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26 august 2022, 07:48
Financial Ombudsman Svetlana Maximova has ruled in favour of a client of an insurance company, who failed to receive an insurance payment for the treatment of a Maine Coon cat.
The Financial Ombudsman was approached by the owner of a two-year-old Maine Coon cat living in the Leningrad region with an appeal to recover from the insurance company a payment under a voluntary pet insurance policy.
According to Svetlana Maximova, the policy covered risks of disease or injury up to 30 thousand rubles, tick bite up to 5 thousand rubles and third party liability up to 100 thousand rubles.
The pet fell ill and the girl applied for the insurance payout. The insurance company paid 27,998 roubles for treatment of the cat for cholecystitis, pancreatitis and gastroenteritis.
After 2.5 months, the furry pet became ill again with a dense lump of hair (trichobezoar, a foreign body in the intestine) was lodged in the intestines and the owner applied for payment under the same contract to pay the costs at the vet clinic. “This time the insurance company notified the client that the second disease was a consequence or continuation of the first disease and, accordingly, there were no grounds for payment of the insurance benefit,” Svetlana Maximova explained.
The Financial Ombudsman said that an independent expert examination was organized when considering the appeal. “The expert examination showed that there was no cause-and-effect relation between the first and second diagnosed diseases; in other words, there were two different insurance events. Therefore, there were confirmed the facts of occurrence of two insurance events specified in the insurance terms and conditions at the insured risk of “sickness”,’ Svetlana Maximova added.
According to the Financial Ombudsman’s decision, the insurance company must pay 23,148 roubles to the cat’s owner.
“This case once again confirms that you should always carefully study the terms of the insurance contract and fight for your rights. If the insurance company refuses to pay and gives its reasons, you shouldn’t give up, especially since you can turn to the Financial Ombudsman, where the documents will be sorted out, an examination arranged if necessary, and a fair decision made. And all this is absolutely free of charge for the consumer,” Svetlana Maximova noted.
