1
out of 5
POSTED: | BY: dogownerr
Unfair denial of claim
Re:
Policy Number: A6790211
Claim Number: 5007339
In December 2023, my dog suffered CCL tear while playing catch in the back yard grass, suddenly she yelped and not able to put weight on left rear leg. She was not able to put weigh to the leg and was limping on the other 3 legs for two weeks. When we took her to veterinarian, after examination and imaging, she was diagnosed with CCL tear. To enable her to walk again and have a normal quality of life, my dog underwent TPLO surgery and had her joint repaired. The orthopedic surgeon performed surgery confirmed CCL rupture noted during surgery.
My dog is an otherwise healthy and young 4 year old dog; she has seizure disorder that is well controlled on medication and seizure free for more than two years. She has annual physical and blood work by her veterinarian clinic, which knows her well. In fact, my dog had completely normal physical exam and blood work less than 2 months prior to the occurrence of injury.
When I filed for reimbursement of services related to this injury, including initial office visit after the injury, orthopedic surgeon consultation, pre-op visit, operation, post-op visit, my claim was denied and when I appealed, it was denied again. Of note, the insurance policy does not exclude coverage of ligamentous injury if not a pre-existing condition and the mechanism of my dog’s injury falls within the definition of accident as stated in the policy itself "a sudden, unexpected or unintended action or event with a specific time and place which results in injury." When I called ASCPA Pet Insurance claim support line, the most senior supervisor can only offer to read me the denial letter that I received in email and also my pet coverage policy without able to discuss or elaborate on any further details.
To quote the reasoning of denial of my claim as follow: “Animals with healthy cruciate ligaments are not expected to partially or completely rupture their cruciate ligaments during the course of normal activities such as running, jumping, playing, chasing, navigating stairs or uneven terrain, or even following minor slips or falls. Veterinary literature concludes that cruciate ligament ruptures and cruciate ligament disease are the result of a multi-factorial degenerative illness process. Although symptoms often appear suddenly during activity or a minor trauma, ligament rupture is the end result of a disease process that is often asymptomatic in the early stages. As such, cruciate ligament conditions are only eligible for reimbursement under illness coverage.”
My issue with the denial of my claim is that while as owner and the veterinarian are well aware that my dog is young and healthy without any pre-existing joint illness, the insurance company is attempting to build a narrative that her injury is classified as illness in order to avoid to be held accountable in reimbursement. It is unreasonable for the insurance company to issue denial without any evidence that my dog actual had prior ligamentous illness, only able to make such an assumption based on “literature” that it was not able to provide. It is shameful and reprehensible that while my dog’s injury was completely accidental, the insurance company is portraying this accident as the result of pre-existing condition to avoid their responsibility to a paying customer. As a pet owner I would rather not to see my pet comes to any harm, however I purchased catastrophic injury protections specifically for unfortunate situations such as the injury my dog suffered. This incident has brought our family pain and challenges, a fair evaluation for reimbursement would help alleviate some of the burden it has put our family through.
Read more on Trustpilot