Fillable How to claim Your Vet Fee Claim Pack

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How to claim Your Vet Fee Claim Pack

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To help us progress your claim, please ask your Veterinary Practice
to complete all sections on pages 3 and 4 of this claim pack.
Points to note…
Please read your policy documents to ensure you know which level of cover you have and what you’re
covered for.
•
The vet fee limits applicable to each condition are dependent on the policy limits in force at the time
the condition first started. These may not be the same as our current policy wording or if you have
changed your level of vet fees cover.
•
Your Vet Fee excess applies to each separate condition. If a claim includes costs for more than one
condition (e.g. multiple lumps that do not have the same diagnosis) an excess is applied per condition.
•
All cover for ongoing claims is subject to your policy remaining in force.
•
If any details for the pet on this form (e.g. age, breed) are dierent to the information we hold then this
will delay the claim
•
Either you or your vet can email / send the claim form back to us.
It’s your responsibility to check the accuracy of all information provided on this form.
Code:885463
Continued overleaf
Key Exclusions…
You’re not covered for:
•
Any injury, illness or disease or symptoms relating to any injury, illness or disease that was in existence
prior to your pet being insured with us, will not be covered. This includes any recurring conditions.
•
Any claim arising from any illness or disease that happens within the first 14 days of the pet being
covered under this policy. This includes any recurring conditions.
There is a full list of exclusions and benefits in your policy wording.
This list does not cover all of the policy exclusions so please read your policy documents for full terms
and conditions.
During your claim…
We may contact you about this claim and future claims by:
•
Text Message
•
E-mail
•
Letter
•
Phone
As such, please ensure that all relevant contact details provided on this form are correct.
We also suggest that you keep copies of all documents you send us for your reference.
Claims helpline: 0345 246 8496
Open Monday-Friday 8am-6pm
Saturday 9am-5pm
petclaimreturn@ukipartnerships.com
Your Vet Fee Claim Pack
How to claim
Sign up to Pet Drugs online and you could save on the cost of your pet medication.
As long as the condition is covered by your policy, you can claim up to £15 to help
cover the cost of your vet prescription when you order through Pet Drugs Online
Visit petdrugsonline.co.uk/directline
This oer is not an endorsement by Direct Line of www.petdrugsonline.co.uk and customers should always rely on
the advice of their vet with regard to diagnosis, treatment and medicines for their pet.
Code:885463
Details of the claims
Condition 1:
Please tell us what this claim is for? ___________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
When did your pet first show any signs of this illness/injury? ________________________________________
_______________________________________________________________________________________
Condition 2:
Please tell us what this claim is for? ___________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
When did your pet first show any signs of this illness/injury? ________________________________________
_______________________________________________________________________________________
Your Details (please note incomplete sections may delay the claim)
Policyholder Name: ___________________________
Policyholder Address: __________________________
___________________________________________
___________________________________________
Continued overleaf
Your Vet Fee Claim Pack
How to claim
Policy Number: ___________________________
Telephone No: ___________________________
Mobile No: ______________________________
Email: __________________________________
Details of your pet
Pet’s Name: ________________________________
Dog: Cat: Sex: M F Age: _______
How long have you owned your pet? Years: _______ Months: _______
Policyholder Declaration
• I am aware that Direct Line Insurance regularly exchanges claims information with other insurance
companies that provide related insurance.
• I hereby give my consent for the release of any medical information necessary
to process this claim,
both from and to Direct Line Insurance.
• To the best of my knowledge all details supplied are true. I understand that in the event this claim
is found to be fraudulent in whole or in part, this will invalidate the policy and may render me liable
for prosecution.
Signature: _________________________ Date: ___/___/_____
Continued overleaf (for completion by the vet)
Payment: Please tick one option
Bank Transfer (recommend)
Postal Cheque
Direct to your Vet
Not needed if emailing to us
This can now be saved and emailed to your vet
Bank Transfers can only be made into the account from which your premiums are paid. Cheques will be made payable to the policyholder.
Please ensure your vet has agreed to direct payment first.
Claims helpline: 0345 246 8496
Open Monday-Friday 8am-6pm
Saturday 9am-5pm
petclaimreturn@ukipartnerships.com
Code:885463
Details of Condition(s)
(please provide a copy of the full clinical history and any other vets history)
Please provide a detailed description of the condition(s) and previous similar conditions.
(If unknown, please describe the signs and symptoms.)
If you are submitting a claim for lumps please state each diagnosis separately.
Condition 1:
When did the condition first start? ____________________________________________________________
Description of condition: ___________________________________________________________________
_____________________________________________________________________________________
Is this a new or continuation claim?
If this is a new claim, has the pet had this or any similar problems before? _____________________________
Will the pet require further treatment for this condition?
Condition 2:
When did the condition first start? ____________________________________________________________
Description of condition: ___________________________________________________________________
_____________________________________________________________________________________
Is this a new or continuation claim?
If this is a new claim, has the pet had this or any similar problems before? _____________________________
Will the pet require further treatment for this condition?
Pet Registration (please note incomplete sections may delay the claim)
When was the pet registered with your practice? ________________________________________________
If you are a referral or out of hours practice and not the policyholder’s usual vet, please provide details of
the pet’s regular vet: ______________________________________________________________________
Your Vet Fee Claim Pack
How to claim
Important Information for the attending Vet
Lump Claims
Each lump type that has the same diagnosis will be treated as one condition and subject to its own policy limit.
Therefore you will need to split any claims where multiple lumps have been treated.
Histological/cytological diagnosis. Each lump with a dierent pathological diagnosis is treated as a separate
condition and any future lumps with the same diagnosis will be a continuation of that claim.
Lipoma – If the vet believes this to be the diagnosis, no histology or cytology is required.
Any lumps other than lipomas that have not been diagnosed by histology or cytology are treated as one
condition as an undiagnosed lump. Any future lumps that are not diagnosed will be classed as a continuation
of that claim.
Yes No
Yes No
Claims helpline: 0345 246 8496
Open Monday-Friday 8am-6pm
Saturday 9am-5pm
petclaimreturn@ukipartnerships.com
New Continuation
New Continuation
Code:885463
Claim Costs – Please attach all invoices & full clinical history
Please provide the treatment dates and costs for this claim.
(If the customer is claiming for more than one type of lump please detail each one separately)
Condition 1:
Treatment date: _____________________
Costs (£): __________________________
Your Vet Fee Claim Pack
How to claim
Vet’s Declaration
I certify that the details above are accurate and complete and that the fees charged are reasonable and
necessary and are the usual fees charged by this practice.
Signature: ____________________________________________________________________________
Print name: ___________________________________________________________________________
Date: ________________________________________________________________________________
If sending back via email, this section does not need completing, just tell us who to make the cheque payable to.
Condition 2:
Treatment date: _____________________
Costs (£): __________________________
Ongoing Treatment
Condition 2:
Yes No
Condition 1:
Yes No
Now send this back to us
petclaimreturn@ukipartnerships.com
or: Pet Claims
Leeds Processing Centre,
42 The Headrow,
Leeds, LS1 8HZ
Open Monday-Friday 8am-6pm
Saturday 9am-5pm
petclaimreturn@ukipartnerships.com
Claims helpline: 0345 246 8496
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Completed 10 January 2022

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