The complaints authority has allowed Petsure to reject a claim for $30,176 in medical costs after a puppy suffered seizures and had to be euthanised.

The policyholder said his pet fell ill shortly after receiving vaccinations. It was later found to have had a genetic defect that caused severe reactions to some common drugs.

Petsure said its policy covered specified illnesses and accidental injuries, and not conditions related to seizures, genetic defects or reactions to vaccinations.

The claimant argued the insurer relied on incorrect information, including misquoted expert opinions, and suggested it fraudulently changed its position to deny the claim.

He said the insurer wrongly categorised the puppy’s illness as a pre-existing condition, when it had been a temporary condition. And he argued the policy should cover vaccine reactions, given it required pets to be vaccinated.

In a dispute ruling, an Australian Financial Complaints Authority adjudicator says Petsure’s decision was consistent with the policy terms.

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“While I sympathise with the complainant for what must have been an extremely difficult time losing [his dog], unfortunately, the pet insurance cover was limited to specified circumstances that did not include [the puppy’s] illness.”

AFCA acknowledges the claimant’s “position that the policy should cover responses to vaccinations” but notes the policy “does not provide that cover. AFCA cannot compel an insurer to provide cover for a risk that it did not insure.”

The ruling notes the insurer made errors handling the claim, including initially relying on exclusions for pre-existing conditions.

These mistakes caused confusion and distress, and the insurer should pay $500 compensation. Petsure was also told to refund the claimant’s premiums from the date of the euthanasia.

See the ruling here.

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