Pet Insurance Decision Reference 2025-0144

• Case Outcome: Rejected
• Year: 2025
• Reference: 2025-0144
• Date: 14 October 2025
• Subject Matter: Pet Insurance
• Finantial Sector: Insurance
• Conducts Complained Of: Rejection of claim - pre-existing condition,Claim handling delays or issues, Failure to process instructions, Failure to process instructions in a timely manner

Decision Ref:

2025-0144

Sector:

Insurance

Product / Service:

Pet Insurance

Conduct(s) complained of:

Rejection of claim - pre-existing condition

Claim handling delays or issues

Failure to process instructions in a timely manner

Failure to process instructions

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

Background

The Complainants incepted a Pet Insurance Policy with the Provider on 4 June 2020. The

complaint refers to the Provider’s decision to decline the claim the Complainants made in

respect of treatment their pet underwent from 31 August 2020 to 9 September 2020. The

policy period in which this complaint falls is from 4 June 2020 to 3 June 2021.

The Complainants’ Case

The Complainants say their complaint dates back to August 2020 when they first made a

claim to the Provider with whom they had a Pet Insurance Policy in respect of their pet

who at the time was just over a year old.

The Complainants state that on 8 February 2020, they presented their pet to a veterinary

clinic as she had prolonged diarrhoea and vomiting and that upon examination, it was

deemed necessary to keep the pet in overnight for medical care. The Complainants say it

was suggested that the pet may have an infection because she had raised white blood cells

and was anaemic, and that the treating veterinary consultant believed there may have

been a possible perforation. The Complainants say the pet recovered from this episode,

however, she struggled to gain weight.

The Complainants incepted a Pet Insurance Policy with the Provider on 4 June 2020.

The Complainants say that on 31 August 2020, the pet underwent spaying in the

veterinary clinic and that at this time, the veterinary consultant telephoned to discuss his

concerns regarding the pet’s weight.

The Complainants say that the veterinary consultant’s suspicions of the pet’s increased

hunger and low weight led him to investigate for exocrine pancreatic insufficiency (EPI),

which was confirmed by blood tests a week later.

The Complainants say a treatment plan was put in place and remains ongoing since.

The Complainants say that in September 2020, through their veterinary clinic, they

submitted a completed Claim Form for Veterinary Fees, to the Provider in the amount of

€430.20 (four hundred and thirty euro and twenty cents), but that the Provider declined

this claim in October 2020 on the basis that symptoms of the pet’s EPI condition were

present prior to the Complainants incepting the policy in June 2020 and therefore any

claims in relation to that condition were not covered by the policy.

The Complainants say they appealed this claim declinature decision in October 2020 and

submitted to the Provider, in support of their appeal, a letter from their pet’s treating

veterinary consultant, wherein he stated that:

“I refer to your refusal to cover the claim 31/8 – 9/9 stating that the issue of

diarrhoea was pre-existing.

The investigations 31/8-9/9 led to diagnosis of EPI and secondary low b12, this

confirmed our clinical suspicion due to bright demeanour of the patient,

characteristic pale pasty grey stools of EPI and indeed response to diet/lypex and

b12 supplementation.

The episode in February which you feel characterises a pre-existing condition was

very different – patient was anaemic, hyproproteinaemic, dull, high white cells and

vomiting as well as diarrhoea all relating to likely perforation and secondary

infection with a splinter of wood. She fully resolved on treatment for perforation

with antibiotics, anti-ulcer meds etc and no treatment for EPI such as Lypex.b12

used.