Allianz Insurance Plc · DRN-6114121

The complaint Mr B has complained that Allianz Insurance Plc unreasonably and unfairly imposed a too wide exclusion on his pet policy following a claim. What happened Mr B bought an ‘essential time limited insurance policy’ for his dog which limits cover for each illness or injury for 12 months only, in 2021. So any injury or illness is covered for 365 days from when the pet first received vet treatment for that injury or illness up to the cover limit of £3,000 per condition. Mr B got in touch with Allianz in June 2025 after he noticed his dog had some loose teeth and enquired about claiming under his policy. The adviser said the treatment should go ahead and the condition that caused it to occur would be excluded after 12 months. So Mr B’s dog got several teeth removed due to gingivitis and Mr B claimed for the vet fees for this, which Allianz accepted and paid. Then Mr B asked Allianz to detail the exclusion as he didn’t want to wait until the policy renewal to find out. So Allianz provided this for Mr B and it detailed that the exclusion covered his dog’s mouth including teeth and gums up to £2,692.98 or until 23 June 2026, whichever comes first, which was further confirmed by its underwriters. Mr B felt this was too wide an exclusion and complained. Also Allianz made an initial mistake quoting that the end date for cover was 19 February 2021 which Mr B queried. When Mr B phoned Allianz about this it apologised and said it would send out a corrected copy. Mr B also queried whether his premium would be reduced due to the exclusion. Allianz explained there would be no reduction in the premium level. Given Allianz agreed the date error was confusing – it made a proactive settlement offer of £63.88 – being two months premium payments as compensation with its apologies. This was after Mr B had brought his complaint to us. Otherwise it didn’t think it had done anything wrong. Mr B disagreed so the investigator assessed the matter. His view was that Allianz didn’t have to do anything more as it was entitled to assess the risks and therefore the exclusion, as it saw fit. Mr B didn’t agree and ultimately asked for an ombudsman’s decision so his 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’m upholding this complaint along the lines of the proactive settlement only. I appreciate Mr B will be disappointed, so I’ll now explain why.

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First however, as the investigator explained I can only consider the contents of Mr B’s complaint form along with Allianz’s final response letter and Allianz’s further proactive settlement offer. I cannot consider all the issues Mr B has since raised with the investigator to include Mr B’s thoughts on what Allianz advertises, and his belief we are investigating the pet insurance industry. However this service is not doing this, other organisations are considering some issues with vet costs, but that is not this service. Plus I can’t consider any of Mr B’s thoughts on his premium increases since he first bought the policy. Whilst he may consider them part of the same complaint, he has not yet raised any of those issues with Allianz. So if Mr B wants to continue to complain about them he must make a fresh complaint to Allianz, so that it can have the opportunity to consider them. Then if Mr B wishes he can bring that complaint back to this service at that stage. Under our rules, we are simply not authorised to consider any complaint to which the business complained of, hasn’t yet had the chance to consider. I should also explain to Mr B that the Financial Ombudsman Service is independent of both consumers and the businesses they are complaining about. This means that we don’t act for consumers or businesses. And more importantly given Mr B’s specific instructions to me, nor do we take instructions either from consumers or businesses or allow either party to direct the course of our investigations or the parameters of our final decisions. Were we to do so, it would compromise our independence and impartiality. It’s up to us to determine what evidence is relevant to the complaint made to the business and the enquiries we need to make in order to investigate the complaint. So again like the investigator, I will only comment on what I consider to be the key issues here. No disrespect at all is intended by this either, it is simply the rules under which we operate. Mr B also remains free to decide if he accepts my final decision or not also. Any final decision only becomes binding if and when the complainant accepts it. For clarity therefore as detailed in Mr B’s complaint form, the issues I will be considering here are as follows: • The extent of the exclusion to be imposed on Mr B’s policy from 23 June 2026 bearing in mind his claim for the removal of some teeth of his dog due to gingivitis. • The error Allianz made with the date that exclusion will take effect and its apology and compensation for that. In complaints of this nature my role is to assess whether Allianz did anything wrong in imposing this exclusion having regards to the terms and conditions of the policy, the Financial Conduct Authority’s (FCA) regulations and the pet insurance industry’s practice. How the policy works Mr B chose to buy Allianz’s essential time limited pet insurance policy for his dog. This limits cover for any vet fees in treating any injury or illness to one year’s cover only for that injury or illness, up to a maximum per condition of £3,000. So if Mr B’s dog developed diabetes, for example, which is an ongoing chronic condition, the vet costs for treating the dog’s diabetes would only be covered for one year and only up to £3,000. Once the 12 months was up (which starts from when the vet first started to treat the diabetes) then there is no further ongoing cover for that diabetes and Mr B would have to fund the ongoing treatment for his dog’s diabetes thereafter which would include all the insulin the dog might require plus all the ongoing testing for the blood sugar readings. Diabetes would then be excluded and shown to be excluded when the policy renewed once

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the 12 month period had expired, or the £3,000 cover limit was all used up, whichever occurs first. So effectively each condition or treatment identified in the vet history of the dog is subject to this 12 month and £3,000 cover limit. This is irrespective if Mr B claims or not too. For example, Mr B mentioned what if the claim for the teeth removal was now cancelled wouldn’t that mean the exclusion would be then removed. The answer to that is no. This is because the time limit starts when the vet first started to treat the issue, not when a claim is made by the policyholder. So for example if Mr B decided not to make a claim for this incident of teeth removal due to gingivitis and his dog unfortunately developed another incidence of gingivitis (which can happen), and then Mr B decided to claim for the second lot of vet costs in treating that second bout of gingivitis, it’s highly likely Allianz would say that he couldn’t deal with his claim for the second bout of gingivitis as the dog had gingivitis previously and the 12 month period from the start of that initial bout of gingivitis had already expired, so his claim wouldn’t therefore be accepted or paid by Allianz. Given the limited cover available Allianz is therefore able to keep the premium payments much lower than say for a lifetime pet policy where vet costs of any condition which first arose after the policy inception date would remain covered year on year subject to the annual vet costs cover amount provided in the policy. All pet policies are sold on what is called an ‘unadvised basis’. This means that Allianz or any other pet insurer doesn’t provide any consumer with any advice on whether any particular policy is suitable for that consumer’s needs. Based on the policy documents plus the Insurance Product Information Document that is something for the consumer to work out for themselves. What the policy says In order to see whether Allianz might have done anything wrong, it’s useful to look at what the policy actually says. Allianz said in the Petplan Essential policy document effective from 17 June 2024, the policy says the following: ‘Petplan doesn’t provide advice or any personal recommendation about the insurance products offered. Who is this product suitable for This product meets the demands and needs of a pet owner who wants cover for the cost of vet treatment for each injury and illness for 12 months only.’ On page 8 it says: ‘12. The changes we can make at the renewal of your policy a) At the renewal of your policy we can change the: • Premium, • Excesses that you pay, and/or • Terms and Conditions of your policy. We can also place exclusions because of your pet’s claims and vet history (please also read the ‘Exclusions on your pet’s cover’ section on page 9 which explains this in more detail). We’ll always tell you before your renewal date of any changes so you can consider if your policy still meets your needs.’ On page 9 it says:

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‘When do we place exclusions We can place exclusions on your policy at the start of your cover and at each renewal. We place exclusions based on your pet’s vet history: • Following a claim • At renewal • For a pre-existing condition Exclusions placed following a claim Your policy covers an illness or injury for 12 months from when your pet first received vet treatment. When we find out your pet needed treatment for an illness or injury, we can place exclusions on your policy that show: • The date your 12 month limit will be reached and we’ll stop covering the injury/illness and • The health condition(s), part of your pet’s body or incident that’s no longer covered from that time. For example, if your pet needed treatment for arthritis, we’ll place exclusions on your policy related to arthritis that will be effective 12 months from the start of your pet’s vet treatment. We do this to ensure it’s clear what your pet’s covered for once they have been treated for a condition and these will be detailed in your pet’s Certificate of Insurance, at renewal. To understand your cover limits, please read ‘How long we’ll cover each injury and illness’ in the Vet Bills section.’ On page 10 it says: s product is suitable for If your pet has exclusions Where are exclusions shown? Any exclusions on your pet’s cover are detailed on your Certificate of Insurance, in the ‘Exclusions and Clauses’ section. Are exclusions permanent? Exclusions placed because of the 12 month limit for vet treatment: These exclusions are permanent, because the policy only covers a condition for 12 months How long we’ll cover each injury and illnesss 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.

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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. To fully understand how we’ll apply the time limit and monetary limit, you need to read points 1 to 5 in ‘Conditions for Vet Bills and Pet Therapies’ on pages 12 and 13. We also confirm the exclusion can be for: the health condition(s), part of your pet’s body or incident that’s no longer covered from that time.’ What did Allianz do? Following Mr B’s claim, Mr B wanted to know what the exclusion would be on his policy rather than to wait until renewal. So he asked Allianz to provide this, which it did. The exclusion it was going to put on his policy at renewal after the 12 months and/or £3,000 pot allotted for this condition was the following: ‘The mouth, including the teeth and gums.’ Mr B complained this was too wide. However under the regulations by which insurers operate, insurers are permitted to decide what risks they want to cover and what risks they don’t want to cover and indeed the premium price for the risks covered too. This is part of their commercial discretion so there is nothing wrong with an insurer deciding it didn’t want to insure a specified risk or indeed to limit how it would deal with a specified risk either. Further under these regulations, these insurers must be seen to be treating all customers fairly and ensuring they don’t single out anyone and treat them differently to anyone else. Consequently they then write underwriting guides which detail for example in Mr B’s case that if x is claimed then the exclusion reads like y exclusion. Underwriting guides are extremely commercially sensitive so this service can’t share them with consumers or detail them in decisions given our decisions are also published. So whilst I have seen Allianz’s underwriting guide, I can’t share its contents with Mr B. However I can assure Mr B that if someone else’s dog had teeth extracted due to gingivitis they too would have a similar exclusion applied to their equivalent policy with Allianz. So this shows me that Allianz didn’t single out Mr B and treat him differently to anyone else. Therefore given Mr B chose this policy which is set up to exclude any condition treated by the vet after one year, Allianz has done nothing wrong at all in confirming this exclusion will be placed on Mr B’s policy at the end of 12 months after the vet removed some of his dog’s teeth on 23 June 2025. Given Mr B’s dog also had some trouble with his baby teeth, the policy also has an exclusion in relation to that too, which is unconnected to this gingivitis problem. Given his dog had treatment for these baby teeth there is nothing wrong with Allianz ensuring this is then excluded going forward. It’s irrelevant that Mr B’s dog might not have any baby teeth left, the exclusion is simply noting the fact the vet treatment occurred. As the policy progresses, anything his dog has been treated for by Mr B’s vet will be similarly excluded. Therefore with these sorts of policies it is always going to be in Mr B’s best interests to claim as soon as the treatment commenced in order to avail of the £3,000 available to treat for that condition, as once the 12 months has passed there is no further cover available for the treated condition under this policy. Given this is the policy Mr B chose to insure his dog, there is nothing to show me that Allianz has therefore done anything wrong.

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Mr B sent in what his vet thought about the exclusion too. However vets aren’t insurers and aren’t trained or qualified to decide things like the risks insurers are prepared to insure. So what his vet might think about Allianz’s exclusion doesn’t really have much bearing on the matter. This is because it was Mr B’s decision only, to decide to buy this policy for his dog, therefore he is bound by the provisions of the policy, which he chose too. It should be noted that gingivitis can be a recurring condition, probably less so since I can see Mr B does brush his dog’s teeth, but nonetheless such gum issues can always reoccur. This service has no remit or authority to tell any insurer what risks it must insure or how. And neither do we have any authority or remit to tell any insurer how to write any exclusion its policy terms permit it to impose. All that, remains under the regulations, as part of the insurer’s commercial discretion. Mr B should also be aware unlike something like insuring a car in order to drive it, there is no legal requirement for him to have pet insurance, although it is considered a sensible thing to do. Having listened to the call recordings, I don’t consider Allianz misinformed Mr B how the condition would be excluded. This is because in the first call, this only covered the fact his dog had loose teeth. The reason why his dog had these loose teeth was only identified as being caused by gingivitis once the vet had anaesthetised the dog and could see the situation more clearly. Allianz explained that given the cover provided by this policy and the fact that its renewal premium is not rated on the claims made (given the condition that caused the claim is always excluded after 12 months) it does not subsequently reduce the premium payable. This is because there are still other risk factors such as the pet aging which means the incidence of claims increases, the cost of inflation affecting vet costs and other issues. Again this service can’t tell any insurer how it must assess or price the risk as I explained above. It remains that Mr B chose this policy and that this is how its cover operates. Allianz has said that it is happy to review the exclusion once 12 months has passed with Mr B’s dog not needing any further dental treatment as a result of gingivitis. This would mean his dog would need a vet exam at that time (not now) to confirm his dog had no further problems with his mouth, along with the full vet history updated to that time being sent to Allianz. I consider this is reasonable. Allianz further elaborated that it doesn’t pay for dental exams and wouldn’t pay for this dental exam either. Further under the policy there is only a requirement for a dental exam once a year. And Allianz also said exclusion reviews don’t automatically mean the exclusion will be removed or changed. It merely means it will be reviewed which may lead to such removal or change, but that isn’t guaranteed. I also consider this is reasonable given the policy conditions. So I don’t consider Allianz did anything wrong in applying the exclusion it did to Mr B’s policy as it acted completely in line with the policy terms and conditions, which Mr B chose, and which he therefore agreed to, when he first bought his policy in 2021. It also acted in line with its underwriting guide which shows that it treated Mr B fairly as it didn’t single him out and treat him differently to anyone else in the same circumstances. Allianz’ typographical error in its communication to Mr B over the date this exclusion would be imposed. There is no dispute that Allianz first said the exclusion would be applied from 19 February 2021 whereas it should have been 23 June 2026. This did cause confusion. Further confusion was caused when the adviser told Mr B that the wording of the exclusion had been done by a robot.

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Allianz decided that in addition to its apology to Mr B, it would offer to pay two months’ worth of monthly premium payments which Mr B was paying, which amounted to £63.88 by way of a proactive settlement. In other words its offer was made after Mr B brought his complaint to us. I’ve considered this and agree with the investigator that this is reasonable compensation for the confusion it created over the wrong date and deciding the wrong thing was written by a robot. This is because it’s in line with our approach to compensation more fully detailed in our website. Therefore I don’t consider Allianz needs to do anything further. Overall conclusion I am aware Mr B has several other issues and as I explained above, our rules don’t permit me to consider them as Mr B hasn’t first raised these issues with Allianz. Under our rules we can only become involved in any complaint once the business complained of has had the required statutory time to consider the consumer’s complaint. Leaving those issues aside, bearing in mind the policy terms and conditions which Mr B chose to insure his dog, I don’t consider Allianz was wrong to impose the exclusion it did, plus the extent of the exclusion, given its underwriting guide. Therefore there is nothing to show me that Allianz has done anything wrong as simply this is how the policy Mr B chose, operates. It remains Allianz did cause some confusion in its customer service to Mr B over the date when the exclusion would run from and what might have been generated by a robot. I consider it’s right Allianz apologised for this. I also consider its compensation made by way of a proactive settlement is fair. And it remains for Mr B to accept that or not, as he wishes. o this product is suitable f My final decision So for these reasons and in view of the proactive settlement, it’s my final decision that I uphold this complaint. I now require Allianz Insurance Plc to do the following: • If Mr B accepts the compensation offered by Allianz Insurance Plc, then it should pay him the sum of £63.88. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr B to accept or reject my decision before 22 April 2026. Rona Doyle Ombudsman

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