A long time ago I dealt with some pet insurance complaints and an interesting death of a pet claim. This, to the best of my recollection, was the content of the letter I sent in response. Some details have been changed for anonymity purposes and the passage of time means others are a little hazy.
Dear Mrs Smith
Firstly, I would like to say how sorry I am to hear about the loss of Lucy. Please accept our condolences.
Following your call last week I have completed a full review of your file, including telephone calls, all paperwork submitted and the medical history provided by your veterinary surgery. I would like to point out that the medical history is a legal document and as such is required to be accurate by both the law and regulatory bodies.
I notice on the 1st of May you contacted us to query if you could claim the cost of Lucy’s purchase price if she died as the result of the medical condition. We confirmed that this was not the case and she was only covered through an accidental death. This raised concerns on two points. Firstly, insurance is for unforeseeable events, and to checking cover just before a claim suggests her death might not have been unexpected. Secondly, according to the medical history that was the day she was diagnosed with a heart condition.
The claim for Lucy’s accidental death was submitted to us via a typewritten letter dated 26th May. In the letter you describe how on the day before Lucy, on returning from the vets after a check up, she ran through the vestibule of your home and caught her lead on a door, slamming it shut behind her. The door was jammed and by the time you were able to access it (with the help of your builder) she was dead.
I compared this to the medical history and the notes state she died on the way home, presumably from her heart condition.
We have received a letter from your vets stating that you have since contacted them to explain you were so distraught on the day of Lucy’s death that the communication was garbled and incorrect information was logged. However, the vet that wrote the letter was not the individual who logged the telephone call. The telephone call took place on the 27th of May, after your detailed letter was written. We have also spoken to the vet who made the notes. She has confirmed they accurately record the information you gave her.
During the course of the claim we asked for a statement from an independent witness to confirm the circumstances of Lucy’s death. We specifically asked for a description in their own words. The letter sent to us by your builder was typewritten using the same typewriter and notepaper as the original claim letter and even used the same unusual vocabulary such as ‘vestibule’. As this suggests the description was not in his own words.
We contacted your builder to ask him to clarify some information. Despite being able to describe Lucy in great detail (he clearly had come to know her well over the years), he wasn’t able to confirm important aspects of her accident. For example, which part of the door her lead had become caught on, how long the lead was or the size of the gap between the door and the door frame. I would expect an experienced builder to be very familiar with the construction of a door in a door frame, particularly if he had removed the door and rehung it.
I also note that during telephones with our department whenever we ask you to clarify any detail regarding your claim you immediately state we are calling you a liar and trying to commit insurance fraud.
On balance I have reviewed your claim and found there is insufficient evidence to conclude Lucy died as a result of an accident and have no option but to decline your claim.
Kind regards Murka Lurka
submitted by /u/Murka-Lurka
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