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Legalease, Lawyer
Category: Legal
Satisfied Customers: 16166
Experience:  15 years exp all aspects of general law
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I want to file small claim against a pet insurance policy provider

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I want to file small claim against a pet insurance policy provider? Do I have a case and should I cancel my policy when I file suit because this scam pet insurance provider only knows how to take customer's monthly premium payments and not promise them a reimbursement per the benefit schedule. I submitted my claim to my pet insurance provider & they repeatly tried to make many excuses to denie my claim by saying that they did not receive all medical records. Then all my vets faxed & confirmed to me that they fax. Then they made another excuse to that I have to send them a letter that clarifies the apparent discrepancy between the medical history provided at the time of policy application and the unavailability of records for that time period.   I faxed you the letter twice that explains the apparent discrepancy between the medical history provided at the time of policy but I still got no answer or resolution. I emailed them 3-4 times & faxed them 4 times & no one has replied to me.
Hi. Let me see if I can sort this out with you.

What was the discrepancy in the medical records at the time the policy was issued that VPI claimed existed?

Customer: replied 7 years ago.
The discrepancy was that VPI needed a letter explaining medical records from 1/01/08.

I told VPI that the latest updated Medical records for the past 12 month period prior to policy enrollment was on 1/10/09 and 3/26/09. I also told VPI that I do not have medical records from 1/01/08 because Mee Mee did not need to see a Vet on the year 2008 because she was healthy and the last time she went to see the Vet, NSAL Pet Health Center was on 6/30/07 and she had her annual vaccinations done at the Vet Clinic located at Petco on 8/19/08. I also notified VPI that I faxed them a letter several times on mid July that clarifies the apparent discrepancy between the medical history provided at the time of policy application and the unavailability of records for that time period.

BotXXXXX XXXXXne is that I faxed my letter of explanation as they requested for it and they did not reply or give any resolution and the status on the claim states reimburse denied. No one from VPI has responded to my emails or faxes!!

Okay. Now I understand. So it appears to me tha you are saying that there is a lack of medical records for that time period. The reason I asked is because VPI pet insurance and other pet insurance company make a big deal of providing coverage, but then the minute you make a claim, they search for something in the pet's medical records and then try to say the new/current condition is a "pre-existing" condition and they deny the claim.

If you are telling me that there are no indications of a pre-existing condition, then you absolutely hae a valid small calims court claim. First, you should write them a detailed letter AGAIN (I know it is frustrating) and explain Mee-Mee's history of going to the vets offices again (enclose all records that you have, including the Petsmart invoice) and state very clearly that Mee-Mee had NO pre-existing conditions that should prevent the claim from being paid. Enclose the bills you want reimbursed and tell them that you are requesting payment of the bills within 30 days or you will take them to small claims court over the matter. Send this letter certified mail (return recipt requested) to all of the addresses that you have for VPI (even if it is 2 or 3 different addresses).

If this does not get any action, then sign the matter up in small claims court. The people at the clerk's office for civil business / small claims should be able to help you with what address to use on the summons (you may have to use all of them, or there may be an address onfile with the NY Secretary of State's Office for VPI where they receive summons -- to check, go to - if nothing on file, then you will probably haveto use all addresses to make sure they receive "notice").

I am not surprised by your run-around with these people. I purchased VPI policies on my 4 dogs, thinking it was a great idea because vet bills are HIGH. However, my sasha (chow chow mix) had to have a foreign object removed from under her left eye. VPI then searched sasha's records and found that sasha had been treated for conjuctivitis of the RIGHT eye 2 years before and denied the claim. Because I was only 3 months into the policies, I simply cancelled them and got my premium payments returned.

My point is, that for the mot part these pet insurance companies are just in it to make money -- and they will try to find any reason to deny a claim if they can do it. Then, even if they pay a claim, the reimbursement rates are only about 25% of what the actual bill was, so it is just a bunch of baloney. It is handy in the event that your dog is hit by a car (it is hard for them to claim pre-existing conditions then), but the odds of that happening to my dogs is low -- they have a fenced in back yard that they neer leave. So, you need to make your own individual assessment regarding whether these pet insurance will ultimately be of any value to you in the long run.

I hope that helps. Good Luck.

Customer: replied 7 years ago.
How much am I able to sue for in small claims court? Should I file electronically onine with a vendor or go straight to civil court to file the small claims suit?

Should I cancel my policy with VPI then file small claim suit?

I do not know if the Vet will provide me the chart and laboratory charts because they only provided me medical invoices because when VPI requested the records it indicated on the form that the Vet may only fax it to VPI directly. So that's going to be a challenge!!

I'll try what you advised me to do but I highly unlikely believe tht they will not reply to me and will ignore me because in my previous emails and faxes to them I had indicated if VPI do not reimburse my claim then I will file law suit against their company, and I will report their lousy service, unreliable service, and misleading customers to the Better Business Bureau, Consumer Affairs, FCC, Attorney's General, National TV News, Radio Stations, National Newspaper company, and Magazines!   That is what I told them.

It sure worked against the other Pet insurance company ( and they reimbursed 90% of the bill and applied the deductibles for separate incidents for my cat that had a foreign object removed from stomache and leg amputation from motor vehicle accident.

When you canceled your policy, how did you receive all your premium payments returned?
They sent me a check for the remainder of the policy premiums (I had paid for a year, and they deducted 3 months and returned the 7 months remaining).

In small claims court you are able to sue for at least $5,000. GO straight to the civil court -- that way you can keep your ownfees down, and the people at the clerk's office can help you with the addresses to send the summons to. The people at the court are really very helpful to consumers who come in to file small claims actions without an attorney. I would cancel my policy with them if I were you. In fact, the court may continue to question why you did not cancel it after receiving such lousy service and then making a small claims suit.

I am sure that they probably will ignore you. But, having the certified letter receipts show to the court that they ABSOLUTELY received your correspondence. As to your prior correspondence, sit down and write it all in a log and organize it (dates, times, etc) to present to the court. Log every phone call, every fax, etc (even if you have no concrete proof -- a log goes a long way in showing the court that you have been trying to sort this out in a friendly way before you resorted to court action).

And, you should make filing with the BBB, the AG and any other consumer affairs complaint division you can think of. I always tell clients that even if these agencies take no action with your individual complaint, they will keep the complaint on file and if they receive enough complaints, they will eventually take action against the merchant involved.

Customer: replied 7 years ago.
The reason why I did not cancel yet because they recently sent me a letter that requested a letter of explanation and then they would send me a result of the claim but nothing happened. But do you advise me to cancel now by writing or phone?

But in previous emails and faxes to them I indicated a warning to VPI that if they do not reimburse my claim then I will file lawsuit against their company. So will the court think that this is considered sorting this out in a friendly way?

Customer: replied 7 years ago.
Should I first write VPI a certified letter then cancel policy? Or should I first cancel then write VPI a certified letter?

Is VPI able to reverse the situation and file against me?
When you write your certified letter to them (that you will use in court), tell them that you consider this your second response to the letter requesting information, and that you will not respond via letter again. Tell them that they have 30 days to pay your claim or you will take the matter to small claims court.

If you hear nothing from them in 30 days, then send another letter cancelling your policy in writing (send this certified also). Tell them that because you have herad nothing from them regarding the letter you sent on [date of letter] you are now proceeding to file the matter in small claims and that you are officially cancelling your policy and want all already paid premiums returned to you as soon as possible.

Your previous emails and faxes are good evidence towards sorting this out, but the certified letters will be considered demand notices by you for them to resolve the claim. Trust me, the court looks for such final demand letters with proof that they actually received them (thus, the certified ltter, return reciepts requested). With those letters and prrofs of receipt, there is no way they can claim that "we did not receive this notice, or it was directed to the wrong department." With these letters, they should know you mean business, and the court will know that also.

With the log and proof of the prior corresponence you can say "I tried to work this out amicably -- look at myproof -- but then I got so frustrated, I had to start sending certified demand letters to them, and then I had to cancel my policy because they did not respond."

I believe you have a good claim (although none of us can guarantee the outcome of litigation) -- just send the certified letter as I advise above and go from there. They mau just pay the claim. Even if they do pay it, I would still cancel the policy right afterwards -- this is just too much trouble to deal with a company to get reimbursement.

1. Certified letter telling them its a second response to their request for information AND a demand letter for reimbursement or you will seek redress in small claims court, then
2. Certified Letter #2 (if they do not respond to the first in 30 days, or if they do respond and do not give a valid reason for the denial), tell them since they failed to respond to your first request (or the answer they gave was unacceptable) that you will sign them up in court and at this point, you are very dissatisfied with them, cancel your policy, request immediate refund of any unused premiums and tell them you are reporting them to the BBB, the Attorney General's office, etc.

VPI can file a counterclaim against you if they are so inclined, but I seriously doubt they will do that -- what would be the grounds? That you were persistent in asking for reimbursement? The only othe way they can proceed against you FIRST is if you owed them money (and they are trying to collect), and that does not appear to be the case here, so I would not worry about that).


Customer: replied 7 years ago.
Is the certified letter and demand letter all in one letter? Is a draft I could get online to be certain I got this done correctly?

In the event, if VPI does pay the claim, should I file suit anyways?

I'm looking thoroughly at my previous records with my cat and in July 2007 I took my cat a few time to the Vet, NSAL Pet Health Center and the Vet tested my cat for blood test, culture test, to see if why she had allergic skin discharge on some parts of her body and eyes and they said she was healthy and that I could try the precribed derma shampoo on my cat or they would refer me to a Vet Specialist (Opthamologist). But after July 2007, I was too busy and occupied with my job, going to school, taking care of my mother, and besides that my cat seem healthy but it wasn't until Jan 2009 when my cat start developing alot of dark discharge around her eyes and I was concerned so I got the referral and took my cat to the Vet Specialist and she was diagnosed with Conjunctivitis and further tests results said that my cat had Bartonella. I got the medications for my cat and paid alot for the exam and then filed a claim for VPI and still this is where VPI did not want to help me. A rep from VPI replied to me via voice mail but told me to await for 30 days for the status of the claim but I ended up getting no reply after that.

Do you think I could still file a small claim suit against them or should I just cancel my policy and get my paid premiums returned to me?
Demand letter must be sent certified. All one letter. There is no where that I can direct you on how to write this letter on the internet or anywhere else. Perhaps a friend or relative can help you? I cannot write the letter for you because Just Answer does not allow experts to engage clients off-site. I have, however, given you several pointers on what to put in the letter in my three prior answers. That is about all we can do here at Just Answer.

If VPI pays the claim, you have no suit to file.

If they can relate the current health problem back to something in the medical records that is related to the current health problems, then, by the terms of the agreement, they CAN deny the claim (this is what they did with my dog. Technically, they were correct with my dog and I had no suit, but the relation to the prior treatment was small, practically non-existent -- it was the OTHER eye - but they argued my dog probably had it in both eyes at that time -- and I just decided it was easier to cancel the policy and give them a poor recomendation whenever I could in the future, as I have done with you here).

That being said, small claims is up to you -- if you think the reason for denial is bogus, then you may want to try it. If VPI can make even a samll connection to prior medical records, they probably COULD win.

It may be less aggravating just to cancel the policy and get a refund - but they will only refund payments for FUTURE insurance already made - they will not refund for payments made for months that have already passed).


Customer: replied 7 years ago.
My prior medical records are not related so much with the eye because it was mainly a skin allergic that made discharge from the legs, neck, and some parts of stomache and eye. At the time, the Vet said she can give me a referral for Vet specialist Dermatologist.

If you are able to help me in this small claim suit via contingency fee, I will be happy for you represent me. In any event, I appreciate your assistance and advice you given me. I will most likely proceed with the small claim suit against VPI.

After you send me a reply, I will click on the accept button.

Thank you very much and I wish you all the best!!
Ok. Then if you can show that the prior medical records do not relate to the current condition, you should be fine in small claims court. Just follow the advice on the letters and order of letters and you should be in good shape.

I am sorry -- though I would like to, I cannot represent you outside of this website -- it is against the rules and I could lose my privileges to answer questions on the website. None of the legal experts here on Just Answer are permitted to do that.

I wish the best also. Take Care.



Legalease, Lawyer
Category: Legal
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Experience: 15 years exp all aspects of general law
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