Allianz Insurance Plc · DRN-6240387

The complaint Ms L complains that Allianz Insurance Plc has unfairly treated two claims as one condition under her pet insurance policy, reducing the settlement amount payable. Where I refer to Allianz, this includes the actions of its agents and claims handlers for which it takes responsibility. What happened The detailed background to this complaint is well known to both parties, so I’ll only summarise the key events here. • Ms L holds a pet insurance policy for her dog, underwritten by Allianz, effective from 27 February 2024. • On 9 May 2024, Ms L took her dog to the vet as she was lame on her left fore paw after rough playing with another dog. The vet recommended rest and pain relief. • Three weeks later, the pain hadn’t improved, so Ms L returned to the vet. And in early June 2024, x-rays of her dog’s front legs were taken. • A claim was made under the policy for veterinary fees of “investigating lameness” between 9 May and 3 June 2024. Allianz paid out £1,131.17. • The x-ray results showed that Ms L’s dog had elbow dysplasia. After a consultation with a specialist, surgery took place in July 2024. • A second claim was made under the policy for treatment of “bilateral ununited anconeal process” between 3 July and 15 July 2024. Allianz paid out £1,868.83 towards the vet bills of almost £8,000, as this was the remaining balance of the policy’s maximum benefit limit of £3,000 per condition. Allianz said it wouldn’t pay any further costs towards treatment of elbow dysplasia and a third claim was declined. • Ms L didn’t think it was fair for Allianz to treat these claims as one condition. She says the first claim was as a result of an injury whilst her dog was playing, which was unrelated to the second claim for elbow dysplasia. • The treating vet wrote to Allianz confirming the injury to the dog’s fore paw and the subsequent elbow dysplasia were separate conditions. • Allianz maintained its decision to treat both claims as one condition. It relied on an opinion from its own veterinary expert which said as the initial lameness didn’t improve and no problems with the paw were found in the x-rays, it indicates the lameness was caused by the elbow dysplasia.

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• Ms L raised a complaint. And when Allianz didn’t respond, she contacted our Service. After hearing from us, Allianz subsequently issued a complaint response maintaining its decision to decline the claim. But it acknowledged its failure to respond to Ms L’s complaint and offered £200 compensation. • One of our Investigators reviewed Ms L's complaint, but she was satisfied Allianz had handled the claims in line with the policy terms and hadn’t treated Ms L unfairly. As Ms L didn’t agree with our Investigator, the complaint has been passed to me to decide. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. Having done so, I’ve reached the same outcome as our Investigator, and for broadly the same reasons. Before I explain why, I wish to acknowledge the parties’ submissions in respect of this complaint. Whilst I’ve read them all, I won’t comment in detail on every single point that has been made. Instead, I’ll focus on the key points that are relevant to the outcome I’ve reached. That’s in line with our remit, which is to resolve complaints promptly and with minimal formality. The terms and conditions of Ms L’s pet insurance policy say: “How long we’ll cover each injury and illness Your cover has two limits: • A time limit for how long you can claim for each injury or illness, and • A monetary limit for how much we’ll pay for each injury or illness (this is called the maximum benefit). We’ll keep paying for an injury or illness until one of these limits has been reached. The time limit: Your policy covers the treatment of each illness and injury for 12 months. The 12 months start from when your pet first receives vet treatment for the injury or illness. After this time all cover for that injury or illness will stop. The monetary limit: Your policy provides a maximum amount of money for you to claim for each separate injury and illness. This is called the maximum benefit. For each injury and illness you have one maximum benefit for Vet Bills and another separate maximum benefit for Pet Therapies. The amount you can claim in each section for each injury and illness is shown on your Certificate of Insurance.” Ms L’s certificate of insurance shows the maximum benefit limit for vet bills is £3,000 per condition. The issue in dispute here is whether Ms L has claimed for one condition or two separate unrelated conditions. I’ve reviewed all the available evidence, and I’m persuaded this is one condition. I’ll explain why. The lameness started on or around 9 May 2024 after Ms L’s dog had been rough playing with another dog. The problem appeared to be in the left fore paw and toes. The vet suspected a sprain and recommended rest.

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But three weeks later, Ms L returned to the vet because the issue hadn’t resolved. The vet notes say the “pain in leg/foot no better” and that the dog was yelping in pain if Ms L touches the leg at all. The dog was pulling away when the vet tried to examine the mid radius and there was inflammation over the carpus. X-rays was taken four days later, which didn’t highlight any problems with the fore paw, toes, or carpus. Instead, the problem was located in the elbows. If the initial lameness was a separate condition, I would’ve expected the injury in the dog’s fore paw to have either recovered or shown up on the x-ray alongside the elbow dysplasia. The vet notes indicate there was no recovery. I say this because it’s clear Ms L returned to the vet in late May because her dog was still experiencing pain. And I’m not persuaded there was a full recovery in the short period between this appointment and the x-rays when there hadn’t been any recovery in three weeks. As there was no recovery, the injury should’ve been visible on the x-ray. But it wasn’t. So if there was no recovery and nothing evident on the x-ray, it seems to me the more plausible explanation here was that the initial pain and lameness was as a result of the elbow dysplasia. This might have been triggered by the rough playing and caused pain throughout the leg and foot, but I’m not persuaded there was a separate and unrelated condition. I’m mindful that Ms L’s dog was less than six months old at the time of the initial lameness. Whilst puppies can get injured during rough play, they tend to recover quickly. Lameness and three weeks of pain seem to me to be an extreme reaction to playing, and unusual for a dog so young. It does indicate there was an underlying problem which was causing the severe discomfort. I’m also mindful this breed is prone to elbow dysplasia and signs can be evident from a young age. I appreciate Ms L’s vet now says these two presentations are separate conditions. But they haven’t explained why an injury to the foot which didn’t recover wasn’t evident on the x-rays and the only problem found to be in the elbows. And this seems contradictory to the claim form they completed for the “bilateral ununited anconeal process” which said this condition was a continuation, rather than a new and separate condition. Overall, I haven’t seen any evidence to persuade me that Ms L’s dog suffered an injury to her fore paw and then separately was diagnosed with elbow dysplasia. On the balance of probabilities, it seems more likely that the underlying cause of the pain suffered when rough playing was as a result of the dog having elbow dysplasia. Allianz has offered £200 compensation for failing to log a complaint when Ms L raised one. It didn’t respond until it heard from our Service some six months later. I’m satisfied this offer is fair, taking into account the impact this would’ve had on Ms L bearing in mind she was able to bring her complaint to our Service without Allianz’s response. My final decision Allianz Insurance Plc has already made an offer to pay £200 to settle the complaint and I think this offer is fair in all the circumstances. So my decision is that Allianz Insurance Plc should pay £200.

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Under the rules of the Financial Ombudsman Service, I’m required to ask Ms L to accept or reject my decision before 17 April 2026. Sheryl Sibley Ombudsman

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