Simon adopted a greyhound called Zac.
Before Simon took Zac home with him, he organised pet insurance. The pet insurance policy had a 21 day stand down period. This meant that if Zac received treatment for an illness within 21 days of the policy’s commencement date, the cost of that treatment would not be covered by the policy.
Simon had purchased the insurance policy online on 22 March 2016. He received a certificate of insurance which provided that the period of insurance commenced on 22 March 2016 at 4pm and ended on 22 March 2017 at 4pm.
At 5am on 12 April 2016 Zac suffered from vomiting and diarrhoea. Simon took Zac to the vet where several tests were administered. Zac recovered from his illness although Simon paid $1,738.90 in vet fees.
Simon submitted a claim to his pet insurance company. However, the insurance company declined Simon’s claim. The insurance company said that Zac had fallen ill within the 21 day stand down period so the vet fees were not covered under the insurance policy.
The complaint
Simon considered that his claim should be covered because, in his view, Zac did not fall ill within the 21 day stand down period.
The insurance company had calculated a day as being each consecutive 24 hour period starting from the time and date the policy commenced. The insurance company considered that the stand down period ended at 4pm on 12 April 2016.
Simon disagreed with the pet insurance company’s method of calculating a day. Simon argued that a new day begins each time the date changes. By his calculations, the stand down period started on 22 March 2016 and ended at 11.59pm 11 April 2016.
Simon said the policy wording was unclear and that the insurance company was interpreting its policy in such a way to support its position.
Simon complained to FSCL about the decline of his claim.
Review
We found that the stand down period did not end until 4pm on 12 April 2016. As Zac first became ill at 5am on 12 April 2016, his treatment costs were not covered by the policy.
We considered that ‘a day’ was the 24 hour period between 4pm and 4pm the following day because the policy certificate stated that the policy commenced and ended at 4pm.
Unfortunately we could not direct the insurance company to make a goodwill contribution to the vet fees as we had found that the insurance company was not obligated to pay Simon’s claim.
It was clear that Simon acted in good faith and he had taken all the right steps to ensure Zac had insurance cover from the earliest opportunity. Simon was the victim of very unfortunate timing. Had Zac fallen ill just 12 hours later, at 5pm rather than 5am on 12 April 2016, then this would have been outside the 21 day stand down period.
Our insight
While we sympathised with Simon’s position, an insurance company is entitled to restrict cover under its policy wording. In this instance, the policy included a 21 day stand down period. It was very unfortunate that Zac became ill so close to the end of that 21 day stand down period. However, as it was within that period, the insurance company could decline the claim.
