How to Make a Claim
FIND OUT HOW GOOD YOUR INSURER REALLY IS
You only find out how good your insurer really is when you need to make a claim on the policy that you purchased from them. Our commitment to dealing efficiently with all requests for reimbursement of veterinary costs, means that our clients can look forward to a swift resolution of any claims that they may make.
88% of claims processed within 1 day, 98% processed within 5 days*
*After all documentation received. Source: PetSure data Feb-23 to Jan-24
What's Covered
| What is Covered in all Plans |
|---|
Specified Accidental injuries and illnesses |
Tick paralysis |
Cancer treatment |
Skin conditions |
Hereditary and congenital conditions |
Emergency boarding |
Eye and ear conditions |
Cruciate ligament conditions (6 month waiting period applies but may be waived on application) |
Essential euthanasia |
Pet overseas travel insurance (New Zealand and the Norfolk Islands only) |
| Exclusions |
|---|
Certain pre-existing conditions |
Dental procedures |
Behavioural problems |
Elective treatments and procedures |
Food and diets |
Grooming |
Pregnancy |
Pet accessories |
How quickly do you want to be reimbursed for eligible claims?
When it comes time to submit a pet insurance claim, chances are you’ll be a little stressed with your pet being unwell, so you’ll want a process that’s simple and gets your expenses reimbursed as quickly as possible. There are a few different ways to submit a pet insurance claim, with options and time taken to be reimbursed varying by providers, so research is key depending on what’s most important to you. Let’s look at the ways to submit a pet insurance claim:
CLAIM PRE-APPROVAL
- the itemised estimate of costs from your vet,
- with the treatment required and
- relevant clinical records and/or veterinary history.
WANT TO KNOW IF YOU ARE COVERED PRIOR TO TREATMENT?
You can check out the Pet portal for a summary of your coverage or refer to your PDS and Certificate of Insurance for all your coverage information.
Pre-approvals aren’t mandatory, but can provide you with additional reassurance, so if you want to know if an upcoming or specific treatment for your pet will be covered, all we need is for you to email us at claimreview@petsure.com.au with the following:
- Policy number or Policy Holder and Pet Name
- Name of the condition being treated and the proposed procedure
- Name of your regular vet and the vet where the procedure will take place
- An itemised estimate of costs relating to the procedure (optional- if you have it!)
Once we receive this information, you can expect to hear back from us within two business days.
Note: A pre-approval will not be deemed to be valid unless we have agreed to it in writing. The reimbursed amount may vary from the pre-approval if the treatment provided by your vet differs from the treatment request in the pre-approval.
ON THE SPOT WITH GAPONLY®
GapOnly® is the latest pet insurance claims technology available at participating vets that helps pet owners access their pet insurance benefit right away on eligible claims. Claims are submitted by the vet while you’re still in-clinic, and are settled in around 10 minutes. This has been a long-awaited feature by pet parents, as on-the-spot claims processing on eligible claims means less upfront expense.
The service is currently available for all PIA Pet Insurance policyholders, with the latest list of participating vets available at gaponly.com.au
ELECTRONICALLY BY YOUR VET
More than 1,050 vets across Australia can submit your pet insurance claim for you in-clinic electronically – otherwise known as an eClaim. Apart from the GapOnly® claims service, this is the next fastest way to claim, with claims typically processed within five business days. This service is available with all PIA pet insurance policies
ELECTRONICALLY THROUGH AN ONLINE CUSTOMER SERVICE PORTAL
All PIA pet insurance policies will come with access to an online customer service portal, that conveniently houses key policy documents for easy reference, and features to submit a pet insurance claim online and track its progress in real-time. Outside of GapOnly® and submitting an eClaim through your vet, this is the next fastest way to claim, with the added benefit of being available 24/7 online.
POSTING A PAPER CLAIM
Common and Past Claims
| Accident or Illness | Average Claim Amount | Maximum Claim Amount |
|---|---|---|
| Traumatic Injury | $408.50 | $20,114.10 |
| Foreign Body Ingestion | $953.67 | $17,955.80 |
| Neoplasia (Tumour) | $912.99 | $16,168.56 |
| Fractures | $550.63 | $14,957.15 |
| Gastrointestinal Conditions | $463.77 | $12,652.40 |
| Ear Conditions | $231.99 | $11,172.11 |
| Cruciate Disease | $996.20 | $9,543.29 |
| Arthritis | $181.67 | $6,930.56 |
| Eye Conditions | $226.13 | $6,594.66 |
| Snake Bite | $1,242.87 | $6,196.96 |
| Skin Conditions | $248.27 | $5,811.07 |
| Insect Bite | $304.58 | $5,780.39 |
How to Make a Claim Online via Pet Portal
- An existing member: please visit the pet portal to submit your claim.
- A new member: you will be sent an e-mail/text message to sign up to pet portal.
- Simply upload a copy of both the itemised invoice and the consultation notes from your vet visit.
- In some instances, we may require more information to process your claim, such as previous medical history or pathology/laboratory results. If this is the case, we will contact you for this information.
- If your pet was adopted at an older age, please supply adoption paperwork and relevant medical records since adoption.
How to Make a Paper Claim via Post
If you would prefer to send us your claim through the post, please ensure you have completed the following additional steps:
Print a claim form and fill in your details.
Take it with you to the vet and ask them to fill out Section 2. Both you and your vet will need to sign the form.
Attach the original itemised invoices, payment receipts and consultation notes and post them to the following address:
Pet Insurance Australia
Locked Bag 9021
Castle Hill NSW 1765
