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Pet Insurance Dispute

May 23rd, 2005, 03:13 PM
Hi again. I have a question about pet insurance. My sister took her pup to a canine physiotherapist and the physiotherapist suggested that her dog might have hip dysplasia and recommended seeing a vet. My sister decided, based on that information, that she'd better get pet insurance in case the physiotherapist was right.

My sister took pup to the vet and the physiotherapist was right.

So she paid for the surgery and submitted her bill to her pet insurance company.

The insurance company refused her claim and said that since the physiotherapist diagnosed the condition prior to the insurance policy being started, it was a pre-existing condition.

So here's my question. Is that right? Can a physiotherapist who is not a vet diagnose a pre-existing condition? I thought only a vet could do that. Should my sister fight this insurance company, or are they right?


May 23rd, 2005, 03:45 PM
I learned about pet insurance a few years back and this is why I didn't buy any. They will not cover annual shots, spay or neuter or anything that has been found before policy was bought. I think it's wrong but the truth is yes the pet insurance is not always the best. I will never have it for my dogs unless it changes alot and it doubt that will ever happen. :eek:

May 23rd, 2005, 05:09 PM
You would have to look into thecoverage to see who they see as an expert and can diagnose things. They may just use the word 'expert' or some other legal term.
I don't know that fighting it would help.

May 23rd, 2005, 06:09 PM
Yep, sounds like a losing battle to me. My sister is a fighter though. I'll post the outcome when she's done raging. :)

May 23rd, 2005, 06:21 PM
I was an insurance adjuster for 3 years. Anything that "exists" prior to the inception of an insurance policy, is not covered no matter what. THere is no point in fighting it as it is written in the policy. It doesn't matter who diagnosed it.

For example, my dog has cherry eye. It doesn't need to be diagnosed to exist. If we noticed his cherry eye on May 1, and got insurance May 15, and went to the vet May 31, the vet will ask when we noticed it. If we say, May 1...then it goes on record what we say. The insurance company will ask for ALL your pets records, see this, and it will not be covered because it was there before the policy was in force.

It's like if your house has a fire, then you buy insurance, the new insurance is not going to cover the damage from the old fire. Same with car insurance. If you windsheild is cracked, and you get insurance, it will not cover the windshield as it was like that before.

Only "events" that happen during the term of the policy are covered as outlined in the policy.

Now, some policies have a 6 month waiting period, where if a condition is not treated for 6 months consecutively, then they will cover it even if it happened before the policy started...but not all policies cover that.

That was just an example though. OUr dog does have cherry eye, but had it before we got him, so it is not covered by his pet insurance. We decided to get pet insurance anyway, because bulldogs are prone to SOOOOO many health problems, like hip dysplasia, breathing problems, back problems, allergies, etc, and if he got any of these, the insurance would be paying for itself. We got the insurance the day we got him, just in case.

I hope this helps.

May 23rd, 2005, 06:46 PM
Ahh that's interesting, thank you! I was under the impression that a pre-existing condition could only be diagnosed by a vet. My sister said the physiotherapist said she wasn't qualified to make a diagnosis, but by your explanation, it sounds as though pre-existing conditions can be identified by anyone and it doesn't have to be a vet, or even a professional. Thanks for the information... I'll pass it along!

May 23rd, 2005, 10:40 PM
The insurance company is right to be suspicious being that your sister took out the policy BECAUSE of the physio's suggestion... I wouldn't fight it because your sister was being a bit sneaky, wouldn't you say?

May 23rd, 2005, 10:56 PM
Oh yes, absolutely. There's no question she got her policy in place quickly because she was worried that there might be something wrong. She does have two other policies on her cats, though, with the same company, so it's not as though she was just trying to scam the insurance company. But you're right, the suggestion from the physiotherapist definitely got her moving faster than she would have otherwise. I don't think she's going to win this one.

May 24th, 2005, 07:27 AM
Have your sister read her insurance policy very carefully. It will outline any exclusions that may exist.

Also, when you buy pet insurance there usually is a 30 day period where if any illness were to happen, your insurance company can reject it and exclude it on your policy, so long as it was not an accident. Accidents are usually covered as soon as you purchase your policy.

I got insurance for my beagle and it has already paid for itself. Unfortunately I only got it after she was diagnosed with osteoarthritis of the hips and knees and I paid for her knee surgery out of my own money. Her insurance would not cover it.

Unfortunately, I think your sister may not be able to fight this as it was preexisting.

toby's tracy
May 24th, 2005, 08:08 AM
It was recommended to me that, since I have a large breed puppy, it is a very very good idea to get pet insurance for at least 1 or 2 years...NOW, before there are any pre-existing conditions. I was told that hip dysplasia would probably emerge during the first couple of years of my Toby's life.

I guess that doesn't help much in this case, but it is something to think of for people who have puppies or are thinking of bringing one into their families.

May 24th, 2005, 10:23 AM
Pet insurance plans have evolved over the years. Some plans specifically state that certain health conditions will not be covered - it does not matter when the diagnosis is made. When we got our Eskimo we were shown a new plan that cost $26 a month and would pay a maximum payout of $12,000 over the life of the dog - and would cover everything except Hip Dysplasia and Teeth (also it would not cover annual shots, heartworm tests - in short, normal checkups). My Eskimo was only 13 weeks old and so far has no symptoms at 14 months of dyplasia - but point is academic since plan would not cover it - pre-existing or not. Plans that we had in earlier years cost $60 to $80 a month - also did not cover annual checkups etc. There was also a breed deductible, a secondary deductible, exclusions of certain diseases - pre-existing or not - and a cap on certain expenses. For those of you with children requiring braces - same type of cap per child. So a lot of money was spent on premiums that was not recovered. Our safest bet was a collie/shepherd cross - $6,000 in premiums later she needed $1,100 in surgery. $500 was paid to us. Would have been better to put money in the bank. Now with the cheaper plan at $26 I would have gone for it, except when I saw the refusal to cover any hip dysplasia cost. I am not worried about teeth with an Eskimo. Dysplasis is the most likely. If plan covered shots etc. that would be different. So I bank the funds and hope. You should always read the fine print - but a lot of people in the waiting room at the vet's have come to same conclusion - bank the funds. I worry a lot about the dysplasia. After all, 2 of my mini Dachshunds had worst case Dachshund disease seen by Guelph neuologists - so why should I luck out now? I look at those gorgeous TOO long legs and worry.

May 24th, 2005, 11:02 AM
I have pet insuarance but I know the pitfalls and the fact it does not cover vaccines and so forth. Most provincial health care plans do not cover vaccines either so it is not surprising. I think it's useful in the event of a catastrophic illness or injury that one did not anticipate. That's about it!

May 31st, 2005, 07:38 PM
Well, here's a surprise. My sister actually won this dispute and is getting her 80% back. After a lot of digging through files and papers and policies, the insurance company conceeded that only a vet could diagnose a pre-existing condition. Amazing!

May 31st, 2005, 08:02 PM
wow, that's a loophole that will disappear pretty quickly I bet. Nice surprise for your sister though.

May 31st, 2005, 09:13 PM
WOW Lucky sister! I've never heard of someone winning against insurance... :pawprint: