Not sure how to go about making a claim? These steps will make it easy for you to claim on your pet insurance.
If you’ve just rushed your dog or cat in for surgery, the last thing you want is to be confused about how to make a claim. Fortunately, it’s fairly straightforward. This guide explains how to make a claim, and what you’ll need to include.
In general, you have 90 days following vet treatments to claim the costs and complete the following steps:
- Get a claims form from your insurer’s website.
- Fill out your part of the form.
- Have your veterinarian fill out their section.
- Send it in to your insurer along with any relevant documentation.
It’s important to note that all pet insurance policies contain exclusions, so it’s a good idea to familiarise yourself with your cover before signing up. This can help reduce the chance of being surprised at having your claim denied.
How to fill out a claims form
The good news is that your vet does the hardest part here. You just have to fill out the appropriate details about the accident, illness or injury. Some insurers will even let you do it all online and upload any supporting documentation.
You’ll need to fill in the following information:
- Your policy number. You will find this on your personal Product Disclosure Statement (PDS) or other documentation you received after signing up.
- Your pet’s details. This includes your pet’s name, gender, species, age, colour, breed and whether it’s been desexed.
- Your details. This includes your name, address and contact information. You’ll typically have to inform your insurer if you’ve moved house since signing up for the policy.
- GST ITC and ABN. This is the percentage of the GST Input Tax Credit you’re entitled to, if any, as well as the relevant Australian Business Number. This is only applicable if you’re claiming pet insurance as a business expense, so most people will be leaving this part blank.
Your vet will need to provide the following information:
- Injury information. Your vet will need to give a description of the injury or illness as well as the diagnosis. Also, the vet will need to disclose whether there have been previous clinical signs of injury.
- Treatment information. The vet needs to detail what the treatment was and when it was given, as well as provide any case notes.
- Other information. This may include background details on vaccinations, how long the pet’s been under this vet’s care and some case notes.
Your vet should also attach the relevant radiology, pathology and consultation notes where applicable and a few personal details of their own. Both you and the vet will then need to sign the form, declaring that it’s an honest and genuine claim. Now, your claims form should be complete.
What documentation will I need to include?
The additional documentation is mainly to show the cost of treatment, so the insurer knows how much to reimburse you. You will need to attach the original itemised invoices and payment receipts with the claims form.
If you’re claiming online, you can usually upload copies of these, either by scanning or taking a photo of them.
How will my claim be paid?
Generally, you will be able to choose how you’d like to receive your payment. Once you have submitted a claim with all the appropriate information, the insurer will start processing it. Once this is competed, you will receive a certain percentage of the cost back.
If you’re paying your premiums with a direct debit from your bank account, you can usually opt to have claims deposited directly into your account. If you are using a different payment method, you will receive a cheque.
Common claims conditions
All insurance policies have certain conditions that need to be met in order to have claims paid, and pet insurance is no exception.
- You have 90 days following veterinary treatment to make a claim.
- You need to provide evidence of the diagnosis and services rendered. Your vet can do this by filling in the appropriate sections of a claims form or by giving you the appropriate documentation to upload when claiming online.
- If this is your first pet insurance claim, the insurer might also request a full veterinary history, which means attaching a copy of medical records from all previous veterinary visits.
- You need to provide evidence of how much the treatments cost by uploading or sending in the original itemised invoices and other evidence of costs incurred.
- When making a claim for extra cover items, such as emergency boarding in the event of you being hospitalised, you will need to prove your right to claim. In this case, an insurer might require evidence of your hospitalisation.
How to avoid having your claim rejected
The main way to ensure that your claims are not rejected is to understand the terms of your policy, the different kinds of pet insurance available and some of the common pet insurance exclusions.
- If you have accident-only cover, you cannot claim for pet illnesses under your policy.
- If you have accident and illness cover, you can claim for both accidents and illnesses, but they are still subject to some exclusions. Certain conditions or treatments might not be covered.
The following are some limitations and exclusions that may be in your policy:
- No cover beyond the annual limits of your policy. You cannot get reimbursed more than the annual limits of your policy in a 12-month period. This is typically based on the policy anniversary and not the actual calendar year.
- Limitations for foreign object removal surgery. Some policies will only let you make one claim per year for surgical removal of foreign objects that your pet has swallowed.
- No cover for behavioural conditions. You cannot claim treatments for behavioural conditions such as anxiety disorders or aggressiveness under many pet insurance policies, even if a vet has diagnosed and recognised the condition.
- Sub-limits apply. Sub-limits might apply to certain treatments and conditions. For example, routine care costs will typically be limited to a few hundred dollars per year. These still count towards the total annual limit.
- Pre-existing conditions. Usually, you cannot make a claim for pre-existing conditions that were evident before you took out a policy. For this reason, it’s often a good idea to get cover while animals are still young.
Policies will also frequently exclude cover for specific conditions in cats and dogs.
What to do if your claim was rejected or you are not satisfied with how it was handled
If you are dissatisfied with how an insurer has handled your claim, there are several levels of complaints you can make.
- The insurer’s dispute resolution department. This is the first place to go. All insurers are required to have the facilities to handle and address complaints, and you are entitled to receive an answer to your complaint within 15 business days.
- External dispute resolution. If you felt that the insurer’s response was unsatisfactory, for instance if the policy documents were misleading or the insurer doesn’t have adequate grounds to deny a claim, you can escalate it to the Australian Financial Complaints Authority (AFCA). The FOS will look into both sides and attempt to resolve the issue. If one side is clearly in the right, then the FOS might side with that party, or the issue might go into mediation.
- Take legal action. If you are unsatisfied with the outcome of the FOS resolution, your final course of action is to take legal action against the insurer. However, it’s worth noting that if there were valid grounds for legal action against the insurer, the FOS would likely have caught it and raised it in the previous step.
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