To the limit

Chris’s dog, Scout, was injured in early 2019 when he ran into the family’s coffee table. Chris took his dog to the vet who referred him on to a specialist orthopaedic surgeon to fix Scout’s leg. Scout made a full recovery.

The orthopaedic surgeon invoiced Chris for $9,000, so he made a claim under his pet insurance policy.

The insurer accepted Chris’s claim, but only paid Chris $2,000. The insurer said Chris’s policy only provided up to $2,000 cover for specialist treatment.

 

Dispute

Chris did not accept the insurer’s interpretation of the insurance policy. Chris said his policy only had cover up to $2,000 for specialist treatment, but it also had cover for up to $7,000 for injuries suffered by Scout.

Chris accepted the orthopaedic surgeon’s bill was for specialist treatment, but he said the treatment was for an injury, so the higher $7,000 limit for injuries should apply to his claim. Chris complained to FSCL.

 

Review

We reviewed the insurance policy, and found that the insurer had interpreted the policy correctly. Read in context, the lower limit was clearly intended to override the higher limit, where multiple limits could apply to a single claim.

 

Resolution

We told Chris that we had found that the lower limit of $2000 applied to his claim. We advised that this finding was unlikely to change if we proceeded to a final decision. Chris was unhappy with our finding, but decided to discontinue his complaint.

 

Insights for consumers

Exclusions and limits in insurance policies are often worded broadly. If the policy has limits for various different types of illness and injury, it is important to understand what these limits are and when they will apply.

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