Red Sands Insurance Company (Europe) Limited · DRN-5882721

The complaint Mr and Mrs H have complained that Red Sands Insurance Company (Europe) Limited unreasonably imposed an exclusion on their pet policy following a claim. What happened Mrs and Mrs H insured their dog under a time limited pet policy with Red Sands since 2020. In 2021 their dog developed a rash out on a walk which their vet called pyoderma and treated it accordingly. Mr and Mrs H made a claim to Red Sands for these vet costs in treating their dog which Red Sands accepted and paid. Time limited pet policies cover any condition for a maximum of 12 months and thereafter that condition is excluded from cover. So in accordance with the policy conditions once a claim is made, Red Sands sought to ensure the relevant exclusion was put in place at the expiration of 12 months from the date of the claim which occurred from renewal in July 2022 excluding ‘all claims with respect to skin conditions’. Following further evidence from Mr and Mrs H’s vet, Red Sands changed this to excluding conditions of ‘Pyoderma and resulting conditions.’ Mr and Mrs H remained unhappy and complained. Red Sands was of the view based on the vet evidence the claim was for pyoderma and therefore its consequent exclusion was fair. Dissatisfied Mr and Mrs H brought their complaint to us. The investigator didn’t think Red Sands had done anything wrong. Mr and Mrs H disagreed so their complaint has been passed to me to decide. What I’ve decided – and why I’ve considered all the available evidence and arguments to decide what’s fair and reasonable in the circumstances of this complaint. Given the contents of Mr and Mrs H’s referral for an ombudsman’s decision, I think it’s appropriate to explain how this service operates. We are an independent resolution service who decides complaints based on a fair and reasonable remit having regard to the evidence provided by both parties and having regard to industry practice and the law. In insurance complaints like this one, we assess if the insurer has done anything wrong as regards the terms and conditions of the policy. We are independent of the regulator, the Financial Conduct Authority too, and our powers are set out in both legislation and the DISP rules contained in the Financial Conduct Authority’s Handbook, which is available online. Our service is free to consumers and no ombudsman’s decision is legally binding on the parties unless the consumer accepts it. Once the consumer accepts it then it is legally binding on both the consumer and the

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business complained of. The ombudsman’s decision is the final part of our process for the consumer’s complaint, and it remains for the consumer to accept it or not, as they wish. If the consumer doesn’t want to accept it, their rights to pursue the matter elsewhere, for example at Court, remains unfettered. However once the ombudsman’s decision is issued – that is the end of our process for that consumer’s complaint, there is no further escalation within this service beyond the final decision, or indeed any sort of automatic escalation to the Financial Conduct Authority as Mr and Mrs H have assumed. So that means essentially we are an evidence based service and rely on the evidence produced by both parties to decide any complaint. Here, for this complaint, that means the evidence and its quality of Mr and Mrs H’s vet is all important. However before I go through that, I consider its useful to explain how the policy Mr and Mrs H chose to cover their dog operates. I should first explain that pet policies are sold on what is called an unadvised basis. Therefore Red Sands is not involved in providing any advice to consumers about its product beyond detailing the terms of cover. It remains the consumer’s decision to ensure the policy is suitable for their own needs. This policy is a time limited policy with cover for vet fees of up to a maximum of £2,000 per condition per year and allowing a total of £7,000 cover to be claimed per year. The policy says the following: ‘Your Policy This is a Time Limited policy. This means each new condition is covered for 12 months - as long as you renew your policy. The 12 months starts from the date your pet first showed signs or symptoms of the condition. At the renewal after the condition started, we’ll add an exclusion to your policy – but you can carry on claiming for the condition if you haven’t already reached your 12-month limit. At the end of the 12 month period we won’t cover that condition anymore even if you renew. When we say ‘condition’ we mean any injury or illness with a single cause or diagnosis. For example if your pet has an accident, we’ll class any injuries they suffered as one condition – even if they’re in different parts of the body. Likewise, if your pet has symptoms of a condition that later appears in a different side of the body, we’ll class it as one condition.’ So once a claim for vet fees has been made, the condition causing that vet treatment and consequent fees is then excluded once 12 months has passed since the onset of the relevant condition. So the more claims that are made, the more conditions in number going forward are then subsequently excluded. So effectively this type of policy doesn’t provide ongoing cover for any chronic or repeating medical conditions, which the pet might suffer, like allergies, arthritis, gastritis, ongoing dysplasia issues, and many, many, more. In basic terms therefore, whatever is the cause of the vet treatment and consequently vet costs that are claimed won’t be permitted to be claimed again, once 12 months has elapsed from when that condition first arose. Otherwise Mr and Mrs H are entitled to claim up to £2,000 vet fees for the same condition for 12 months and up to £7,000 for other conditions overall for each policy year. So if the vet fees cost £500 for one condition - £1,500 remains to be claimed for any further instances of that condition or ongoing treatment for that condition, for no longer than 12 months. Once the 12 months is spent or expired no vet fees can be claimed for that condition again going forward. There is no dispute that in 2021, Mr and Mrs H’s vet called the condition their dog was suffering from as pyoderma. That is clearly written in the vet history and the claim form. So

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on this basis, since Red Sands are fully entitled to rely on the vet diagnosis as expressed by the vet, there was nothing wrong with Red Sands ultimately deciding their dog suffered a bout of pyoderma and to exclude it accordingly once the 12 month period expired. Vets are required to keep accurate records by their regulator and in turn pet insurers are therefore entitled to rely on what the vet wrote down in the vet history as being accurate. We have little explanation from Mr and Mrs H’s vet over what pyoderma is, why they decided initially it was pyoderma, or that now it was possibly not pyoderma. The explanatory letter from the vet dated 8 July 2022, says the following: ‘[Name of dog] was treated for an acute episode of pyoderma in July 2021. She had no previous history of skin disease and no subsequent skin issues have been reported. We would normally expect skin allergies to result in recurrent episodes requiring ongoing/seasonal treatment. As such we would class [name of dog]’s episode in 2021 as a one off allergy rather than chronic skin disease. I would like to ask you to reconsider the skin exclusion on her policy on the grounds that there is no history of chronic skin diseases and as such subsequent issues should be considered as separate conditions rather than an ongoing issue.’ So first this letter confirms the dog was treated for pyoderma in 2021. It doesn’t say however that that diagnosis was wrong then. It goes on to explain that given the lack of ongoing skin issues, the diagnosis is a one off allergy only – rather than any chronic skin disease. However it doesn’t confirm that pyoderma must always present as a chronic skin disease and neither does it say that the dog didn’t present with pyoderma in any event in 2021. Most importantly this doesn’t confirm that the vet misdiagnosed the condition in 2021 either. In order to consider pyoderma was mis-diagnosed, I would expect the vet to say that in no uncertain terms and this letter doesn’t do that evidentially. Rather it confirms the dog presented with an acute episode of pyoderma instead and simply didn’t go on to develop chronic pyoderma. It was on the basis of this vet letter that Red Sands was happy to amend the exclusion from ‘all skin conditions’ to that of pyoderma only. I consider that’s reasonable on the basis of what the vet said in this letter. A simple search on pyoderma shows that it can indeed be a simple one off condition, often associated with an allergy to something. Far more commonly however, it can end up being a more chronic skin condition given it’s rarely a primary disease and is usually secondary to something else like some sort of autoimmune condition. So Mr and Mrs H aren’t quite correct to so categorically state pyoderma cannot be a one-time condition, as the simple search says otherwise, albeit that it is rare to have it as a simple one off condition. Nonetheless that can indeed happen. Mr and Mrs H subsequently said it seems their dog brushed against a hogweed which in turn caused her skin to react the way it did in 2021, but only this one time. It has not repeated. So in that case it appears their dog’s skin adversely reacted to hogweed (rather like us humans do too) and it exhibited as pyoderma and was successfully treated by their vet with the medications typically used for pyoderma as listed in the claim form and vet history. Very luckily their dog did not go on to develop any type of chronic pyoderma skin disease afterwards, so it’s pretty clear to me on the balance of probabilities that their dog most likely did (indeed very luckily) merely have a one off bout of pyoderma as a reaction to this hogweed. More so as the medications used to treat pyoderma appeared to clear it up too. The later vet evidence of 25 November 2025 simply stating in one line that their dog ‘does not have pyoderma’ in the present tense, is not something that Red Sands has seen or considered so I can’t consider it in this decision. We are only permitted by our rules to deal

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with evidence which the business being complained of has seen and then made a decision on through its final response letter. Red Sands in any event subsequently amended the exclusion to solely ‘pyoderma’ thereby allowing Mr and Mrs H to claim for other skin conditions or even allergies, which are not pyoderma or don’t result in pyoderma going forward. On the basis of the vet evidence of the claim in 2021 and the medications used to treat it, along with the vet letter of 8 July 2022, I consider Red Sands are being reasonable here. Mr and Mrs H’s dog had one instance of a skin condition which their vet called and labelled pyoderma and given the cover provided in this policy, that condition must then be excluded after 12 months. I consider it’s reasonable that Red Sands has now permitted any other skin conditions or allergies to be covered, should their dog present with one of those, but anything in relation to pyoderma is now excluded. I do appreciate Mr and Mrs H’s strength of feeling on the matter, and I understand they might well be very disappointed with my decision also. Time limited pet policies as Mr and Mrs H chose to cover their dog do have these restrictions once any claim has been made, and the premium is also priced accordingly. So given the terms and conditions of the policy, I don’t consider Red Sands has done anything wrong in limiting the exclusion to pyoderma only, as with each condition claimed for, the policy then does exclude that condition claimed for once the 12 months from the onset of that condition has passed. Claims in general will increase premiums at the next renewal. Further given the increase in vet costs generally pet insurance premiums do tend to increase consequently. I’ve seen no evidence from either party concerning what sort of premium increase might have occurred following this claim by Mr and Mrs H or indeed why it might be unfair given the policy provides that each condition claimed for is then excluded once the 12 months’ time period from the onset of that condition has expired. My final decision So for these reasons, it’s my final decision that I don’t uphold this complaint. Under the rules of the Financial Ombudsman Service, I’m required to ask Mr H and Mrs H to accept or reject my decision before 1 April 2026. Rona Doyle Ombudsman

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