Insurers consider contextualised care in high value pet claims

Insurers could review high value pet claims through the lens of contextualised care to better understand whether treatment decisions were appropriate for an animal’s circumstances.

During a session at the Pet and Equine Insurance Association (PEIA) forum, which was held under Chatham House rules, panellists discussed whether reviewing a sample of high value claims could help identify cases where treatment may not have been appropriate to the individual animal, potentially helping insurers and vets understand where claims costs are being driven.

One person on the panel said the ability to challenge treatment decisions was important.

“Insurers, from my perspective, need to be able to challenge,” they said.

“If somebody feels like they’ve been overtreated, over diagnosed and we’ve got contextualized care as a basis, I’m just thinking about the full picture, that eventually claims will start to reduce.”

A vet argued that the profession had, in some cases, been too focused on what treatments were possible, rather than whether they were appropriate.

“Insurance has actually driven some of this work,” they said.

“We should have asked the question first, just because we can, doesn’t mean we should.”

However, speakers stressed that any approach would need to respect veterinary clinical judgement and the complexity of treatment decisions.

One panellist highlighted the challenge vets face in balancing their responsibility to outline available treatment options with the need to guide owners towards appropriate care.

“We do have a duty of care to present every available option, then sometimes people will go for that expensive option and regret it later, so that could open up a little bit of a minefield” they said.

Challenging claims

However, the panel questioned whether some examples of apparently excessive treatment stemmed from defensive medicine rather than a desire to pursue unnecessary care.

One panellist said newly qualified vets could feel pressure to offer every available option due to concerns about complaints or potential legal repercussions.

As a result, vets may feel more comfortable following established treatment pathways than exercising their own judgement in more nuanced cases, the panel heard.

At the same time, speakers warned against insurers using contextualised care retrospectively to challenge claims.

“If you insure a pet and then suddenly turn around to retrospectively say contextualised care wasn’t given and then refuse to pay, that would further erode the satisfaction that people have with insurance,” one vet in the audience at the forum said.

The discussion highlighted the need for greater understanding between the veterinary and insurance sectors about how treatment decisions are made, rather than placing responsibility solely on either side.