Pet insurer refuses to meet hydrotherapy claim because treatment not carried out by a vet or registered member of a relevant association
Mr and Mrs J’s dog, Ruby, was very fit and active until she suffered a prolapsed disc. Her veterinary surgeon recommended a course of hydrotherapy. This would help Ruby to regain the use of her hind legs as well as assisting with her rehabilitation in general.
Mr J told us that he had checked the proposed treatment with the insurer and was told it would be covered. Ruby responded very well to the hydrotherapy. However, when Mr and Mrs J submitted the claim, the insurer refused to pay.
It said that – unless the treatment was carried out by a vet or a member of the Canine Hydrotherapy Association (HCA) or other relevant association. The policy specifically excluded “the cost of hiring a swimming pool, hydrotherapy pool or any other pool or hydrotherapy equipment”. The insurer said that although it had previously paid similar claims, it would not do so in this case as neither the hydrotherapist nor the veterinary nurse were members of the HCA.
We understood why the insurer did not routinely approve all hydrotherapy claims. However, we noted that Ruby’s treatment had been recommended by a qualified veterinary surgeon. The clinical evidence made it clear that the hydrotherapy had contributed to her recovery and that she had derived significant benefit from it. We also noted that the therapy had been administered by an experienced veterinary nurse – the only qualified hydrotherapist within some hours travelling time from Mr and Mrs J’s home.
It was true that the veterinary nurse was not a member of the HCA. However, we were satisfied that she was sufficiently well qualified and experienced to provide an appropriate level of treatment.
We believed that the fair and reasonable outcome in this case was for the insurer to act as if the treatment had been carried out by a member of the HCA. So we instructed the insurer to meet Mr and Mrs J’s claim.