I'm tyring to figure out if I have any options after VHI recently reversed a previous claim settlement and deducted it from a claim almost 12 months later and in a different policy year. To give some background my wife was in a bad accident and has required significant dental reconstructive work over the last 12 months with a final bill shy of 20k. Shortly after her accident, my wife had a denture made up by her dentist whilst we figured out what options were available to her. VHI covered 70% of this cost amounting to a few hundred euros.
In the last year my wife has had major reconstructive work done by a dental surgeon and prosthodontist and I submitted the final claim to VHI recently. The way the policy is structured of the 8 teeth she needed replaced they contributed to a fraction of the cost for 1 of those and then applied the policy limit of €600 and made no contribution towards the other 7 but showed them on their settlement statement.
Now for the kicker as all the teeth were replaced they reversed the decission to pay out for the denture as they determined it to be temporary and deducted it from the €600 limit for this years policy. Of the 8 teeth missing the denture replaced 6 so my argument is that their contribution was towards 1 of the teeth not covered by the denture and us paying for the replacement of the others is irrelevant and the denture payment should stand. Is this a valid argument? They also are applying a single years policy limit to two policy years as they class all of the treatments as occuring in a single year since the first of several commenced in the first year. Is this normal practice?
In the last year my wife has had major reconstructive work done by a dental surgeon and prosthodontist and I submitted the final claim to VHI recently. The way the policy is structured of the 8 teeth she needed replaced they contributed to a fraction of the cost for 1 of those and then applied the policy limit of €600 and made no contribution towards the other 7 but showed them on their settlement statement.
Now for the kicker as all the teeth were replaced they reversed the decission to pay out for the denture as they determined it to be temporary and deducted it from the €600 limit for this years policy. Of the 8 teeth missing the denture replaced 6 so my argument is that their contribution was towards 1 of the teeth not covered by the denture and us paying for the replacement of the others is irrelevant and the denture payment should stand. Is this a valid argument? They also are applying a single years policy limit to two policy years as they class all of the treatments as occuring in a single year since the first of several commenced in the first year. Is this normal practice?