My 16-month-old rescue dog, a Dutch shepherd cross called Dutch, suffers from mental illness, so I made a claim for treatment with my insurer ManyPets. I made two claims for anti-anxiety pills and two more for behavioural sessions – which were accepted and paid. Then I made a claim for three further behavioural sessions totalling £395, but these were denied, even though the treatments were identical. Please help.
E. T., York.
Readers’ champion Sally Hamilton replies: You were getting nowhere fast while your complaint was dealt with by customer services, so after several weeks of chasing your tail, you came to me.
Like you, I felt it was odd that you had a series of bills reimbursed initially, but subsequent ones batted away. You told me that even the first claim took five months to get settled, with a lot of toing and froing before the money was sent – so much so that ManyPets paid you £50 as an apology for delays.
I thought perhaps the second time round you had reached the policy’s payout limit for this condition. Insurance policies sometimes have this type of limitation. But this was not the case as your standard lifetime plan offers £10,000-a-year cover for vet bills, so there was plenty of headroom with no other claims made.
The insurer previously told you it would look at your claim again if you forwarded a report from a qualified behaviourist confirming a diagnosis of Dutch’s mental illness. The specialist you hired diagnosed anxiety and OCD.
These manifested themselves in the form of him reacting badly to other dogs outdoors and then at home, chasing his tail and pacing the room in a figure-of-eight pattern while scratching and sniffing the floor and biting his claws. You submitted the report from the specialist to ManyPets, but the claim was still denied.
I thought this ‘ruff’ treatment so asked ManyPets to reconsider your case.
After some days, it came back to say the reason your claim was denied was the cause of Dutch’s mental health problems. It said your policy only meets claims for behavioural troubles that arise from another illness or injury.
It maintained Dutch’s mental challenges were due to a lack of socialisation as a puppy – which is excluded from the policy. I wondered why then your previous claim had been met, even after a long delay.
It transpires that the insurer’s automated online claims system was likely at fault with the initial request, waving it through when it shouldn’t have, according to the policy terms and conditions. By the time of your second claim, this wrinkle had been ironed out.
However, on my intervention, ManyPets examined your claim in more detail, took into consideration Dutch’s rehoming history – you adopted him at ten weeks old through the Dogs Trust and didn’t know his full background – and agreed to meet your second claim on a discretionary basis.
It has reimbursed £395 and paid £100 extra as an apology for your experience.
A spokesman said: ‘Our policies offer behavioural treatment cover to assist in treating behaviour issues caused by underlying illnesses or accidents. But, sadly, we cannot cover these issues in all circumstances – for example, where puppies have not been socialised during the vital developmental stages. We are taking lessons from this case to improve our automation capabilities and fast-track claims in the future.
‘Separately, we have also recently improved some of our policy wording to ensure that cover is as clear as possible for customers.’
Due to your experience, you have now switched to Sainsbury’s pet cover, which is half the price, although Dutch’s behavioural issues are unlikely to be covered as they are pre-existing.
My late wife took out £5,000 life cover in March 2016 with Reassured, now part of Royal London. She died on Boxing Day 2023. I had to borrow money from my son to pay for her funeral, which cost £4,600.
I hoped to pay him back with the insurance payout. But more than a year after obtaining medical details from my wife’s GP, Royal London has reduced the cover from £5,000 to £2,667. It claims my wife did not disclose fully her medical condition. Please help.
D. B., Eastbourne.
Sally replies: I was so sorry to hear about your bereavement and struggle to get the full payout from Royal London. You told me one contributory factor to your wife’s death was chronic obstructive pulmonary disease (COPD), which you said wasn’t diagnosed until after she took out her policy.
I asked Royal London to reconsider its stance, but I’m afraid it wouldn’t budge. Although it says it believes your wife never intended to mislead or withhold information on her health, it appears she overlooked certain medical conditions when completing the forms, including that she had asthma.
You say she had this well under control all her life. However, medical history is a key factor in determining premiums for life insurance – or even if it can be offered at all. This suggests your wife’s premiums would have been higher had the insurer known about the omitted conditions.
Your experience is a salutary lesson that answering all questions completely during the application process can help avoid horrible surprises and financial disappointment when it comes to claiming.
A Royal London spokesman said: ‘Royal London works hard to pay claims and meet customers’ expectations. In this case we couldn’t pay the full sum assured because questions on the application form were not answered fully and accurately.
‘As a result, the premiums were lower than they would have been if we’d had a more complete picture of the policyholder’s health.
‘The amount paid out represented the sum assured that would have been available for the premiums that were paid.’
Scam watch
People should beware a scam email impersonating Apple, consumer website Which? warns.
Tricksters claim your iPhone has been infected with 44 viruses which will ‘corrupt your SIM card, data, photos and contacts’ if you don’t take action.
The email asks you to install a free ‘removal app’ which will get rid of the viruses. But the link for the ‘app’ will instead direct you to a malicious website designed to steal your financial details.
Do not click on the link in the email – instead, forward it to report@phishing.gov.uk
- Write to Sally Hamilton at Sally Sorts It, Money Mail, 9 Derry Street, London, W8 5HY or email sally@dailymail.co.uk — include phone number, address and a note addressed to the offending organisation giving them permission to talk to Sally Hamilton. Please do not send original documents as we cannot take responsibility for them. No legal responsibility can be accepted bythe Daily Mail for answers given.
