Columbus, OH asked in Insurance Bad Faith, Insurance Defense and Animal / Dog Law for Ohio

Q: Seeking advice on a Pet Insurance Claim. My policy covers Congenital Heart Disease. A defect occurring at birth.

My policy w/MetLife started the day I brought my Rottweiler home at 8 wks.Comprehensive Wellness & Accident & Illness.No heart murmur was heard at the 6wk check w/her breeder.I took her to her first wellness visit A heart murmur was noted but no real concern as murmurs are very common in large breed dogs & they typically resolve by 6 mnth. It was still there at 9 months so we went to a cardiologist & had an EKG. Diagnosed as Congenital Heart Disease. MetLife denied claim stating “pre-existing” because the murmur was “heard” during the 2 wk waiting period on accident & illness. The Wellness started immediately & covers all vet exams & diagnostics. Congenital HD & the resulting heart murmur in its very nature is “pre-existing” since it’s a birth defect. How can it be subject to the waiting period if it’s a covered disease that is present at birth? The policy was in effect prior to any clinical signs. It is not something that happened or began during the waiting period.

1 Lawyer Answer
Nicholas P. Weiss
Nicholas P. Weiss pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
  • Cleveland Heights, OH
  • Licensed in Ohio

A: You may have a claim for bad-faith insurance coverage against met-life for refusing coverage. This can result in hefty punitive damages and attorney fees for refusing to reasonably provide insurance coverage.

1 user found this answer helpful

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