Pet Insurance Claim Form at a glance
What it is: Pet Insurance Claim Form: a claim for a New Condition or a Continuation Condition.
Who signs: G. The attending vet or a person authorised by the vet must fill in this section. "I declare to the best of my knowledge and belief that all information provided in this claim form is true and complete." "The fees I have charged are no more than the fees I would normally charge my clients." Enter Name and Position in the Practice.
A filled-in Pet Insurance Claim Form example: a policyholder claims for a dog
How to fill out Pet Insurance Claim Form, box by box
A. About you (the Policyholder)
If your name or address has changed, please tick (Please note that changes to your address may affect your premium).
Enter Your name, address and postcode.
Enter your Daytime tel, Mobile tel and Email.
Provide your mobile number and email address to keep informed of the progress of your claim. Policy number (must be completed).
B. About your pet
Enter Pets Name. If you have more than one pet insured, please ensure you enter the correct pet's name and only one claim form per pet.
Enter How long have you owned the pet?, Breed, Date of birth and Your pet's microchip number.
C. About your pet's condition
Condition 1 Condition 2. Enter when you noticed your pet was unwell or injured. If your pet has had the same or similar changes in health the first date is required.
Write a description of the changes to your pet's health that you noted.
Did you contact the 24 hour vetfone service for advice on your pet's condition before seeing your vet? Yes No Date. Please call 0800 1974949 if required in the future.
Was your pet under your care at the time of the illness/injury/incident? If no, please provide the name and address of any authorised third party looking after your pet at the time of the incident.
If your claim is for an injury, do you believe that another person was at fault? If so, please provide details separately Yes No.
D. Your previous veterinary practices
Enter the vet(s) details where your pet was previously registered. Enter your name and address at that time, if it was different to the name and address in Section A.
For each practice enter the Practice name, Address, Postcode, Phone number and Date: from to.
E. Your Declaration, who to pay and Data Protection notice
"I declare, to the best of my knowledge and belief, that all the information provided in this form is true and complete." By ticking the following box, you confirm that you agree with the statement.
Enter your name after My name is. Mark I am the Policyholder or I am the Joint policyholder, then enter the date after Dated as DD/MM/YYYY.
Please complete boxes a & b to tell who to pay: Policyholder, Joint policyholder or Vet/Organisation.
If Tesco Bank Pet Insurance decides it cannot pay some or all of your claim, it is your responsibility to pay your vet. If any required information is not received then there will be a delay to your claim.
More rules for Pet Insurance Claim Form
Is this claim for a: New Condition: Please complete all sections. Continuation Condition: Please complete sections A, B & E.
If this claim is for a new condition please ensure that the pet's full medical history from all the vets that your pet has been registered with is submitted with the claim form. If the condition being claimed for is new please enclose a full medical history for the pet.
If this claim is for continuation condition then please ensure that the medical history since the last claimed date of treatment is submitted with the claim form. If the condition is ongoing please enclose the medical history since the last claim.
If any section of the claim form is not filled in, or the supporting information is not submitted, this will delay your claim.
F. The vet must fill in this section about each condition. Please advise when the pet was registered at your practice Date.
Condition 1 Condition 2. What is the diagnosis of the condition (if no diagnosis has been made please provide the main clinical signs). The treatment dates for this claim From To.
If a house call was made, you must confirm why it was absolutely essential. If the pet was seen out of hours please confirm why this was and whether the treatment could have waited until normal surgery hours.
Is this claim for a continuation of treatment? If yes, please advise the previous dates of treatment.
If this pet was referred to you, please advise the name and address of the registered vet which referred it, and submit the referral letter/report with this claim.
If any part of this claim is for dental treatments please tell the date prior to the claimed problem being noted that the pet had its teeth checked, and if treatment was recommended at this check up was this carried out? Treatment recommended Yes No. Treatment was carried out Yes No.
Please advise the cost of treatment incl. VAT Condition 1 £ Condition 2 £.
IMPORTANT: Please ensure that a dated and itemised breakdown of all treatment costs is attached to the claim form before you send it.
Common questions about Pet Insurance Claim Form
Is there a deadline?
If you are claiming for continuation treatment you can batch your invoices up but you must submit your claims every 3-6 months.
Where do I file it?
Once you and your vet have completed the form, email it to tesco.petclaims@uk.rsagroup.com with the supporting documents. Alternatively you can send it by post to: Tesco Pet Insurance, Freepost - RSJG-ZJTB-GAGH, PO Box 1363, Peterborough, PE2 2QZ. The Claims Helpline is 0345 078 3860.
When is this form not the right one?
Your policy does not cover: Any condition, illness or physical abnormality that exists before the policy started. Any accident that happened within the first 5 days after the policy start date (ACCIDENT & INJURY COVER ONLY). Any condition that started within the first 14 days after the policy start date.
Sources
[1] Pet Insurance Claim Form (06-21), Tesco Pet Insurance (the served file; no issuer file found) (the Official source link on this page).
