Crum & Forster Pet Insurance Group

Initial Business Response /* (1000, 8, 2015/09/24) */
Dear Ms***:
We are in receipt of your September 9, 2015, inquiry relative to the above-mentioned policy holder regarding her Level Plan (BAS.3.2013) 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 customer
The customer expressed concern regarding cancellation of coverage
The customer enrolled her dog effective April 1, She elected a monthly payment frequency and provided her credit card information and authorization and selected our "paperless" option agreeing to receive all communications via the email address she provided for her fileWe sent a confirmation email to the customer confirming enrollment and payment along with directions to access her account via the Member Center
On June 23, 2015, we contacted the customer to inform her that her account was in a lapsed status due to non-payment of the June premium dueA follemail notice was sent to the customer on June 25, advising her account is currently past due and directing her to the Member Center for payment optionsOn July and 22, 2015, our Customer Service Department attempted to reach the customer again regarding her lapsed accountA follow up email notice was sent on July 27,
On August 3, 2015, we mailed a final notice letter to the customer indicating the plan would be cancelled effective July 1, 2015, if payment information wasn't provided by August 30, Unfortunately, we did not receive the necessary payment information and the account was cancelled on August 30, 2015, with an effective cancellation date of July 1, This was communicated to the customer on August 31,
Please see below for applicable excerpts from the Level Plan as it relates to cancellation of coverage
When We Cancel
If You fail to pay Your premium, We may cancel Your coverage at any timeA notice will be sent to You providing at least days notice of Our intent to cancel or such other time as required by the state of Your primary address
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
amanda.a***@hartvillegroup.com
Initial Consumer Rebuttal /* (3000, 10, 2015/09/29) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Unfortunately, I find this response to be unsatisfactoryIf you tell a customer they have until the end of the month to make their payment to bring their account current, then you have to honor thatIf there are days in the month, you cannot cancel a policy on the 30th dayI stayed in touch with the company to let them know what was going on, etcI was prepared to make the full payment on 8/31, but when I logged in, no policy was foundThat is unprofessional and it is bad business

Initial Business Response /* (1000, 6, 2015/08/21) */
Dear Ms***:
We are in receipt of your August 7, 2015, inquiry relative to the above-mentioned policy holder regarding her Level Plan 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 for coverage of conditions which occur in one plan period and require continued treatment in subsequent plan periodsThese conditions are not eligible for coverageThe customer's policy will cover costs for an illness or injury which occur and are treated within the originally manifested plan periodAfter re-issuance, any condition that was present in the prior plan year is no longer eligible for coverageThis exclusion or limitation has been present each year since the customer purchased coverage in and it is highlighted in the cover letter that accompanies the plansPlease refer to the enclosed cover letter from as well as a copy of the most recent June 15, plan
The customer submitted Claim #*** for treatment of her dog's Cardiomegaly on March 4, as well as Claim #*** for continued treatment on June 2, These claims were excluded from coverage as treatment for an illness that occurred prior to the June 15, Policy PeriodThis decision was based on a review of veterinary records from ***, which document the presence of a grade 3/heart murmur since July 5, On March 4, 2015, the heart murmur progressed to a grade 5/6, recommending a cardiac consultA radiograph report dated March 5, 2015, diagnosed the customer's dog with mild cardiomegaly with specific enlargement of the right and left atriaComments of the Consulting Radiologist report indicate the enlargement explains the heart murmurFurther evaluation of the dog's heart murmur on June 2, 2015, confirmed a diagnosis of chronic degenerative valve disease - moderate to severe mitral and mild tricuspid regurgitation with pulmonary hypertensionCoverage for any illness is based upon the initial manifestation of symptoms of the illness, not upon the date of the named diagnosis
Please 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 periods
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
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
Lastly, 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 periodThis endorsement was offered to the customer in 2009, 2010, and Unfortunately, we received no communication from the customer electing to add this additional coverageClaim #*** and Claim #*** were processed in accordance with the terms and conditions of the Level PlanPer the customer's request coverage was cancelled effective August 11,
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
***

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 24 Hour Pet Watch has followed up with me to completely resolve my issue with the company. I am now a satisfied customer again. Thank you for your assistance in helping me resolve my issues with the company.Sincerely,[redacted]

Dear Ms. [redacted]: We are in receipt of your October 3, 2016, inquiry relative to the above-mentioned policy holder regarding his Level 3 Plan ([redacted]) with Congenital and Hereditary Care Amendatory Endorsement ([redacted]) for his dog.   This product is an individual...

personal lines, property and casualty product filed and approved in the state of California.  The product is underwritten by 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 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.  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 communicated to the customer via email in 2010, 2011 and 2012.  Unfortunately, our records indicate this additional coverage was never elected.  Beginning with the 2013 re-issuance, this pet is no longer eligible to add the endorsement. The customer submitted Claim #[redacted], which included veterinary expenses for treatment of his pet’s Keratoconjunctivitis Sicca (dry eyes) on June 27, 2016.  This condition is considered hereditary, genetic or congenital in all dog breeds and is subject to the terms and conditions of the Congenital & Hereditary Care Endorsement.  Unfortunately, the condition is not eligible, because it originally occurred prior to the current policy period effective May 1, 2016.  The denial was determined based on a review of the pet’s medical records from LA Village Vet, which document chronic eye discharge and redness since March 10, 2015. Please see below for applicable excerpts from the Congenital and Hereditary Care Amendatory Endorsement as it relates to pre-existing conditions. PRE-EXISTING CONDITIONS – This endorsement does not provide coverage for any charge that results directly or indirectly from a Pre-Existing Condition that occurred on or before the Effective Date of the Congenital and Hereditary Care endorsement.  This exclusion applies to each Policy period.  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.   Based upon this information, our review indicates the veterinary expenses for treatment of the pet’s Keratoconjunctivitis Sicca (dry eyes) on June 27, 2016, submitted on Claim #[redacted] were processed in accordance with the terms, conditions and exclusions of the Level 3 Plan with Congenital and Hereditary Care Amendatory Endorsement. 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]

Initial Business Response /* (1000, 6, 2016/05/02) */
Dear Ms. [redacted]:
We are in receipt of your April 20, 2016, inquiry relative to the above-mentioned policy holder regarding her Level 2 Plan (BAS.2.2013) for her cats. We 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. Further, please be aware, the ASPCA does not offer insurance. We 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 cats.
The customer's cats were enrolled on the Level 2 Plan (BAS.2.2013) with an effective date of October 27, 2015. The Level 2 Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period. An annual incident limit of $3,000 applies per condition. Additionally, a $100 annual deductible and 90% co-insurance will be applied to covered expenses prior to reimbursement.
The customer submitted Claim #[redacted] with veterinary expenses for an annual exam, blood pressure check, urinalysis and blood screening for one of her cats on April 12, 2016. The expenses were ineligible for coverage under the customer's Level 2 Plan, because she does not have the applicable endorsement to allow coverage for these services. The decision was based on the submitted claim form and invoice indicating this was a wellness visit with no underlying illness documented.
The customer also submitted Claim #[redacted] and Claim #[redacted] for treatment of one of her cat's Kidney Disease on April 14, 2016 and treatment of the other cat's Chronic Kidney Disease on April 15, 2016. These claims were excluded from coverage as treatment for a pre-existing illness. This decision was based on veterinary records obtained from Ballston Animal Hospital, which document her cat's Kidney Disease since May 2015 and her other cat's Chronic Kidney Disease since August 20, 2014, both prior to the October 27, 2015 effective date of the issued policies.
Please see below for applicable excerpts from the Level 2 Plan as it relates to the excluded treatments.
3. WHAT IS NOT COVERED
3.1 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, and the Effective Date resulting from a permissible midterm change in coverage resulting in a new Policy.
3.3 Policy Exclusions
Unless covered by an applicable endorsement. We will not pay for expenses related to:
a. any Wellness Care
...
3.4 General Exclusions
We will not pay for costs associated with or resulting from the following:
q. preventive care without an Occurrence (including but not limited to general health diagnostics, laboratory procedures, medication, physical examinations and surgery)
10. 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.
Pre-Existing Condition - Illness, disease, Injury, or change to Your Pet's health that first Occurs or shows Symptoms:
a. before coverage is effective
b. during a Waiting Period
c. before the current Policy Period
This includes Conditions that are related to, secondary, or resultant from a Pre-Existing Condition.
Wellness Care - Treatment or diagnostics that are customarily considered preventive in nature where there is no underlying Illness or Injury. May include but is not limited to wellness examinations, coronavirus vaccines, canine distemper (also referred to as "DHLPP" for distemper, hepatitis, leptospirosis, parvo, and parainfluenza) or feline distemper (also referred to as "FVRCP" for feline viral rhinotracheitis, calicivirus, and panleukopenia) combination vaccines or titers, fecal tests, heartworm tests, rabies vaccines, spaying or neutering, bordetella vaccines, dental cleaning, feline infectious peritonitis vaccines, feline leukemia tests and vaccines, canine lyme disease vaccines, flea and heartworm preventive medications, and microchipping
On April 18, 2016, per the customer's request we cancelled coverage of both policies for her cats. A pro-rated refund in the amount of $408.98 was applied to the credit card on file. In her inquiry, the customer requests a full refund since inception on October 27, 2015. Claim #[redacted], Claim #[redacted] and Claim #[redacted] were processed in accordance with the terms and conditions of the policy. However, in an effort to resolve this matter, the company agrees to honor an additional refund in the amount of $368.50. This will also be applied to the credit card on file.
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 Coordinator
Fairmont Specialty Insurance Agency
[redacted]
Initial Consumer Rebuttal /* (3000, 8, 2016/05/03) */
(The consumer indicated he/she DID NOT accept the response from the business.)
This business had a representative at Ballston Animal Hospital when I signed up for this insurance. She said the opposite of everything mentioned in their response. That is why I want a full refund of what I paid to sign up. They have only given me half. This company pays for nothing.
Final Business Response /* (4000, 10, 2016/05/05) */
Dear Ms. [redacted]:
We are in receipt of your May 4, 2016 follow up inquiry, relative to the above-mentioned policy holder regarding her Level 2 Plan (BAS.2.2013) for her cats. We 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 regarding a full refund of premium since the inception of her policy effective October 27, 2015.
As stated in our May 2, 2016 response, the customer requested cancellation of both policies for her cats on April 18, 2016. A pro-rated refund in the amount of $408.98 was applied to the credit card on file. In an effort to resolve this matter, the company agreed to honor an additional refund in the amount of $368.50. This was applied to the customer's credit card on file on May 4, 2016. A total refund of $777.48 has been given to the customer for premium paid since the inception of her policy effective October 27, 2015.
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 Coordinator
Fairmont Specialty Insurance Agency
[redacted]
Final Consumer Response /* (2000, 12, 2016/05/06) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I accept the full refund. Thank you Revdex.com. re: A pro-rated refund in the amount of $408.98 was applied to the credit card on file. In an effort to resolve this matter, the company agreed to honor an additional refund in the amount of $368.50. This was applied to the customer's credit card on file on May 4, 2016. A total refund of $777.48 has been given to the customer for premium paid since the inception of her policy effective October 27, 2015.

Dear Ms. [redacted]: We are in receipt of your November 11, 2017, inquiry relative to the above-mentioned policy holder regarding his Level 2 Plan ([redacted]) for his dog. We 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 2 Plan ([redacted]) with an effective date of September 15, 2017. The Level 2 Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period.  An annual incident limit of $3,000 applies per condition.  Additionally, a $250 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 25 and October 9, 2017. 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 3 dental disease and recommending a dental cleaning, which was declined at that time. An exam dated March 27, 2017 notes, “O says pet has bad teeth, but cannot afford to have teeth cleaned” at which time periodontal disease stage 3-4 was diagnosed, again recommending a dental cleaning. Harley 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 disease. Please see below for applicable excerpts from the Level 2 Plan as it relates to ongoing treatment of an illness that occurs in one plan period and continues in subsequent plan periods. DEFINITIONS  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  3.1 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… 3.4  General Exclusions  We will not pay for costs associated with or resulting from the following:  o. Pre-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 7.2 Coverage Termination at Reissuance All coverage under the current policy ends on the last day of the Policy Period. Pursuant 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 Periods. 7.3 New Policy Amounts at Reissuance Reissued policies are considered new policies. When your policy is reissued, coverage for the new Policy Period is effective on the day immediately following the last day of the prior Policy Period. The full deductible amount and annual Incident Limit are reinstated and apply to the new Policy Period coverage at Reissuance. This 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 2016.  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 15. 2017.   Please see below for applicable excerpts from the letter. As a reminder - Our pet insurance does not cover pre-existing conditions. Unless Continuing Care is applicable, conditions that occurred in the previous plan period will not be covered in the next policy period, unless 180 days have passed since its cure and last treatment. How 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 selected. However, when your plan renews, treatment for diabetes would no longer be covered unless you had Continuing Care in place when the diabetes began. Further, 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 PROVISIONS. Following is an excerpt: Pre-existing condition: Pre-existing conditions are not covered by our plans. However, a condition will no longer be considered preexisting if 180 days have passed since the pet's condition was cured and free from treatment and symptoms. Chronic conditions and ongoing conditions: Chronic conditions are those that can be treated or managed, but not cured. An ongoing condition is any condition that requires treatment in multiple policy periods. Our base plans provide coverage for chronic and ongoing conditions during the plan year in which the symptoms first appear. If eligible, the Continuing Care Endorsement provides coverage for conditions that span to another plan year. The Continuing Care Endorsement has separate deductible and incident/lifetime limits. In his inquiry, the customer stated This company said on the phone “They are reviewing and will put the money in my account in 2 weeks”.  We reviewed the relevant phone calls and the statement is not accurate, there was no pre-authorization of coverage or a guarantee of reimbursement. Lastly, as it relates to the 30 day money back guarantee, in California for each policy period there is a 30 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 8.2 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]

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 mounting. This 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 August 29, 2016, follow up inquiry relative to the above-mentioned policy holder regarding his Level 3 Plan ([redacted]) for his dog. We 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 8 and 22, 2016 responses, we  explained the customer's initial submission on September 17, 2014 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]

Dear Ms. [redacted]: We are in receipt of your November 8, 2016, inquiry relative to the above-mentioned policy holder regarding his Level 3 Plan (BAS.3.2013) for his dog. We are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC 21113.  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.   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 resolved. We hope that the information provided in response to your inquiry are 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 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 2015 (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 still have NOT been told why the initial Rep's information was NOT honored...the SAME coverage for the Second Pet, with a Second Pet Discount. They continue to avoid this specific inquiry which was sent to them again approximately one week ago.I want that answer and will then respond accordingly.Thank you, [redacted]

Dear Ms. [redacted]:   We are in receipt of your March 15, 2017 inquiry relative to the above-mentioned policy holder regarding his Accident and Illness Policy (PET-P-20000-0316) for his cat. We are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC...

21113. 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.    The customer’s cat was enrolled online on January 2, 2017 on the Accident and Illness Policy with an effective date of January 3, 2017.  The customer submitted an estimate on March 8, 2017 for necessary treatment related to his cat’s Stomatitis to be performed at a later date.  The Estimate (identified as estimate #[redacted]) was completed on March 13, 2017 and provided to the customer showing his cat’s Stomatitis is ineligible for coverage as treatment for a pre-existing condition.  This decision was based on veterinary records obtained from World of Animals at Rittenhouse, which document symptoms presented in April 2016, September 2016, and January 2, 2017.  The cat’s Stomatits occurred prior to the January 3, 2017 effective date of the policy and is therefore a pre-existing condition.  This was communicated directly to the customer on March 15, 2017.    Please see below for applicable excerpts from the Accident and Illness Policy as it relates to pre-existing conditions.  This exclusion is clearly disclosed prior to enrollment.               DEFINITIONS   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 – Illness, disease, injury, or change to your pet’s health that first occurs or shows symptoms before coverage is effective or during a waiting period.  This includes conditions that are related to, secondary, or resultant from a pre-existing condition.  A condition will no longer be considered pre-existing if your pet’s condition has been cured and free from treatment and symptoms for a period of 180 days.   WHAT IS NOT COVERED   Exclusions   We will not pay for costs associated with or resulting from the following:   o.   Pre-existing Conditions that occurred on or before the effective date of the policy or during a waiting period.   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 [redacted].   Sincerely,     Amanda A[redacted] Operations Coordinator Fairmont Specialty Insurance Agency [redacted]

Initial Business Response /* (1000, 6, 2015/08/21) */
Dear Ms. [redacted]:
We are in receipt of your August 10, 2015, inquiry relative to the above-mentioned policy holder regarding his Level 2 Plan with Continuing Care Amendatory Endorsement for his dog. We 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. Further, please be aware, the ASPCA does not offer insurance. We are a separate company offering the ASPCA Pet Health insurance branded program.
In his inquiry, the customer expressed concern for coverage of conditions which occur in one plan period and require continued treatment in subsequent plan periods.
The customer's dog is currently enrolled on the Level 2 Plan (BAS.2.2013) with Continuing Care Amendatory Endorsement (END.CCE.072011) with an effective date of April 1, 2015. The Level 2 Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period. An annual incident limit of $3,000 applies per condition. Additionally, a $100 annual deductible and 90% co-insurance will be 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 $1,000 that applies per condition and a lifetime limit of $2,500 that does not reset annually. These are separate from the base policy limits under the Level 2 Plan. Additionally, a $100 annual deductible and 80% co-insurance will be applied to covered expenses prior to reimbursement.
The customer submitted Claim #[redacted], Claim #[redacted], Claim #[redacted], Claim #[redacted] and Claim #[redacted] for treatment of his dog's Cranial Cruciate Ligament (CCL) injury on May 18 and 26 and July 1, 2, 4 and 21, 2015. These claims were determined eligible for coverage under the Continuing Care Amendatory Endorsement. This decision was based on a review of the submitted claim forms as well as veterinary records from [redacted], which document [redacted]'s CCL injury occurred in March 2015, prior to April 1, 2015 effective date of the policy.
Please see below for applicable excerpts from the Level 2 Plan and Continuing Care Amendatory Endorsement as it relates to ongoing treatment of an illness that occurs in one plan period and continues in subsequent plan periods.
Level 2 Accident and Illness Coverage
3. WHAT IS NOT COVERED
3.1 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, and the Effective Date resulting from a permissible midterm change in coverage resulting in a new Policy.
7.2 Coverage Termination at Reissuance
All coverage under the current policy ends on the last day of the Policy Period.
Pursuant 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 Periods.
10. 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.
Continuing Care Amendatory Endorsement
WHAT IS COVERED
Benefits for Accidents and Illnesses that are first eligible under Your base policy during the current Policy Period will continue to be eligible for benefit payment in the following Policy Periods. Coverage is allowed up to the maximum Continuing Care Incident and Lifetime Limits. These limits are separate from Your base policy limits. These limits will not reset at Reissuance.
Incident Limit: $1,000.00
Lifetime Limit: $2,500.00
Claim #[redacted], Claim #[redacted], Claim #[redacted], Claim #[redacted] and Claim #[redacted] were processed in accordance with the terms and conditions of the Level 2 Plan with Continuing Care Amendatory Endorsement.
Notwithstanding the above, please be advised that the company is in direct contact with the customer to discuss the matter further.
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 Coordinator
Fairmont Specialty Insurance Agency, Inc.
[redacted]
Initial Consumer Rebuttal /* (2000, 8, 2015/09/03) */
(The consumer indicated he/she ACCEPTED the response from the business.)
They are attempting to work with me I hope resolution is reached soon

Dear Ms. [redacted]: We are in receipt of your April 20, 2017 inquiry relative to the above-mentioned policy holder regarding his Level 4 Plan (BAS.4.2013) and Level 2 Plan (BAS.2.2013) for his cats. We are responding as the program administrator for the carrier, United States Fire Insurance...

Company, NAIC 21113. 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.   In addition to this inquiry, we received an appeal in our office on March 7, 2017, wherein the customer raised the same concerns.  At this time we are in the process of reviewing 17 claims previously processed for the customer’s cats to ensure accuracy.  We have been in direct contact with the customer regarding his appeal and we expect to have our review completed shortly with a written response to the customer. The customer’s concern is specifically directed at claims reimbursement that is based on usual and customary costs. The claims reimbursement method on this product is supported by our policy language and disclosed prior to enrollment.  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 [redacted]. Sincerely,  Amanda A[redacted]Operations CoordinatorFairmont Specialty Insurance Agency[redacted]

Initial Business Response /* (1000, 5, 2015/12/09) */
We are in receipt of your December 1, 2015, inquiry relative to the above-mentioned policy holder regarding his Level 3 Plan ([redacted]) for his cat. We are responding as the program administrator for the carrier, United States Fire Insurance...

Company, NAIC [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 cat.
The customer's cat was enrolled on the Level 3 Plan (BAS.2.2013) with an effective date of April 1, 2015 with Congenital and Hereditary Care Amendatory Endorsement (END.CHC.2013). The Level 3 Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period. An annual incident limit of $5,000 applies per condition. The Congenital and Hereditary Care Amendatory Endorsement provides coverage for eligible hereditary, genetic or congenital conditions including conditions that are related, secondary or resultant. There is an incident limit of $500 that applies per condition and a lifetime limit of $1,250 that does not reset annually. These are separate from the base policy limits. Additionally, a $500 annual deductible and 90% co-insurance will be applied to covered expenses prior to reimbursement.
The customer submitted Claim #[redacted], Claim #[redacted] and Claim #[redacted] for treatment of his cat's renal failure on August 24, September 2 and September 5, 2015. These claims were initially excluded from coverage as treatment for a pre-existing illness. This decision was based on veterinary records obtained from Northside Animal Hospital, which document on August 24, 2015, the customer's cat was in early renal failure prior to the April 1, 2015 effective date of the issued policy.
Following the claims denials, we received an appeal request along with an addendum to the veterinary records from Northside Animal Hospital stating that an entry in the medical records on August 24, 2015 documenting "early renal failure three years ago" was incorrect. To aid in our review additional medical records were obtained from Animal Medical Center, which document on September 11, 2015, the customer's cat presented with clinical signs of PU/PD (about 3 years, progressive), mild inappetance and weight loss (2 months), unkempt hair coat (2 months), and mild lethargy (2 months). Diagnostics confirmed Polycystic Renal Disease. The appeal and medical history, including records from Northside Animal Hospital including the addendum, and Animal Medical Center were reviewed by our consulting veterinarian, a licensed Doctor of Veterinary Medicine and member of the American Veterinary Medical Association. Based on the full medical history and the consultant's review, we determined that the initial "three year" notation and subsequent addendum in the records were not dispositive to the issue in light of the other information contained in the medical records including results of bloodwork. Itit remains our position that the early renal failure diagnosed as Polycystic Renal Disease occurred prior to the April 1, 2015 effective date of the issued policy.
Additionally, Polycystic Renal Disease is considered a Congenital, Hereditary, and Genetic condition. (A list of these conditions was included with the customer's policy documents for the April 1, 2015 effective date of the policy. Attached is a copy.) Coverage for this condition is only available under the Congenital and Hereditary Care Amendatory Endorsement that contains a 180 day waiting period from the effective date. A condition that occurs prior to the effective date or within the waiting period is pre-existing and not eligible for coverage.
Please see below for applicable excerpts from the Level 3 Plan as it relates to the excluded treatments.
Level 3
3. WHAT IS NOT COVERED
3.1 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, and the Effective Date resulting from a permissible midterm change in coverage resulting in a new Policy.
10. 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.
Pre-Existing Condition - Illness, disease, Injury, or change to Your Pet's health that first Occurs or shows Symptoms:
a. before coverage is effective
b. during a Waiting Period
c. before the current Policy Period
This includes Conditions that are related to, secondary, or resultant from a Pre-Existing Condition.
Congenital and Hereditary Care Amendatory Endorsement
WHAT IS COVERED
We will pay for diagnosis and Treatment of Your Pet's Hereditary, Genetic or Congenital Condition including those Conditions that are related, secondary, or resultant from a Hereditary, Genetic, or Congenital Condition that Occur after the waiting period described below. Coverage is allowed up to the maximum Congenital and Hereditary Care Incident and Lifetime Limits. These limits are separate from the base policy limits. These limits will not reset at Reissuance.
PRE-EXISTING CONDITIONS - This endorsement does not provide coverage for any charge that results directly or indirectly from a Pre-Existing Condition that occurred on or before the Effective Date of the Congenital and Hereditary Care endorsement. This exclusion applies to each Policy Period. 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.
WAITING PERIOD - no amount is payable for diagnosis or Treatment of Your Pet's Hereditary, Genetic, or Congenital Conditions that Occur during the first 180 days from the first Effective Date of this endorsement. Conditions that occur during the waiting period are not eligible for coverage unless 180 days have passed since Your Pet's Condition was Cured and free from Treatment and Symptoms.

Claim #[redacted], Claim #[redacted] and Claim #[redacted] were processed in accordance with the terms and conditions of the policy..
We hope that the information provided in response to your inquiry is satisfactory. Thank you for the opportunity to respond to this matter.
Initial Consumer Rebuttal /* (3000, 7, 2015/12/10) */
(The consumer indicated he/she DID NOT accept the response from the business.)
This business makes the following incorrect assertions/implications among aothers.
1) They assert that my cat's renal failure is a result of polycystic kidney disease and therefore necessarily a genetic condition. The literature estimates that more than 50% of domestic cats over the age of 15 will develop renal failure, regardless of polycystic kidney disease. There is no evidence to support that the kidney failure is a result of the polycystic kidney disease.
2) They write in reference to the fact that my cat's renal failure was not a pre-existing condition that "records were not dispositive." I have no burden of proof to demonstrate that my cat was free of renal failure prior to the policy effective date. Should the company want such assurances, they should request a physical prior to insuring an animal. They insured my cat on 4/1/15 at which time he had no clinical history of renal failure.
ASPCA Pet Insurance entered into an agreement to insure my cat and they should honor that agreement.
Final Business Response /* (4000, 12, 2016/01/04) */
December 23, 2015
Revdex.com of Akron
222 West Market Street
Akron, OH 44303
Attn: [redacted]
Phone: [redacted]
RE: [redacted]
Case #: [redacted]
Dear Ms. [redacted]:
We are in receipt of your December 10, 2015, follow up inquiry relative to the above-mentioned policy holder regarding his Level 3 Plan (BAS.2.2013) for his cat. We are responding as the program administrator for the carrier, United States Fire Insurance Company, NAIC [redacted]. Per the Revdex.com direction, we have removed any reference that will personally identify our customer.
We appreciate the customer's continued concern regarding the coverage of their cat's claims. As previously communicated in the prior Revdex.com response and in two appeal responses provided to the customer, it remains our position that treatment of the pet's chronic renal failure as the result of polycystic renal disease was for a condition that was present prior to the pet's April 1, 2015 effective date. This decision is based on a thorough review of the pet's medical records as well as a review by an independent veterinary consultant.
In addition to the condition being preexisting, polycystic renal disease is considered Hereditary, Genetic, and Congenital per the policy. While the Level 3 Plan that the pet is enrolled on provides coverage for these conditions, there is a waiting period of 180 days before these conditions may be covered. As the cat's chronic renal failure as a result of the polycystic renal disease did not occur after the waiting period, the condition is considered pre-existing and treatment for the condition is ineligible for coverage.
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 Coordinator
Fairmont Specialty Insurance Agency
[redacted]

Dear Ms. [redacted]: We are in receipt of your December 16, 2016, inquiry relative to the above-mentioned policy holder regarding her Level 2 Plan (BAS.2.2013) with Continuing Care Amendatory Endorsement (END.CCE.072011) for her dog. We 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 claims.   The customer’s dog was enrolled on the Level 2 Plan (BAS.2.2013) with Continuing Care Amendatory Endorsement (END.CC.072011) with an inception date of October 1, 2009.  The Level 2 Plan provides accident and illness coverage for eligible expenses incurred during the annual policy period.  There is a $100 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 $1,000 that applies per condition and a lifetime limit of $2,500 that does not reset annually.  These are separate from the base policy limits under the Level 2 Plan.  Additionally, a $100 annual deductible and 80% co-insurance will be applied to covered expenses prior to reimbursement. The customer submitted multiple claims for her dog since the inception of her Level 2 Plan in October 2009. We reviewed her account and confirmed that the submitted claims were processed in accordance with the terms and conditions of the Level 2 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 $980.74 since the inception of her Level 2 Plan in October 2009.  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, 2016.  A pro-rata refund in the amount of $42.93 was applied to the customer’s credit card on file on December 22, 2016. We hope that the information provided in response to your inquiry are 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 CoordinatorFSIA Insurance Agency[redacted]