How to process pet insurance claim forms in a veterinary practice

To process pet insurance claims without a backlog, treat each claim as a pack with a checklist and an owner: the client's part, the itemised invoice, the clinical history, the policy number and the vet's section. Keep one register of every open claim and what it is waiting for. Most delays are a pack with one piece missing and nobody watching it. An AI worker can assemble and chase the pack. The vet's section, and every clinical fact in it, is the vet's to check and sign.

Whose claim is it, and when does it begin?

A client asks to claim, usually at the desk as they pay or by email a few days later. RCVS guidance is clear whose claim it is: the policy is a contract between owner and insurer, and "the only person that has the right to submit a claim under the policy is the client/policyholder". The practice supplies the facts, and may invoice the insurer when the client authorises it.

Who handles a claim today?

1. The client's part. The owner gives the policy number and completes their section, on paper or on the insurer's site. Reception often has to ask twice.

2. The pack. A receptionist or insurance administrator gathers what the insurer wants. Agria, for example, asks a practice for the itemised invoice, the pet's clinical history, the policy number and the reference of any earlier claim for a continuing condition.

3. The vet's section. The vet who treated the animal completes it, or checks and signs what an administrator has prepared. RCVS guidance says vets "must complete claim forms carefully and honestly", showing the amounts actually paid or, on a direct claim, charged, "with any additional or administrative charges shown separately". Discounts "should be accounted for on any paperwork sent to the insurer", and a vet should not sign a blank form. This step waits for a gap between consults.

4. The client's copy. Where the practice sends the claim itself, RCVS guidance calls it "good practice to send a copy of the completed claim form to the client before submission".

5. Submission. The claim goes by the insurer's portal, by post, or straight from the practice system where it is linked to a claims service.

6. Queries and payment. The insurer asks for more history or pays. On a direct claim the practice then bills the client for the excess and anything not covered.

How do you stop claims stalling?

• Start one register. Every open claim on one list: client, animal, insurer, date opened, what is missing, who has it.

• Ask for the policy number at registration, rather than on the day of the claim.

• Write one checklist per insurer. They differ, and so do their time limits. Agria's is the end of the period of insurance or six months from the first date of treatment, whichever is later. Put each insurer's limit on the register.

• Give the vets a set time. Ten minutes at the end of a session for claim sections, with the packs ready, beats a pile on a desk.

• Tell the client when the claim goes. It saves the call asking why nothing has been paid.

The pack an AI worker can build and chase

An AI worker works to a job that is written down, with a named person at the practice checking its output and a review of the role each month. In this job it can keep the register, ask the owner in writing for their part and remind them until it arrives, and assemble the pack from the practice system. It can check the pack against that insurer's checklist and put it in front of the vet complete, so that your vets can open a whole claim and sign it once. Once the vet has signed, it can send the client their copy, record the date the claim went, and remind the practice manager of any claim still unsettled after the days you set. The role is described on chasing clients for documents, the money owed afterwards on invoice and payment chasing, and the wider desk on our page for veterinary practices.

What only the vet signs, and what a person decides

• The vet's section and signature. The clinical facts on a claim are the vet's. The agent never drafts a diagnosis, a date of onset or an opinion on whether a condition existed before the policy.

• Releasing the claim. Nothing goes to an insurer until the vet has signed and a person has released it.

• An insurer's question about the animal goes to the vet.

• Direct claims. Whether the practice will wait for the insurer to pay is the practice manager's decision, client by client, once someone has checked the policy and its excess with the insurer.

• Calls, disputes and bereavement. Calls to an insurer, a refused claim, a client who cannot pay the shortfall and any account where the animal has died go to a person.

• Any worry about an animal. If an owner's message also describes a symptom, it goes straight to a vet or nurse. RCVS guidance says vets and nurses should ensure support staff "do not suggest a diagnosis or clinical opinion", and the agent is held to it.

What to gather first

• A count of open claims and the age of the oldest.

• The insurers your clients use most, with each one's checklist, route and time limit.

• Your policy on direct claims.

• Whether your practice system is linked to a claims service.

• The wording for each message to an owner, and who releases a claim.

Claims are one of several queues that grow with the consult list; the rest are in our article on scaling a veterinary practice without hiring more staff.

Keeping the claims register and building each pack would fall to an AI worker in a veterinary practice, and every clinical fact and the vet's signature would remain your vets'. Bring us the claims waiting on your desk for a missing history or a vet's signature, and talk to our agent.