In January 2017 Catherine’s dog, Sandy, developed a lump on her chin which required surgery. Catherine submitted a claim to her pet insurer to cover the costs of treatment ($800).
The insurer declined the claim because of an exclusion clause added to the policy when Catherine first took out cover. The clause excluded cover for any injury, illness or condition, clinical sign or diagnosis caused by, relating to or resulting from lumps, tumours, warts, growths and abscesses.
Catherine considered the insurer had unfairly declined her claim. Catherine said the exclusion was added to the policy because Sandy had a lump on her vulva prior to Catherine taking out the insurance. However, because Catherine said the vulva lump and the chin lump were unrelated conditions, the exclusion clause should not apply.
In addition, Catherine considered the exclusion should never have been placed on the policy to begin with, because Sandy’s vulva lump was a very small and minor issue. Moreover, Catherine considered the policy exclusion was too wide and excluded a number of potential claims. Essentially Catherine considered the policy was not fit for purpose.
Catherine complained to FSCL.
We said there was no cover under the policy for the claim. This was because even though the reason for the added lump exclusion was a response to Sandy’s vulva lump, the exclusion clause excluded claims in relation to any lump.
We did not accept Catherine’s view that the policy was not fit for purpose. The insurer provided Catherine with a 21-day free look period to consider whether to retain the policy. The insurer did not need to do anything more than set out the offer of terms. It was up to Catherine to consider those terms and decide whether the cover met her requirements and objectives.
Key insight for consumers
Insurance policies, including pet insurance policies, can have wide exclusion clauses. It’s important you thoroughly read the policy and any policy schedule (which may have further exclusions) to ensure you are taking out cover that meets your requirements and objectives.