mariobres
New Member
- Messages
- 3
Hi,
My dog is insured with "accident only" insurance coverage.
"We can see that you are claiming for treatment for Left Hind Lameness and TPLO surgery. As per the
clinical notes from your vet on 15/03/23 “Lameness LH intermittent” Then on 16/08/23 “History of LH
lameness since March. Started to be intermittent but it's constant at the moment. Toe touching and
avoiding to put weight on the LH”.
As your policy is Accident Only Cover, this is not covered under your policy
Please see your Terms and Conditions under Definitions:
“Accident - A sudden unforeseen and unintended Event causing Injury to Your Pet”
“Illness - Any sickness, disease or changes to Your Pet’s normal healthy state.”
Vet / surgeon have different oppinion:
"I would challenge the insurance company to produce a definition of what is an accident? I cannot confirm or deny that Melody did not have an accident/trauma when off lead or playing back in March which triggered the lameness. At the time of surgery I confirmed that there was a cruciate ligament tear but I cannot prove definitively what the underlying cause was.
In my opinion, there are canine patients who can injure/tear their cruciate ligament via a trauma/accident which can start as an intermittent lameness and progress. Equally there are many patients who have a degenerative injury resulting in a progressive lameness. "
Do you think I have the case against Insurance company?
Do I have even a slightest chance to go through Small Claims Court?
Kind regards and thanks to all who will reply,
Mario
My dog is insured with "accident only" insurance coverage.
"We can see that you are claiming for treatment for Left Hind Lameness and TPLO surgery. As per the
clinical notes from your vet on 15/03/23 “Lameness LH intermittent” Then on 16/08/23 “History of LH
lameness since March. Started to be intermittent but it's constant at the moment. Toe touching and
avoiding to put weight on the LH”.
As your policy is Accident Only Cover, this is not covered under your policy
Please see your Terms and Conditions under Definitions:
“Accident - A sudden unforeseen and unintended Event causing Injury to Your Pet”
“Illness - Any sickness, disease or changes to Your Pet’s normal healthy state.”
Vet / surgeon have different oppinion:
"I would challenge the insurance company to produce a definition of what is an accident? I cannot confirm or deny that Melody did not have an accident/trauma when off lead or playing back in March which triggered the lameness. At the time of surgery I confirmed that there was a cruciate ligament tear but I cannot prove definitively what the underlying cause was.
In my opinion, there are canine patients who can injure/tear their cruciate ligament via a trauma/accident which can start as an intermittent lameness and progress. Equally there are many patients who have a degenerative injury resulting in a progressive lameness. "
Do you think I have the case against Insurance company?
Do I have even a slightest chance to go through Small Claims Court?
Kind regards and thanks to all who will reply,
Mario