue here is they have paid for it previously - had they declined payment initially and explained clearly why then fair enough.  Here, they have moved the goalposts with no rationale. 

Teddy is firmly in the pram, as is the dummy.  But why should one pay for a service, in this case insurance, only to have the insurance company decide on a whim they ar eno longer going to pay?

>Before you throw your teddy out of the pram

What an offensive way of talking to someone who was simply asking a question!

I think maybe Tohme meant that before the OP loses her rag at the Insurance Company, she should check the terms of the policy (or that's how I read it anyway??)

He should to - and he did... lol

:) :)

Words are beginning to fail me, how this phrase can be construed as "offensive" makes the mind boggle!

However, as I have said many times before, it is impossible to avoid offending "someone" on the planet whatever one says. :rolleyes:

Hi Woo19711

I don't want to be argumentative, but I'm afraid if I were you I would come at it from a different angle :)  It sounds to me as if you accept that maybe a DAP diffuser isn't amongst the things they would cover you for because you say it would have been fair enough if they had told you this originally.  Your beef is that they paid and then said they shouldn't have and won't any more.  You feel this is unfair of them, that they are changing the conditions and that they should continue to pay.  I disagree with that interpretation.  If I were in your shoes I wouldn't be looking for them to continue to pay, I'd be thinking it was a bonus they had paid for it in the first place when they shouldn't have and weren't going to ask for the money back :)  Yes, they made a mistake, but it was in your favour.  The mistake has now been pointed out, so surely that is the end of the matter?

Lesley

Lesley,

It;s a matter of principal.  Yes I was surprised they paid - but I assumed that they were paying within their terms and conditions.  They paid for around six claims for the DAP - it was not simply a one off.  So therefore I think it was a safe assumption that it was paid within the T&Cs and not simply a mistake.

On speaking with an individual in Petplan they made the conscious decision to stop paying for these sometime this Spring - and I am assuming not just on my policy but for others too.  So because of custom and practice, they have changed their conditions without informing anyone.  Their policy states it is for the lifetime of the illness/treatment. 

Ah!  In that case I apologise woo19771, as I thought they had only paid for one DAP.  However, if you've had it paid 6 times then I quite agree that it is a different matter :)  Let us know how you get on with challenging them. 

Lesley

No problem... I should have explained more clearly in my original post

Interested to hear your outcome - I was told by the vet that they would not pay out for DAP products so never claimed them (I was using the DAP Collars), and I'm very surprised you were paid.

No problem Jen, I'll share what happens here.  Had a phone call from them today.  I need to have a response from them tomorrow according to their own process but they are still reviewing the case after my vets wrote to them and explained that they would pay for more expensive treatment which may not work so why not continue paying for the DAP which does work....

So hopefully they may overturn their decision.  If not then this is their final decision not to pay and I'll end up going to the Financial Ombudsman Service...

Just by way of an update - Petplan's final decision was not to pay.  I've since submitted a cas to teh Financial Ombudsman Service.  We'll wait and see....