Not upheld: claim decline - waiting period exclusion complaint against Allianz Insurance Plc

Decision detail

Summary

Mrs B claimed on her pet insurance policy for treatment of her dog's lameness observed on 21 March 2025, within 14 days of the policy start date. Allianz declined the claim as an illness showing symptoms within the waiting period. The treating vet initially stated the cause was obesity-related but later claimed it was an acute injury from a fall. Allianz obtained independent veterinary opinions concluding elbow dysplasia (indicated by sclerosis on X-rays) was the likely cause. The ombudsman found the treating vet's inconsistent statements (confirming obesity diagnosis in email before changing position) reasonably led Allianz to place less weight on that opinion, and concluded there was insufficient evidence of an external traumatic injury. The complaint was not upheld as the lameness was more likely caused by illness within the waiting period.

The Ombudsman's reasoning

The ombudsman found that while the treating vet's opinion carried weight due to direct examination of the dog, significant inconsistencies in the information provided (initial claim forms stating obesity as cause, confirmed in email, later changed to injury claim) reasonably led Allianz to place less weight on that opinion. The ombudsman found persuasive evidence from two independent veterinary opinions that sclerosis indicating elbow dysplasia was present, and no clear evidence of an external traumatic injury. The absence of any reference to injury in initial veterinary notes, the dog walker not witnessing a fall, and the fact that effective treatment for elbow dysplasia can eliminate symptoms meant the ombudsman concluded the lameness was more likely caused by illness (elbow dysplasia) showing symptoms within the 14-day waiting period.

How this compares

Source

Read the original decision on the Financial Ombudsman Service website