Understanding the fine print

We thought it a good idea to explain what a pet medical insurance policy really is. What are your rights? What are your obligations? And where do you go if you’re an aggrieved consumer?

It’s just a contract

Pet insurance is really just a contract of insurance between yourself and the insurer. You may end up going through a broker or advisor, but ultimately you have signed a contract with the insurer.

In terms of this contract you are obliged to do (and not do) certain things, and likewise, you have rights and expectations as to what the product should do for you.

As you’re on your way to entering into a legally binding contract, getting around to actually reading the terms of the contract (the policy document and maybe a schedule of benefits), should be high on your priority list.

The policy document will clearly list everything that your pet insurance product covers and what it doesn’t.

Any pet insurance product provider will also require that you have acknowledged the policy terms and conditions upon entering the policy. You would do this either on their online form, or when completing a paper form.

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You get what you get, and you don’t get upset!

This should not be the case at all.

The creators of this site have spent an inordinate amount of time talking to the various pet insurance providers about their products, how they work, and their various policy terms. Contrary to what you might believe, pet insurers are not generally out to screw you over.

Any benefit that you might be entitled to would be clearly worded in your policy document. There are various pieces of legislation that require the policy terms to be easy to understand and in plain language. If an insurer is not willing to settle a particular claim you may have, chances are that you are not entitled to have that claim settled.

There should be very few grey areas when it comes to actual policy wording for a product such as pet insurance. It is not a desirous place to be, where you’re fighting for your rights, as your rights should be clearly laid out.

In unfortunate circumstances though, it may be that the product was mis-sold to you; you were under the belief at the time of entering this product that it would meet certain needs – but they fell short. This is not the insurer’s fault, nor theirs to fix.

Understand that insurers cannot pay according to how sorry they might feel for you, or how much they want to help you out. For every Rand spent on honouring a claim, that makes the product less profitable for the insurance underwriter who carries the risk on these products. Poorly managed underwriting risk can sink a product, make it expensive for the consumer, and ultimately make it uncompetitive in the market.

Insurers price the risk that they are exposed to by issuing these products very carefully, and dishing out what essentially amounts to free cash, is not high on their agenda.

Your obligations

If you want the rainbow, you have to put up with the rain.

Pay particular attention to what you’re supposed to do, not do, and disclose at the time of entering into your policy. This might be things like disclosing any prior medical conditions or ailments that your pet suffers from, or being truthful about your pet’s age.

It may be making sure that you apply for pre-approval, before incurring expensive medical costs, as well as making sure that you claim for any costs within the time frame given in the policy.

Our best advice to you, is that if you’re unsure about what you’re supposed to, speak to your broker, advisor, insurance company, product administrator BEFORE doing anything. You cannot be accused of doing anything wrong if you simply pick up the phone and ask for help.

Your rights

Most people focus on these when entering into a contract of insurance.

Read the policy document, ask questions, and don’t be afraid to wait until you fully understand what it is that you’re getting into.

I’ve always personally found it a good idea to pitch a scenario to someone selling me something; a ‘use-case’ if you will.

“So if while walking my dog, he pulls away from me, runs across a road, gets hit by a car, and requires emergency veterinary care, can I take him to the nearest vet on a Sunday for emergency care?

Yes

“Okay, and what if they tell me they need to perform emergency surgery and that it might cost R17,000?”

“Then our product would provide cover up to an amount of R15,000, and the excess would apply.”

“Ahhhh, so what is your excess? How does it work?”

I think you get the picture

Take the time.

Know what it is that you’re buying.

Get informed.

When all else fails

There may be times that you’re adamant that you’re right and they’re wrong.

All insurance products have an Ombud who can mediate and rule on insurance contract disputes. The short-term insurance Ombud does precisely that.

If you cannot have your claim resolved internally then you do have the right to approach the Ombud for assistance. Please note that running to the Ombud should be reserved for matters where you’ve considered all communication channels within a product provider, and feel convinced by your legal rights afforded to you in the policy document.

Looking a fool for running to the Ombud, when you clearly don’t understand why your claims were rejected, simply because you didn’t take the time to read the terms, is not cool.

The Short Term Insurance Ombud can be contacted per the below details

Address: P.O. Box 32334, Braamfontein, 2017 Tel: (011) 726 8900 Fax: (011) 726 5501

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