Insurance query

blahblah06

Hi, what position is one in if they take out an insurance policy and when claiming for life saving opp your told it takes 48 hours for an answer but this was not in the terms n conditions?
Also, when claim was first lodged over the phone (recordings for evidence provided) I told them I'd be getting the opp done up north. However, they didnt tell me that they don't cover outside Ireland until after the dog passed away then declined the claim and said it was in there terms and conditions.
Please note claim went in on a Thursday for pre authorisation so didnt hear back till the Monday as they didnt have staff in the office to approve a claim so high and had to send externally.
I wouldn't have took the policy out if I knew this.
They are saying that I didn't supply a full detailed estimate of opp needed ie every injection etc but the vet did write a note saying it would cost the max benefit and wanted pre authorisation.
There is nothing about pre authorisation in there terms n conditions but only full claims
Does anyone have any come back when it comes to terms n conditions?

goz83

If the terms and conditions are reasonable and if they are clear, they will stand. It is the customers responsibility to ask questions and make themselves aware of Ts & Cs. The insurer didn't have to specify anything unless asked. At least, that's my understanding of it.

NUTLEY BOY

It is not the responsibility of the policyholder to do the work of the insurance company staff especially if they are incompetent in line with modern standards !!
Write to the insurers by way of formal complaint setting out the background facts and demand a formal WRITTEN decision on your claim that explains their position. Tell them that you need this for your solicitor with a view to taking the matter further ! Don't take any guff.

ThreeLineWhip

You need a final response letter. The insurance company will just continue to feck you around until those 3 words are mentioned.

You need to clearly state that you require a final response letter. Once you have that you can take matters further.

mitzicat

blahblah06 wrote: »

Hi, what position is one in if they take out an insurance policy and when claiming for life saving opp your told it takes 48 hours for an answer but this was not in the terms n conditions?
Also, when claim was first lodged over the phone (recordings for evidence provided) I told them I'd be getting the opp done up north. However, they didnt tell me that they don't cover outside Ireland until after the dog passed away then declined the claim and said it was in there terms and conditions.
Please note claim went in on a Thursday for pre authorisation so didnt hear back till the Monday as they didnt have staff in the office to approve a claim so high and had to send externally.
I wouldn't have took the policy out if I knew this.
They are saying that I didn't supply a full detailed estimate of opp needed ie every injection etc but the vet did write a note saying it would cost the max benefit and wanted pre authorisation.
There is nothing about pre authorisation in there terms n conditions but only full claims
Does anyone have any come back when it comes to terms n conditions?

1) do the T&Cs say they only cover the Republic of Ireland or Ireland? Because the North is in Ireland.
2) if you told them on the phone that you were taking the dog up to the North and they didn't say, only the republic is covered in the T&Cs they may be estopped from denying a claim.

Sorry about your dog.

234

mitzicat wrote: »

1) do the T&Cs say they only cover the Republic of Ireland or Ireland? Because the North is in Ireland.
2) if you told them on the phone that you were taking the dog up to the North and they didn't say, only the republic is covered in the T&Cs they may be estopped from denying a claim.

Sorry about your dog.

I'm sorry, but the name of the country we are living in is Ireland, the name of the country bordering us to the north is Northern Ireland. Contracts will use the names of jurisdictions, not geographical appellations.

Your advice on estoppel is dangerous at best. It's also difficult to see how estoppel would be relevant after the incident which had been indemnified against had occurred.

mitzicat

234 wrote: »

I'm sorry, but the name of the country we are living in is Ireland, the name of the country bordering us to the north is Northern Ireland. Contracts will use the names of jurisdictions, not geographical appellations.

Your advice on estoppel is dangerous at best. It's also difficult to see how estoppel would be relevant after the incident which had been indemnified against had occurred.

Odd, all contracts I have signed that speak to jurisdictions say the Republic of Ireland, not just Ireland. Those who draft contracts are wise to be as specific as possible. Ireland, to me, is ambiguous and attracts the contra proferentem rule.

From OP's statement, I don't how the event had already occurred, when he asked about coverage:

Also, when claim was first lodged over the phone (recordings for evidence provided) I told them I'd be getting the opp done up north. However, they didnt tell me that they don't cover outside Ireland until after the dog passed away then declined the claim and said it was in there terms and conditions.

Your statement that advice on estoppel is dangerous is an assertion and you haven't qualified it with any analysis or law. Poor form.

234

mitzicat wrote: »

Odd, all contracts I have signed that speak to jurisdictions say the Republic of Ireland, not just Ireland. Those who draft contracts are wise to be as specific as possible. Ireland, to me, is ambiguous and attracts the contra proferentem rule.

From OP's statement, I don't how the event had already occurred, when he asked about coverage:

Also, when claim was first lodged over the phone (recordings for evidence provided) I told them I'd be getting the opp done up north. However, they didnt tell me that they don't cover outside Ireland until after the dog passed away then declined the claim and said it was in there terms and conditions.

Your statement that advice on estoppel is dangerous is an assertion and you haven't qualified it with any analysis or law. Poor form.

Your criticisms apply as much to yourself, and I'm not the one purporting to give out legal advice.

If you think that the OP has some cause of action then he should be going to a solicitor. If there was any, and it's not at all evident from the facts given that there is then it would be for damages for breach; the dog is dead and estoppel is obviously irrelevant at this point.

mitzicat

234 wrote: »

Your criticisms apply as much to yourself, and I'm not the one purporting to give out legal advice.

If you think that the OP has some cause of action then he should be going to a solicitor. If there was any, and it's not at all evident from the facts given that there is then it would be for damages for breach; the dog is dead and estoppel is obviously irrelevant at this point.

Hardly legal advice, just pointing to some hypothetical arguments the OP may have against the Insurance company's refusal to pay the claims. Hence why there was not a detailed legal analysis.

And, about the only recourse being damages for breach. He wants them to pay his claim. From what I gather he brought his dog to have the surgery? It's not clear. However, if he didn't, the actions by the insurance company still seem fishy to me.

Procrastastudy

mitzicat wrote: »

Odd, all contracts I have signed that speak to jurisdictions say the Republic of Ireland, not just Ireland. Those who draft contracts are wise to be as specific as possible. Ireland, to me, is ambiguous and attracts the contra proferentem rule.

From OP's statement, I don't how the event had already occurred, when he asked about coverage:

Also, when claim was first lodged over the phone (recordings for evidence provided) I told them I'd be getting the opp done up north. However, they didnt tell me that they don't cover outside Ireland until after the dog passed away then declined the claim and said it was in there terms and conditions.

Your statement that advice on estoppel is dangerous is an assertion and you haven't qualified it with any analysis or law. Poor form.

I'd say Ellis v O'Dea might give you a problem with that theory.

mitzicat

Procrastastudy wrote: »

I'd say Ellis v O'Dea might give you a problem with that theory.

That case only found that Ireland was the constitutional name of the State. The legal name of the State was bestowed by the Republic of Ireland Act 1948. The legal name is used to differentiate north from south where there may be ambiguity because, as I said, in contracts it is necessary to be as clear as possible. I often see promotions that say - open to residents in the republic of ireland.

Procrastastudy

mitzicat wrote: »

That case only found that Ireland was the constitutional name of the State. The legal name of the State was bestowed by the Republic of Ireland Act 1948. The legal name is used to differentiate north from south where there may be ambiguity because, as I said, in contracts it is necessary to be as clear as possible. I often see promotions that say - open to residents in the republic of ireland.

Contract doesn't need to be 'as clear as possible' only reasonably clear. The use of the name of the state enshrined by Article 4 of the constitution is pretty clear. I don't belittle you for putting it forward as a hypothetical argument but I think in real life you'd not get very far. As always I'm open to correction.

A minor correction to your point though;

The Republic of Ireland Act, 1948

2.—It is hereby declared that the description of the State shall be the Republic of Ireland.

mitzicat

Procrastastudy wrote: »

Contract doesn't need to be 'as clear as possible' only reasonably clear. The use of the name of the state enshrined by Article 4 of the constitution is pretty clear. I don't belittle you for putting it forward as a hypothetical argument but I think in real life you'd not get very far. As always I'm open to correction.

When someone could use Republic of Ireland to be as clear as possible as to their intention in a contract, they'd be a pretty poor drafter if they said, ah sure I don't really need to be completely clear I only mean the entity independent of the UK, I'll just use Ireland.

Ireland vs. Republic of Ireland is not as certain as you seem to think. In fact, do a search on Irish government official statements and regulations, you will see the government uses both Ireland and the Republic of Ireland.

Saying the constitution shows it is Ireland does not further your argument, I already conceded that the Constitutional name of the State is Ireland, as found by the Courts. This doesn't mean it is the legal name, used to pinpoint, in an agreement, exactly what portion of the Island they are referring to.

For example, Vodafone T&Cs for contests state "only open to residents of the Republic of Ireland"

Procrastastudy

mitzicat wrote: »

When someone could use Republic of Ireland to be as clear as possible as to their intention in a contract, they'd be a pretty poor drafter if they said, ah sure I don't really need to be completely clear I only mean the entity independent of the UK, I'll just use Ireland.

They may feel that they are being unclear as it's not the legal name of the state. But thats not the issue here - the issue is whether you'd progress a claim with your argument. I don't think you could.

mitzicat wrote: »

Ireland vs. Republic of Ireland is not as certain as you seem to think. In fact, do a search on Irish government official statements and regulations, you will see the government uses both Ireland and the Republic of Ireland.

Not really sure how that's relevant.

mitzicat wrote: »

Saying the constitution shows it is Ireland does not further your argument, I already conceded that the Constitutional name of the State is Ireland, as found by the Courts. This doesn't mean it is the legal name, used to pinpoint, in an agreement, exactly what portion of the Island they are referring to.

For example, Vodafone T&Cs for contests state "only open to residents of the Republic of Ireland"

Again not really relevant. Ireland is Ireland in the legal sense. It's just as valid to say if they wanted to include the whole island they would have said the island of Ireland.

Procrastastudy

BTW OP make a complaint to the ombudsman if you're unhappy.

234

mitzicat wrote: »

That case only found that Ireland was the constitutional name of the State. The legal name of the State was bestowed by the Republic of Ireland Act 1948. The legal name is used to differentiate north from south where there may be ambiguity because, as I said, in contracts it is necessary to be as clear as possible. I often see promotions that say - open to residents in the republic of ireland.

As has been pointed out to you, the legislation deals with the description of the state only. The Act had the effect of making Ireland a republic ie affecting its nature. It's name in English, has always been (since 1937), Ireland.

There have been cases of judges sending foreign arrest warrants back to England because they used the term Republic in the name of the state.