Am I expecting too much from my insurance commpany?

[PucciNPoni]

I have a policy (well, three actually) with one insurance company. It has two horses and my wee lorry on the policies.

Two years ago, the insurance company refused to pay for scintigraphy on horse number 1 because I had not notified them in writing prior to the procedure. I had telephoned them beforehand, and in fairness, they did say the vet should contact them in writing before they would pay out. This didn't happen so I had to shell out some £600 to pay for the bill.

Fast forward to January 2011. I have a horse on loan that I have had for almost a year. I had been trying to get weight off this horse and it would gradually come off and then just sort of plateau and then pile on again. The weight just wasn't coming off and staying off despite me doing several different things (I'm not looking for advice on this, so please no comments - it's now coming under control). However in January I spoke to the vet and asked her about EMS/IR. We decided that it would be a good idea to have him blood tested for this and before proceeding with the blood work, I contacted the insurance company to ask about whether they'd cover, and did they need any special notification etc? They never indicated to me they would not cover.

I submitted the bills, and got a phone call and then a letter to basically ask for more details surrounding the dates of illness? As this was something that didn't have a specific date I said as such. I explained as best I could over the phone. Then on the letter they wrote to me they were bascially telling me that if it was a prior condition, they'd not cover. I wrote back to say that the horse is FAT, not ill - but the blood work is to verify whether or not there is a condition. He was never diagnosed previously with anything - but I wanted to ensure that he doesn't BECOME ill or have a laminitis attack etc.

So they finally wrote back the other week stating that;

"in order to claim under the vetinary fee section of your policy, the horse must bbe proved to be suffering from an actual injury, illness or disease that first manifested within the policy period. As a result of the IR and EMS are both negative, it appears that HORSE 2 is not actually suffering from a clinical condition."

So at the time, horse 2, fat and can't get weight off despite my best efforts of diet/soaking hay/exercise/muzzling/underrugging etc - suspect there might be something underlying that should be attended to - and get bloods to verify whether there is or is not. Spend nearly £300 in bloods and vet appointments and have results come up negative so the insurance company says horse is healthy, so we won't pay?

I'm a little confused. If a horse has a lameness workup and nothing conclusive is found would they not pay because they couldn't find anything?

Meanwhile, the information that was gathered by the vet was sent to a nutriotionist who then said "You're not feeding too much, but just feed him less anyway" (arrrgh!).

An expensive lesson learned, but as glad as I am that this horse isn't diagnosed with anything, the vet still thinks I should treat as a laminitis risk. He's wearing a muzzle, eating straw/hay mixed in very small holed nets (and silly small quantities) with good doer chaff. I've had to resort to someone helping me exercise him as I simply cannot ride him as much as required to keep him fit. He's been fully clipped again and is wearing next to nothing. The weight is reducing again, and I'm pleased. But a little annoyed with the insurance company - so DO I expect too much from them? I have my friends tell me that the insurance company is barking and I should switch to someone else? But is it justified?

 

[Shay]

You might want to name and shame the company - although I think I can guess who it is.

But basically - yes you are expecting too much. They offer insurance because it makes them money. Not because it protects you or your horse. The devil is always in the small print. If there is a way to avoid paying a claim they will. And then exclude that condition from next year's policy when you renew!

 

[PucciNPoni]

You might want to name and shame the company - although I think I can guess who it is.

But basically - yes you are expecting too much. They offer insurance because it makes them money. Not because it protects you or your horse. The devil is always in the small print. If there is a way to avoid paying a claim they will. And then exclude that condition from next year's policy when you renew!

I can understand that all businesses want to make money or they'd not be doing what they do. And perhaps my claim is far fetched -but I didn't think it was that unreasonable?

However, if they exclude my horse for being fat, I will blow a gasket!

 

[0ldmare]

I assume the NHS class obesity (particularly the unexplained type) as a medical condition? It might be worth finding out as it would give you the opportunity to appeal (and threaten them with the Insurance Ombudsman)

Just as an aside (and I know you are not looking for advise) but the chestnut in my siggy was the same, literally lived on fresh air and I had great difficulties keeping her weight down. Turned out she had an underactive thyroid and she had to have 27 dog thyroxine pills a day. It was much easier after that!

 

[YasandCrystal]

Hi I think you will find that all the insurance companies are becoming extremely pedantic on their policy terms and conditions. I believe that the reason for this is the massive advances in diagnostic equipment and procedures and the commensurate cost of these procedures.
Many insurance companies now exclude or only pay half the costs of a body scan. My insurance company is categoric in saying they will not pay for veterinary work if the investigative work is based on anything behavioural in the horse. That is harsh as many complaints cause irritability in a horse and basically if nothing is found then the procedure is down to the owner.
You need a sympathetic and supportive vet.

 

[PucciNPoni]

I assume the NHS class obesity (particularly the unexplained type) as a medical condition? It might be worth finding out as it would give you the opportunity to appeal (and threaten them with the Insurance Ombudsman)

Just as an aside (and I know you are not looking for advise) but the chestnut in my siggy was the same, literally lived on fresh air and I had great difficulties keeping her weight down. Turned out she had an underactive thyroid and she had to have 27 dog thyroxine pills a day. It was much easier after that!

That's a great idea re NHS and how they view Obesity. Of course, insurance company likely to state that the obesity was a pre-existing condition as it predated the policy (he was fat when I got him) and therefore will not pay out. I think they are just looking for every single loophole they can.

We checked the thyroid one the the first blood panel we ran and the only thing that was elevated was the glucose...hence the EMS/IR testing. We didn't check Cushings as he doesn't look like a typical cushinoid. He just thrives on fresh air, hence the muzzling thru October and again restarted in February. Poor horse

 

[PucciNPoni]

Hi I think you will find that all the insurance companies are becoming extremely pedantic on their policy terms and conditions. I believe that the reason for this is the massive advances in diagnostic equipment and procedures and the commensurate cost of these procedures.
Many insurance companies now exclude or only pay half the costs of a body scan. My insurance company is categoric in saying they will not pay for veterinary work if the investigative work is based on anything behavioural in the horse. That is harsh as many complaints cause irritability in a horse and basically if nothing is found then the procedure is down to the owner.
You need a sympathetic and supportive vet.

Arrrgh, a bit frustrating isn't it? An ounce of prevention and all that doesn't mean much to an insurance company.

My vet is supportive, and probably sympathetic enough to maybe write a letter on my behalf. She thinks my insurance company is pretty rubbish, but as far as I know they aren't one of the reputedly bad ones for paying out.

 

[BigRed]

You are being unreasonable. The policy is designed to help you pay vet bills if your horse becomes ill, or injury. The cover is not meant for preventative medicine, after all you wouldn't ask for the money back for vaccinations.