Crum & Forster Pet Insurance Group

Dear Ms [redacted] : We are in receipt of your November 8, 2016, inquiry relative to the above-mentioned policy holder regarding his Level Plan (BAS.3.2013) for his dogWe are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC Please be aware, the ASPCA does not offer insurance We are a separate company offering the ASPCA Pet Health Insurance branded programPer the Revdex.com direction, we have removed any reference that will personally identify our customer The customer expressed concern for coverage of treatment submitted on Claim # [redacted] and Claim # [redacted] At the time this inquiry was received, we were in direct contact with the customer and it is our understanding this matter has been resolvedWe hope that the information provided in response to your inquiry are satisfactory Thank you for the opportunity to respond to this matterIf you have any questions or need additional information, please contact me at [redacted] Sincerely, Amanda A [redacted] Operations CoordinatorFSIA Insurance Agency [redacted]

I am rejecting this response because: The whole point here is that it is not a pre-existing illness The illness allegedly became known in (the vet in Connecticut at that time never revealed that he had dental disease or needed surgery), he recommended a cleaning, which was done This insurance has been had since 2008, since my dog was born I am so far from the only one to report this type of fraud from this company

I am rejecting this response because: I will be pressuring the ASPCA to withdraw their support from this product I also see where two new claims recently settled surprisingly did not contain the "Code 19" exclusions? Coincidence? Hardly--this company knows the legal pressure is mountingThis response is also full of contradictions and inaccuracies.On May 1st they wrote to the Revdex.com that the review was "ongoing" In this letter, they state the review was completed on 4/19, prior to their first response So why say otherwise? Sorry, but I don't believe anything coming from this company I will be speaking to an attorney about a possible class action lawsuit over this "Usual and Customary" clause One vague, ill-defined sentence in a policy is used to underpay who knows how many claims Consumers, be warned of these people They do not, in my opinion, deal in good faith ASPCA, please withdraw your support of this business

Dear Ms [redacted] : We are in receipt of your November 11, 2017, inquiry relative to the above-mentioned policy holder regarding his Level Plan ( [redacted] ) for his dogWe are responding as the program administrator for the carrier, United States Fire Insurance Company, [redacted] *** Per the Revdex.com direction, we have removed any reference that will personally identify our customer The customer expressed concern regarding denial of claims submitted for treatment of his dog’s dental surgery for gum disease The customer’s dog was enrolled on the Level Plan ( [redacted] ) with an effective date of September 15, The Level Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period An annual incident limit of $3,applies per condition Additionally, a $annual deductible and 80% co-insurance will be applied to covered expenses prior to reimbursement The customer submitted Claim # [redacted] and Claim # [redacted] for treatment of his dog’s Periodontal Disease on September and October 9, These claims were excluded from coverage as treatment for a pre-existing illness This decision was based on veterinary records obtained from Best Friends Animal Hospital document moderate to severe dental tartar on May 28, 2015, diagnosing the dog with grade dental disease and recommending a dental cleaning, which was declined at that timeAn exam dated March 27, notes, “O says pet has bad teeth, but cannot afford to have teeth cleaned” at which time periodontal disease stage 3-was diagnosed, again recommending a dental cleaningHarley presented at Green Dog Dental & Wellness on September 25, 2017, which documents, “Chronic periodontal disease has led to bone loss along the gingival margin and secondary furcation exposure ” Multiple tooth extractions were required as a result of the dog’s progressive dental diseasePlease see below for applicable excerpts from the Level Plan as it relates to ongoing treatment of an illness that occurs in one plan period and continues in subsequent plan periodsDEFINITIONS Occur or Occurrence – When signs or symptoms related to a condition first were observed by any individual or recorded in your pet’s medical record Pre-Existing Condition – means any condition for which a Veterinarian provided medical advice, the pet received treatment for, or the pet displayed signs or symptoms consistent with the stated condition prior to the effective date of a pet insurance policy or during any waiting period WHAT IS NOT COVERED Pre-Existing Conditions We do not pay benefits for any charge that results directly or indirectly from a Pre-existing Condition that occurred on or before the Effective Date of the policy This exclusion applies to the Effective Date following initial enrollment, the Effective Date of a subsequent Reissuance General Exclusions We will not pay for costs associated with or resulting from the following: oPre-existing Conditions that occurred on or before the effective date of the policy or during a waiting period WHAT HAPPENS WHEN THIS POLICY IS REISSUED Coverage Termination at Reissuance All coverage under the current policy ends on the last day of the Policy PeriodPursuant to Section 3.1, Conditions that Occur during the current Policy Period are not eligible in subsequent Policy Periods unless the Continuing Care Endorsement is in effect for the current Policy Period and subsequent Policy PeriodsNew Policy Amounts at Reissuance Reissued policies are considered new policiesWhen your policy is reissued, coverage for the new Policy Period is effective on the day immediately following the last day of the prior Policy PeriodThe full deductible amount and annual Incident Limit are reinstated and apply to the new Policy Period coverage at ReissuanceThis coverage restriction has been included in the customer’s coverage since it’s inception Please be aware, we began offering a Continuing Care Endorsement to provide continuous coverage for treatment of a condition which occurs in one plan period and requires care in a subsequent plan period This endorsement was offered to the customer annually through Unfortunately, our records indicate this additional coverage was never elected Additionally, the coverage restriction has been highlighted in the letter included with the customer’s annual plan documents, most recently for the plan period effective September Please see below for applicable excerpts from the letterAs a reminder - Our pet insurance does not cover pre-existing conditionsUnless Continuing Care is applicable, conditions that occurred in the previous plan period will not be covered in the next policy period, unless days have passed since its cure and last treatmentHow does Continuing Care work?Here's an example: If your pet develops diabetes eight months into the plan year, it would be covered by your base illness coverage, if selectedHowever, when your plan renews, treatment for diabetes would no longer be covered unless you had Continuing Care in place when the diabetes beganFurther, information relating to how the policy responds to pre-existing conditions including chronic or ongoing conditions was highlighted in the INSURER DISCLOSURE OF IMPORTANT POLICY PROVISIONSFollowing is an excerpt: Pre-existing condition: Pre-existing conditions are not covered by our plansHowever, a condition will no longer be considered preexisting if days have passed since the pet's condition was cured and free from treatment and symptomsChronic conditions and ongoing conditions: Chronic conditions are those that can be treated or managed, but not curedAn ongoing condition is any condition that requires treatment in multiple policy periodsOur base plans provide coverage for chronic and ongoing conditions during the plan year in which the symptoms first appearIf eligible, the Continuing Care Endorsement provides coverage for conditions that span to another plan yearThe Continuing Care Endorsement has separate deductible and incident/lifetime limitsIn his inquiry, the customer stated This company said on the phone “They are reviewing and will put the money in my account in weeks” We reviewed the relevant phone calls and the statement is not accurate, there was no pre-authorization of coverage or a guarantee of reimbursementLastly, as it relates to the day money back guarantee, in California for each policy period there is a Day Free Look Period which allows the customer to cancel for a full refund for that Policy Period provided no claims have been applied towards the deductible or reimbursed In this case, the cancellation was requested on November 10, 2017, outside of the free look period On November 10, 2017, per the customer’s request we cancelled coverage of the policy for his dog A pro rata refund was applied to the credit card on file in accordance with section POLICY CANCELLATION We hope that the information provided in response to your inquiry is satisfactory Thank you for the opportunity to respond to this matter If you have any questions or need additional information, please contact me at [redacted] Sincerely, Amanda A [redacted] Operations CoordinatorC&F Insurance Agency (NPN # [redacted] )Crum & Forster Pet Insurance GroupSM| a Fairfax Company [redacted]

Dear Ms [redacted] : We are in receipt of your December 16, 2016, inquiry relative to the above-mentioned policy holder regarding her Level Plan (BAS.2.2013) with Continuing Care Amendatory Endorsement (END.CCE.072011) for her dogWe are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC Per the Revdex.com direction, we have removed any reference that will personally identify our customer The customer expressed concern for coverage of claims The customer’s dog was enrolled on the Level Plan (BAS.2.2013) with Continuing Care Amendatory Endorsement (END.CC.072011) with an inception date of October 1, The Level Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period There is a $annual deductible and 80% co-insurance applied to covered expenses prior to reimbursement The Continuing Care Amendatory endorsement provides coverage for conditions which occur in one plan period and require continued treatment in subsequent plan periods There is an incident limit of $1,that applies per condition and a lifetime limit of $2,that does not reset annually These are separate from the base policy limits under the Level Plan Additionally, a $annual deductible and 80% co-insurance will be applied to covered expenses prior to reimbursementThe customer submitted multiple claims for her dog since the inception of her Level Plan in October We reviewed her account and confirmed that the submitted claims were processed in accordance with the terms and conditions of the Level Plan with Continuing Care Amendatory Endorsement and eligible veterinary expenses were either properly applied to the applicable deductible or reimbursed accordingly The customer was reimbursed a total of $since the inception of her Level Plan in October We were not able to identify any issues or discrepancies in the claims adjudication process Per the customer’s request, coverage was cancelled effective December 16, A pro-rata refund in the amount of $was applied to the customer’s credit card on file on December 22, We hope that the information provided in response to your inquiry are satisfactory Thank you for the opportunity to respond to this matterIf you have any questions or need additional information, please contact me at [redacted] Sincerely, Amanda A [redacted] Operations CoordinatorFSIA Insurance Agency [redacted]

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me.I am writing to inform you that Oscar S [redacted] from Hour Pet Watch has followed up with me to completely resolve my issue with the companyI am now a satisfied customer againThank you for your assistance in helping me resolve my issues with the company.Sincerely, [redacted] ***

Dear Ms [redacted] : We are in receipt of your August 29, 2016, follow up inquiry relative to the above-mentioned policy holder regarding his Level Plan ( [redacted] ) for his dogWe are responding as the program administrator for the carrier, United States Fire Insurance Company, [redacted] *** Per the Revdex.com direction, we have removed any reference that will personally identify our customer The customer expressed continued concern regarding the coverage provided for his dog With respect to the assertion that we have been unresponsive we do not agree with this statement In our August and 22, responses, we explained the customer's initial submission on September 17, resulted in a quote not an enrollment, because he did not complete the application process at that time The company reached out shortly thereafter to follow up on the quote and confirmed with the customer that he did not have the dog and would not be enrolling at that time We have attempted to contact the customer in an effort to resolve the matter and are awaiting his response before we are able to proceed We hope that the information provided in response to your inquiry is satisfactory Thank you for the opportunity to respond to this matter If you have any questions or need additional information, please contact me at [redacted] Sincerely, Amanda A [redacted] Operations CoordinatorFairmont Specialty Insurance Agency [redacted]

We are in receipt of your September 18, inquiry relative to the above-mentioned complainantPer the Revdex.com direction, we have removed any reference that will personally identify the complainant. Please be aware, C&F Insurance Agency, Inc., Crum & Forster
Pet Insurance GroupSM, and the related insurance companies, United States Fire Insurance Company and The North River Insurance Company do not provide microchipping services. We contacted our insurance partner and its affiliate organization, Pethealth, Incand confirmed this is their client. Our insurance partner advised they were able to contact this customer directly to resolve the issue. We hope that the information provided in response to your inquiry is satisfactory. Thank you for the opportunity to respond to this matter. If you have any questions or need additional information, please contact me via phone or fax at 234-231-1771. Sincerely, Amanda A***Operations CoordinatorC&F Insurance Agency, Inc(NPN # ***)Crum & Forster Pet Insurance GroupSM| a Fairfax Company***

Dear Ms***: We are in receipt of your August 30, 2016, inquiry relative to the above-mentioned policy holder regarding her Level Plan (***) for her catWe are responding as the program administrator for the carrier, United States Fire Insurance Company, *** ***. Per
the Revdex.com direction, we have removed any reference that will personally identify our customer. The customer expressed concern regarding the coverage provided for her cat on the Level planThe customer submitted Claim #***, for treatment of her cat’s ocular discharge and sneezing on July 25, 2016. The veterinary expenses were determined ineligible for coverage based on the cat’s claims history Prior to receipt of this inquiry we received an appeal on August 16, 2016. At that time, we reviewed medical records from One Love Animal Hospital and the ASPCA Animal Hospital (there was a typo in our appeal response to the customer referring to a June 19, visit at ASPCA Animal Hospital, which should have read June 19, 2015)Based on this review, it appears as if the cat’s ocular discharge and sneezing on Claim #*** were for treatment of a chronic respiratory illness that was present prior to the June 18, inception date of the policyMedical records from ASCPA Animal Hospital note on June 19, 2015, the cat has a history of sneezing since adopted on June 11, 2015. Medical records from One Love Animal Hospital document on July 25, 2016, the cat has had symptoms of watery eyes and a runny nose since being adopted Despite the notations in the medical records, there is no definitive link between these general symptoms. As such, the related veterinary expenses on Claim #*** and related Claim #*** will be submitted for reprocessing Thank you for the opportunity to respond to this matter. If you have any questions or need additional information, please contact me at *** Sincerely, Amanda A*** Operations Coordinator Fairmont Specialty Insurance Agency *** Tell us why here

Dear Ms***: We are in receipt of your March 23, 2018, inquiry relative to the above-mentioned policy holder regarding his Level Plan (***) for his dogWe are responding as the program administrator for the carrier, United States Fire Insurance Company, *** ***. Per the
Revdex.com direction, we have removed any reference that will personally identify our customer. The customer expressed concern for coverage of conditions which occur in one plan period and require continued treatment in subsequent plan periods. Without the proper coverage endorsement, these conditions are not eligible for coverage. The customer’s policy will cover costs for an illness or injury which occur and are treated within the originally manifested plan period. After re-issuance, any condition that was present in the prior plan year is no longer eligible for coverage. This coverage restriction has been included in the customer’s coverage since United States Fire Insurance Company began underwriting the policy in 2007. Additionally, this exclusion is highlighted in the cover letter that accompanies the customer’s policy documents, which are provided on an annual basis. Attached is a copy of the most recent cover letter for your reference The customer submitted Claim #*** for veterinary expenses incurred on February 9, 2018, for his dog’s treatment of Gingival Hyperplasia. The veterinary expenses related to Gingival Hyperplasia were excluded from coverage as treatment for conditions that occurred prior to the February 1, Policy Period. This determination was made based on a review of veterinary records from Patter Paws Animal Hospital, which document on January 15, 2018, “owner worried about abscess in mouth”. Additionally, the customer contacted us on January 24, advising his dog was diagnosed with an oral mass. Even though the condition was not precisely treated until February 9, 2018, based on how our coverage works, a condition occurs when signs or symptoms first become obvious, which in this case is prior to the February 1, Policy Period effective date. Notwithstanding the above, please be advised that the company is in direct contact with the customer to discuss the matter further. Thank you for the opportunity to respond to this matter. If you have any questions or need additional information, please contact me at ***. Sincerely, Amanda A***Compliance AnalystC&F Insurance Agency***

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID *** and would need to see the processed claims in order to make a determination as whether this is a satisfactory response to the complaint Sincerely, *** ***

Initial Business Response /* (1000, 5, 2015/08/31) */
Dear Ms***:
We are in receipt of your August 18, 2015, inquiry relative to the above-mentioned policy holder regarding his Level Plan (BAS.3.2013) for his dogWe are responding as the program administrator for the carrier, United
States Fire Insurance Company, NAIC Per the Revdex.com direction, we have removed any reference that will personally identify our customer
The customer expressed concern regarding coverage for a claim based on affirmative representations by a company representativeUpon receipt of this inquiry we again reviewed the phone callsWhile we disagree with the customer's assertion regarding representations made by the company relating to coverage, we acknowledge that our omission may have resulted in a misunderstanding for treatment rendered on July and 16, 2015, in the amount of $For clarity, please note the company's position on treatment advice is for the customer to consult with their veterinarianWe will reach out to the customer directly to resolve the matter
We hope that the information provided in response to your inquiry is satisfactoryThank you for the opportunity to respond to this matterIf you have any questions or need additional information, please contact me at ***
Sincerely,
Amanda A***
Operations Coordinator
Fairmont Specialty Insurance Agency
***
Initial Consumer Rebuttal /* (2000, 7, 2015/09/01) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I requested that I be reimbursed for the treatment I sought after I was advised to do so as the representative instructed me that this was an "Accident Claim"These are their words, not mine
I was assured over and over again that this claim would be covered by their representatives (more than one)
The individual that called me yesterday (J***) to tell me that they intend to pay the claims I requested was far more humble than the individual above that responded to the Revdex.comHe was the person that agreed I was correct but refused to pay prior to my filing my complaint with the Revdex.com and anyone else that would listenThat being said I still consider the matter to be resolved to my satisfaction, though I have yet to be paidThey seem to be fairly reputable and I believe they will
Thank you to the Revdex.com for assisting me in this matterBusinesses such as this need to learn a valuable lessonIf you promise something, stick to itIf their associates advise incorrectly, acknowledge itThe difference between myself and most others is that when I get froggy, I leapI believe they counted on me being a pushover and walking away with my tail between my legsI say nay nay
I run a small business from my homeI'm not an it or a pushoverDealing with a claim such as this likely cost them times the amount they refused to payI even told the person I talked to exactly that prior to filing my claim with the Revdex.comI guess they disagreedThey likely had to rope 10+ employees into this fray when all they had to do was listen to how I was advised and admit fault

Dear Ms***: We are in receipt of your May 1, follow up inquiry relative to the above-mentioned policy holder regarding his Level Plan (BAS.4.2013) and Level Plan (BAS.2.2013) for his catsWe are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC Please be aware, the ASPCA does not offer insurance. We are a separate company offering the ASPCA Pet Health Insurance branded program. Per the Revdex.com direction, we have removed any reference that will personally identify our customer. As indicated in our previous response, we received an appeal in our office on March 7, 2017, wherein the customer raised the same concerns. The customer’s previously processed claims for his cats were reviewed to ensure accuracy. This review was completed on April 19, 2017. At that time, our Customer Service Supervisor reached out to the customer via phone to advise the results. Our review determined an adjustment was warranted in regards to the “Chem (24) CBC Thyroid” expense on Claim #1277157. A detailed appeal response further explaining this adjustment as well as our methodology for determining usual and customary costs was sent directly to the customer on May 4, 2017. Lastly, as previously stated, the claims reimbursement method on this product is supported by our policy language and disclosed prior to enrollment. We do not publish a list of Usual and Customary costs. Usual and Customary costs are determined by using proprietary and industry data. Publicly available industry data is used to validate the results of our calculations. Please note, if a customer knows their pet(s) will be receiving specific treatment, they can submit an estimate to us prior to having the treatment done and receive an explanation of benefits showing what the reimbursement may be We hope that the information provided in response to your inquiry is satisfactory. Thank you for the opportunity to respond to this matter. If you have any questions or need additional information, please contact me via phone or fax at ***. Sincerely, Amanda A***Operations CoordinatorFairmont Specialty Insurance Agency***

Dear Ms***: We are in receipt of your October 31, 2016, inquiry relative to the above-mentioned policy holder regarding her Level Plan (BAS.4.2013) for her dogWe are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC 21113. Per
the Revdex.com direction, we have removed any reference that will personally identify our customer. The customer expressed concern for coverage of treatment submitted on Claim #*** and Claim #***, which we initially determined were not eligible. Upon a further review of the customer’s account, the claims in question will be reprocessed in accordance with the remaining terms and conditions of the Level policy. Thank you for the opportunity to respond to this matter. If you have any questions or need additional information, please contact me at *** Sincerely, Amanda A*** Operations Coordinator Fairmont Specialty Insurance Agency ***

Initial Business Response /* (1000, 5, 2015/09/28) */
Dear Ms***:
We are in receipt of your September 16, 2015, inquiry relative to the above-mentioned policy holder regarding her Level Plan (BAS.1.2013) for her dogsWe are responding as the program administrator for the carrier,
United States Fire Insurance Company, NAIC ***Per the Revdex.com direction, we have removed any reference that will personally identify our customer
In her inquiry the customer references service issues related to the processing of Claim #***Claim #*** was received in our office on August 24, 2015, for services rendered on August 23, On August 26, 2015, it was determined the itemized invoice necessary to aid in our review was not included with the submitted claim formAs such, we contacted the treating veterinary clinic directly in an effort to obtain the necessary informationOn August 26, and September 1, this was communicated to the customerOn September 2, 2015, we followed up with the treating veterinary clinic as we were still in need of the itemized invoiceAn email notification was sent to the customer informing her of this updated statusOn September 10, 2015, we contacted the treating veterinary clinic again and on September 11, 2015, the itemized invoice necessary to accurately process the customer's claim was received in our officeThe claim was completed on September 12, 2015, and on September 14, an email notification was sent to the customer informing her that her claim was complete
Claim #*** was for the evaluation and treatment of a fever and skin issuesThe related veterinary expenses were excluded from coverage as treatment for an illness not eligible as a covered benefit on the customer's Level Plan, which provides coverage for veterinary expenses incurred as the result of an accidentThis decision was based on the obtained medical records documenting the fever and skin issues with no mention of traumaAs such the occurrence was not indicative of treatment as the result of an accident, but rather an underlying illness
Please see below for applicable excerpts from the Level Plan as it relates to an illness
Policy Exclusions
Unless covered by an applicable endorsement, We will not pay for expenses related to:
aany Illness
Lastly, in her inquiry the customer requests cancellation of coverage for her dogs and a refund of all premiums paid since inception on October 7, The customer received the benefit of insurance for the time her dogs were insured with usAs such we are unable to honor this requestThe earliest date for cancellation of coverage can be September 16, 2015; the date of the customer's inquiry stating her wish to cancelWe will contact the customer directly to confirm her desire to cancel
We hope that the information provided in response to your inquiry is satisfactoryThank you for the opportunity to respond to this matterIf you have any questions or need additional information, please contact me at ***
Sincerely,
Amanda A***
Operations Coordinator
Fairmont Specialty Insurance Agency
***

Dear Ms***: We are in receipt of your March 27, follinquiry relative to the above-mentioned policy holder regarding his Accident and Illness Policy (PET-P-20000-0316) for his catWe are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC As stated previously, the ASPCA does not offer insurance. We are a separate company offering the ASPCA Pet Health Insurance branded program. Per the Revdex.com direction, we have removed any reference that will personally identify our customer. The customer submitted an estimate for necessary treatment related to his cat’s Stomatitis. Veterinary records obtained from World of Animals at Rittenhouse document symptoms presented in April 2016, September and January 2, 2017. The customer’s cat was enrolled online on January 2, on the Accident and Illness Policy with an effective date of January 3, 2017. Conditions that occur prior to the effective date or during the day illness waiting period, are pre-existing and are not eligible for coverage. A condition occurs when signs or symptoms first become obvious. In this case there are three different entries in the veterinary records evidencing symptoms of the condition from April through January 2, 2017, the day of enrollment. In order for a condition to be considered a new condition, and not a recurrence of a previous condition, the condition must be cured and treatment free for days. This requirement is clearly listed in our policy documents and website (refer to attached screenshots from the website). The product at issue in this complaint is a separate product from his previous insurance and underwritten by a different company, though within the same larger corporate structureUnfortunately, his previous insurance has no bearing on the benefits offered under the current productThis product does not cover pre-existing conditions, this exclusion is made conspicuously clear prior to and during the enrollment process. Per the customer’s request, coverage was cancelled effective March 3, 2017. We hope that the information provided in response to your inquiry is satisfactory. Thank you for the opportunity to respond to this matter. If you have any questions or need additional information, please contact me via phone or fax at ***. Sincerely, Amanda A***Operations CoordinatorFairmont Specialty Insurance Agency***

Initial Business Response /* (1000, 5, 2016/05/19) */
Dear Ms***:
We are in receipt of your May 5, 2016, inquiry relative to the above-mentioned policy holder regarding her Level Plan (BAS.2.2013) for her dogWe are responding as the program administrator for the carrier, United States
Fire Insurance Company, NAIC Per the Revdex.com direction, we have removed any reference that will personally identify our customerFurther, please be aware, the ASPCA does not offer insuranceWe are a separate company offering the ASPCA Pet Health Insurance branded program
The customer expressed concern regarding denial of claims submitted for treatment of her dog
The customer's dog was enrolled on the Level Plan (BAS.2.2013) with Continuing Care Amendatory Endorsement (END.CCE.072011) an initial effective date of July 1, The customer submitted Claim #*** and Claim #*** for treatment of her dog's heart condition on March 31, April and April 14, These claims were initially excluded from coverage as treatment of a Congenital, Hereditary, and Genetic condition (A list of these conditions was included with the customer's policy documents for the July 1, effective date of the policy)This decision was based on a review of veterinary records from VCA Bay Area Veterinary Specialists, which document the customer's pet was diagnosed with Myxomatous Mitral Valve Degeneration (a.k.aMitral Valve Disease)Coverage for Congenital, Genetic, or Hereditary conditions are excluded from the Level plan
Please refer to the applicable excerpts from the Level Plan (BAS.2.2013) as it relates to hereditary, genetic or congenital conditions
Policy Exclusions
Unless covered by an applicable endorsementWe will not pay for expenses related to:
bany Hereditary, Genetic or Congenital Condition including those Conditions that are related, secondary, or resultant from any Hereditary, Genetic, or Congenital Condition
DEFINITIONS
Hereditary, Genetic or Congenital Condition - Illness, defect, disorder or disease that is present from birth, inherited by Your Pet or to which Your Pet is predisposed through hereditary or genetic factorsA list of these conditions is available upon request and on Our website ***
Separate from this inquiry, the customer appealed the matter directly with us which resulted in a further review of the veterinary records by an independent consultantThe company agrees to allow coverage of the dog's Mitral Valvular Disease in the July 1, Policy Period
We hope that the information provided in response to your inquiry is satisfactoryThank you for the opportunity to respond to this matterIf you have any questions or need additional information, please contact me at ***
Sincerely,
Amanda A***
Operations Coordinator
Fairmont Specialty Insurance Agency
***
Initial Consumer Rebuttal /* (2000, 7, 2016/05/20) */
(The consumer indicated he/she ACCEPTED the response from the business.)

Initial Business Response /* (1000, 5, 2015/10/13) */
Dear MsLandis:
We are in receipt of your September 29, 2015, inquiry relative to the above-mentioned policy holder regarding her Level Plan (BAS.2.2013) for her dog and catWe are responding as the program administrator for the carrier,
United States Fire Insurance Company, NAIC Per the Revdex.com direction, we have removed any reference that will personally identify our customer
The customer expressed concern regarding denial of claims submitted for treatment of her dog
The customer's dog was enrolled on the Level Plan (BAS.2.2013) with an effective date of July 15, The plan was subsequently re-issued on an annual basisThe Level Plan provides accident and illness coverage for eligible expenses incurred during the annual policy periodAn annual incident limit of $3,applies per conditionAdditionally, a $annual deductible and 90% co-insurance will be applied to covered expenses prior to reimbursement
The customer submitted Claim #*** and Claim #***, which is a duplicate of Claim #***, for treatment of her dog's benign follicular hamartoma on August 1, A dental cleaning and teeth extractions were also performed at this timeVeterinary records obtained from Town & Country Veterinary Clinic, document the mass presented "a few months prior" to a visit on July 26, 2014, which places the occurrence date prior to the July 1, effective date of the re-issued policyTherefore, treatment of the follicular hamartoma was excluded from coverage as treatment for an illness that occurred prior to the July 15, Policy PeriodThe dental cleaning is Wellness Care which is not covered under the Level PlanPer medical records from Town & Country Veterinary Clinic, the teeth extraction is related to the teeth being mobile and is not covered under the Level PlanExcerpts from the policy language are below
The customer also submitted Claim *** for treatment of her dog's right hock mass on August 5, This claim was excluded from coverage as treatment for an illness that occurred prior to the July 15, Policy PeriodThis decision was based on a review of veterinary records from Town & Country Veterinary Clinic, which document the mass presented July 3, prior to the July 15, effective date of the policy
Please see below for applicable excerpts from the Level Plan as it relates to the excluded treatments
WHAT IS NOT COVERED
Pre-Existing Conditions
We do not pay benefits for any charge that results directly or indirectly from a Pre-existing Condition that occurred on or before the Effective Date of the PolicyThis exclusion applies to the Effective Date following initial enrollment, the Effective Date of a subsequent Reissuance, and the Effective Date resulting from a permissible midterm change in coverage resulting in a new Policy
General Exclusions
We will not pay for costs associated with or resulting from the following:
idental cleanings unless covered by an applicable endorsement; aesthetic, cosmetic, endodontic, or orthodontic dental services such as caps, crowns, fillings, implants and root canals
Coverage Termination at Reissuance
All coverage under the current policy ends on the last day of the Policy Period
Pursuant to Section Conditions that Occur during the current Policy Period are not eligible in subsequent Policy Periods unless the Continuing Care Endorsement is in effect for the current Policy Period and subsequent Policy Periods
DEFINITIONS
Occur or Occurrence - When signs or symptoms related to a condition first become obvious, including when Your Pet first shows signs or symptoms related to a Condition that a Veterinary could have diagnosed or treated
Claim #***, Claim #*** and Claim *** were processed in accordance with the terms and conditions of the Level PlanPer the customer's request, coverage was cancelled effective September 28, A refund in the amount of $was applied to the customer's credit card on file on October 5,
Lastly, in her complaint the customer requests cancellation of coverage and a refund of all premiums paid since inception on July 15, The customer received the benefit of insurance for the time her dog and cat were insured with usAs such we are unable to honor this requestHowever, in an effort to resolve this matter, the company agrees to cancellation of coverage back to the most recent effective date of the policy for each of the customer's pets (July 1, and July 15, respectively)An additional refund in the amount of $will be applied to the customer's credit card on file
We hope that the information provided in response to your inquiry is satisfactoryThank you for the opportunity to respond to this matterIf you have any questions or need additional information, please contact me at 234-231-
Sincerely,
Amanda A***
Operations Coordinator
Fairmont Specialty Insurance Agency
***
Initial Consumer Rebuttal /* (3000, 7, 2015/10/18) */
(The consumer indicated he/she DID NOT accept the response from the business.)
The response from this business is not acceptableThe costs for the removal of the follicular hamartoma and the removal of the right hock mass should have been covered

We are in receipt of your November 21, 2017, follow up inquiry relative to the above-mentioned policy holder regarding his Level Plan (***) for his dogWe are responding as the program administrator for the carrier, United States Fire Insurance Company, *** ***. Per the Revdex.com direction, we have removed any reference that will personally identify our customer. The customer expressed continued concern regarding coverage for treatment of his dog’s dental surgery for gum disease. As stated in our November 21, response, the customer’s dog was enrolled on the Level Plan (***). The current policy period has an effective date of September 15, The Level Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period. Per the veterinary records obtained from Best Friends Animal Hospital, the dog’s Periodontal Disease presented or “occurred” in May 2015, prior to the current policy period. The treatment at issue was provided on September and October 9, 2017, therefore treatment of the condition was excluded from coverage as treatment for a condition that initially occurred prior to the current policy period (e.gpre-existing illness). Also, as previously indicated the Continuing Care Endorsement which provides continuous coverage for treatment of conditions that occur in one policy period and requires care in subsequent policy periods was never elected. We hope that the information provided in response to your inquiry is satisfactory. Thank you for the opportunity to respond to this matter. If you have any questions or need additional information, please contact me at ***. Sincerely, Amanda A***Operations CoordinatorC&F Insurance Agency (NPN # ***)Crum & Forster Pet Insurance GroupSM| a Fairfax Company***

I am rejecting this response because:
Once again I am going to repeat, that my cat had an episode of stomatitis that was treated with half of her teeth being extractedFollowing this procedure, the stomatitis resolvedIt then returned; being that this is a disorder with poor understanding and limited treatment options, it is impossible to reasonably and fairly state that it was a pre-existing condition if, upon enrollment, she was NOT AT THAT MOMENT suffering from stomatitis, but DID develop it againI say once more that the day period for which a condition can be considered not pre-existing is ARBITRARY and NOT based on science or veterinary medicine. And I repeat once more that the Pet Watch and ASPCA insurance is underwritten by the SAME corporate structureIf Amanda wants to reach a fair and reasonable agreement she has to begin negotiating with me on reimbursement for my veterinary fees regarding this procedureMy cat was NOT experiencing disease when I enrolled her in ASPCA insurance and so it was NOT a condition concurrent with my enrollment. I would like to see Amanda and her corporate structure explain to me where the day period comes from, I want to see medical documentation and research which underpins this length of time which according to them determines "pre-existing" otherwise it is completely arbitrary and completely unreasonable and unfair