7th February 2025
Bilateral conditions are a source of customer complaints in pet insurance. While the subject can be fairly complicated, there's more that insurers can do to help customers understand the potential exclusions.
Cruciate ligament damage is a condition that affects many pets, whether through accidental causes or illness. For dogs, in particular, treatment can be expensive - especially for larger dog breeds.
Pet insurance policies often have complex exclusions around cruciate ligament claims. The fact that these exclusions are not always fully understood is shown by the number of complaints the FOS receives about these types of claims.
In many cases, insurers don’t clarify important exclusions as clearly as they could in their quote and buy journeys, leaving key information to their policy documents. This means that pet owners are potentially unaware of the gaps in coverage until they need to make a claim.
Many insurers classify cruciate ligament conditions as ‘bilateral conditions’. This means that they can affect both sides of the pet's body - particularly the leg and knee joint area.
According to Fairer Finance data, the majority of insurers treat bilateral conditions as a single condition (with the exception of Asda Money and ManyPets, who consider these as separate conditions when diagnosed at different times). Because bilateral conditions are often treated as a single condition, the cover limit for vets’ fees generally isn’t doubled if both sides of the pet’s body require treatment in the same policy year. For example, if a policy’s annual cover limit is £4,000 and treatment is needed on both legs, costing £3,000 for each, the insurer would only pay up to the limit of £4,000, instead of £6,000 (the total cost of the treatment). It is unlikely for a pet to tear both cruciate ligaments in the same year, but greater transparency would be helpful - considering the potential financial strain that these costs can cause pet owners.
Another consequence of bilateral conditions being treated as a single condition is that injuries in one part of the pet’s body can count as pre-existing conditions if they recur in another part of the body. For example, if a pet has had treatment on one leg prior to the policy start date, and then needs treatment in the second leg after their policy starts, this would typically not be covered by the policy since it is viewed by the majority of insurers as being a pre-existing condition, even though different legs are affected each time.
Some insurers, such as Frank and Spot On, may cover pre-existing bilateral conditions after a 12 or 24 month waiting period, so long as no treatment was needed on the specific condition. Others, like Petsure, may offer cover if the claim is approved by them. Again, more transparency around pre-existing bilateral conditions in online journeys is needed for customers to know if they are or aren’t covered.
Pet insurers can do more when it comes to clearly explaining bilateral conditions and their associated exclusions in online quote and buy journeys. Detailed definitions are generally available in policy documents, where most pet insurers have clear explanations of what a bilateral condition is and when it is excluded.
An example is Animal Friends (below), whose policy wording provides clear examples of what would be considered a bilateral condition, and includes a helpful diagram. However, having such information accessible in the product journey would be even better.
Adding a link to this information in the quote and buy journey as ManyPets have, would be a good way to draw customers’ attention to it, potentially when cover limits are displayed.
Information like this could also be set out earlier in the product journey instead of at the end of the journey (where customers are required to enter their details). Agria is a good example of how to display key information earlier in the quote around pre-existing conditions. Agria uses a pop up (if you click ‘yes’ when asked if your pet has had a previous illness or injury). At this point, providers could add information about bilateral conditions, explaining when they count as pre-existing conditions.
It is important that insurers do what they can to help improve customer understanding around difficult terminology and key exclusions. The Consumer Duty rules have made this a requirement for insurers, so that customers can make informed decisions about the benefits and limitations of the product before they buy it.
There is more work for pet insurers to do in terms of improving consumer understanding around what is and isn’t covered for cruciate ligament damage claims. As discussed in this blog, there are some simple, yet potentially effective ways they could address this.