A pet cover policyholder has won a dispute over whether her French bulldog’s spinal condition was hereditary.

The woman claimed veterinary expenses after her pet experienced sudden back pain and began yelping.

Pacific International Insurance accepted the claim and – based on an intervertebral disc disease (IVDD) diagnosis – treated the condition as hereditary, limiting cover to $3800 for the year.

A later medical report based on advanced imaging found the dog in fact had intervertebral disc extrusion (IVDE).

The owner argued the condition should be treated as an illness, not a bloodline condition. Under her policy, a $15,000 illness limit would then apply.

And the Australian Financial Complaints Authority has ruled in her favour.

“The insurer has not shown IVDE was a genetic condition passed down through his bloodline, as the policy definition requires,” the ombudsman said.

“The insurer must assess the veterinary expenses under the $15,000 annual illness limit, rather than the $3800 hereditary condition limit.

“Although French bulldogs may be predisposed to intervertebral disc conditions, the available information does not establish that [this dog’s] condition was hereditary.

“It is therefore fair to assess the claim under the policy’s illness cover.”

Pacific International argued IVDE arises from underlying IVDD in French bulldogs, so the hereditary condition limit should apply.

The breed carries a genetic mutation that causes premature degeneration of the intervertebral discs, it said.

But AFCA says under the policy, “it is not enough to establish that a condition is commonly associated with a particular breed” and the insurer had to show the problem was passed down through the specific pet’s bloodline.

“Articles relied on by the insurer discuss breeds and medical conditions in general terms rather than the individual circumstances; no veterinary specialist has applied the findings in those articles to [the insured dog’s] diagnosis, genetics or bloodline.”

Analysis by the dog’s vet supports the conclusion that not all conditions described as types of IVDD are necessarily hereditary, the authority says.

Pacific International noted a previous AFCA determination found IVDD was a hereditary condition under the same policy. 

But the AFCA member examining the latest matter says they are “not bound by previous determinations. The facts, the pet’s breed and the parties’ submissions in that [previous] matter were materially different from those in this complaint.” 

See the ruling here.

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