Making a pet insurance claim

If you’ve been paying your premiums on time, it is reasonable to expect a pet insurance claim to go smoothly. But while many pet insurers now offer convenient online claims, it doesn’t guarantee that your bill will be fully—or even partially—covered.

Whether your claim is approved depends on several factors, including the type of cover you selected, the condition you are claiming for and whether you have met the required threshold.

The best way to avoid nasty surprises when you make a pet insurance claim is to get the lowdown on pet insurance and read the fine print before you sign up.

For instance, a policy might advertise coverage of up to $20,000 a year, but that doesn’t mean zero out-of-pocket expenses. Most, if not all, pet insurance policies include:

• • a benefit percentage (the portion of the bill they cover);
  • an excess (a fixed amount you pay per claim); and
  • other conditions that may limit payouts.

 

 

Many people also don’t realise that even top cover excludes some common illnesses. It’s essential to get a clear idea of what a policy does and does not cover before you decide whether pet insurance is worth it.

Getting your money back

Most pet insurers now allow claims to be submitted through an online portal, making the process quick and convenient.

You will need to submit a copy of your paid invoice, which clearly outlines the services provided. In many cases, the insurer will also require the vet’s notes to evaluate your claim. Ask reception to email you a copy of the vet’s notes when you pay your invoice.

Some vets offer to lodge insurance claims on your behalf, much like a doctor’s office submitting claims directly to Medicare. If they do, make sure you ask them to include the vet’s notes or you could find yourself chasing them up later.

In most cases, you will receive notice of a refund within 10 days or so, if the insurer does not reject your claim.

 

 

Reasons for rejected claims

When your insurer rejects a claim for a vet bill they should state the reason in writing. Common reasons for pet insurance claim rejections include:

• • You haven’t met the waiting period for a particular condition
  • Your premiums aren’t up-to-date
  • You are claiming for a pre-existing condition not covered
  • The procedure is on the exclusions list in your policy
  • Your pet has not had vaccinations that would have prevented the illness
  • You have reached the annual cap on benefits
  • You are claiming too long after the procedure
  • The level of cover has changed with the age of your pet

Delayed payouts

Even with easy-to-lodge online claims, it can take some time before you hear whether or not your insurance claim has been accepted.

 

 

Although insurers maintain they will reimburse you within five to 10 days, many will take longer and then deny a claim, saying, for example, that the surgery was not covered because it’s considered elective.

All insurers must adhere to the General Insurance Code of Practice and process your claim within fixed timeframes. This includes telling you within 10 business days if your claim has been accepted or rejected, or if they need more information. The insurer must then keep you informed on its progress every 20 days.

If they do eventually reject your claim and you dispute the reason, ask for a review. Contact the insurer’s internal dispute resolution department and outline your case, providing any extra information you may have.

If this goes nowhere, you can complain to the independent Australian Financial Complaints Authority. Better still, lodge your complaint with us and we’ll help you handle it.