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The finer details of Time Limited pet insurance plans catch many pet owners unaware each year. Certain terms and exclusions are particularly problematic for pet owners, leading to claims being rejected by an insurer. While you might be attracted by the low prices of a Time Limited pet insurance plan, find out why 12-month plans are the cause of complaints to the Financial Ombudsman Service (FOS) and what to look for before you buy.
If you're unsure of which type of pet insurance fits into your budget, you might want to read our Average Cost of Cat Insurance, Average Cost of Dog Insurance and Average Cost of Pet Insurance articles.
FOS Complaints: Time Limited Pet Insurance
Most of the 1,820 pet insurance complaints made to the FOS from April to December 2017 arose because an insurer refused to pay a claim. Two common claim-rejection complaints relate specifically to Time Limited pet insurance plans—not paying a claim after the 12-month time limit has passed and not paying claims for bilateral conditions. Find out how you and your pet may be vulnerable if you opt for a Time Limited plan.
The 12-Month Limit
By their nature, Time Limited plans will only cover 12 months of treatment for any condition. However, there is often inconsistency across insurers as to when the 12-month countdown officially begins. Depending on the insurer, the 12-month window might begin from:
- the time the condition was first noticed by you or your vet
- the date of the first treatment (e.g., exam, consultation, test, medication, etc.)
- the date of the first claim
Not only can these discrepancies lead to confusion for policyholders, but they may impact your success in claiming further down the road by effectively shortening the 12-month cover window. For example, if the clock starts when the condition is first noticed, the 12-month window will be shorter than if the clock starts from the first treatment (assuming there is a time lapse between the condition first presenting itself and the time you visit the vet.)
The second issue that pet owners run into with the 12-month window is that in most cases a pet owner is unable to claim for the full 12 months, unless they renew their policy. With most insurers your plan needs to be in force for cover to continue for 12 months, meaning they might not provide cover if your policy ends and you do not renew EVEN IF you are still within the 12-month cover window. Some consumers find it quite unfair that they need to renew in order to get the full 12 months' benefit.
Another source of payment disputes with Time Limited plans is the treatment of bilateral conditions. Bilateral conditions (i.e., conditions that occur on both sides of an animal, to a body part of which your pet has a second, such as an ear, eye or hip) are generally treated as one condition by insurers. This means that, say, an ear infection, cherry eye or hip dysplasia on one side of your pet's body with start the clock ticking for that condition on BOTH sides, significantly limiting the scope of cover.
How to Avoid the Pitfalls of Time Limited Plans
If you want a Time Limited pet insurance plan (perhaps because the premiums tend to be lower than Lifetime and Max Benefit), it's critical to be aware of the treatment windows. We've combed through policy wording for Time Limited plans from a number of insurers, to compare the different triggers.
|What Starts the 12-Month Cover Period?|
|First signs||Asda||First clinical signs of injury/illness|
|Animal Friends||When the condition is first noted by yourself or your vet|
|petinsurance.co.uk||The date when your pet first displayed clinical signs|
|PDSA||When condition first noticed (not when treatment starts)|
|PetPlan||365 days from and including the date an injury happened or the first clinical signs of an illness were noticed|
|First Exam/Consult||Sainsbury's||The date your pet first received treatment, where treatment is defined as any examination, consultation, advice, test, x-ray, diagnostic procedure, surgery and nursing|
|LV||The first date of treatment, where treatment is defined as necessary consultations, examinations, advice, tests, x-rays, drugs, medication, surgery, nursing or care|
|More Than||The date the condition was first treated|
|Argos||The start of treatment, where treatment is any examination, consultation, tests, x-rays, surgery or prescription medication|
|First Treatment||Tesco||When treatment begins, but if your vet gives advice but carries out no treatment, the 12 months period doesn't start|
Plans that start the 12-month clock upon first clinical signs are less ideal; a plan that starts the clock upon first treatment will provide the pet owner with more time for treatment or even waiting to see if a condition may resolve itself before seeking treatment. We find Tesco's language to be the best for pets and their owners—the 12-month clock starts when treatment begins, but if your vet gives advice but doesn't start treatment then the 12-month cover period doesn't start. See the table below for a recap of each insurer's language.
Making a Complaint to the Financial Ombudsman
If you're considering making a complaint to the FOS over an unpaid vet claim, it's useful to have an idea of how they consider complaints. When deciding who is right—the insurer or the pet owner—the FOS will look at the policy wording and/or policy summary, looking for exclusions and limitations. We always recommend that pet owners review the policy working and summary before buying a plan; it's also wise to review the terms regularly so you understand how your plan works.
12-Month Cover: If the insurer has not made clear upon a first claim that any future claims for the same condition won't be covered after the next 12 months, or if the policy documentation doesn't clearly state that cover stops at the end of an annual policy, then the FOS might tell the insurer to pay for the disputed treatment.
Bilateral Conditions: The FOS may determine that the insurer was justified in rejecting a bilateral claim if the underlying condition is deemed to be the same. If, however, they decide that two occurrences of a condition are not directly connected (perhaps different symptoms or manifestations), the FOS may advise they're treated as two separate claims (with 2 distinct 12-month cover windows).
Sometimes when we notice something amiss (whether for our pet or ourselves!) we wait to see if it will resolve itself before seeking medical treatment. If you have a Time Limited plan that starts the clock ticking upon a condition first presenting itself, it may not be a good idea to wait to seek treatment.
If you are considering a Time Limited plan because they tend to be the cheapest way to get Lifetime cover for your dog or cat, please see our article about Cheap Pet Insurance as you may find some Lifetime deals that are within your budget.
While complaining to the FOS may get your claim paid, we recommend that pet owners just avoid Time Limited plans altogether, instead opting for a Max Benefit plan or, if budget allows, a Lifetime plan.