Anyone experience an insurance claim being knocked back?

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Overgrown Pony

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Hey guys

Ive never had to claim on insurance before. Ive just had a claim knocked back for extremely unfair reasons and I'm so very sure I'm entitled to make this claim...

Is there anyone that would be willing to chat via PM? Im not sure on the best and most sensible way to go about asking them to reconsider :s
 
Was the claim knocked back by the insurance company or by a "loss adjuster" (for which ,read theiving con merchant)
 
Yes, purely due to the wording on the form sent to them by the vet!! Vet reworded it correctly and they still refused to pay out. The vet said he had seen the horse for similar treatment before but it was in fact completely unrelated. Put me off insuring for vets fees.
 
Mike007 said:
Was the claim knocked back by the insurance company or by a "loss adjuster" (for which ,read theiving con merchant)
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This happened to me with a NFU, they use a loss adjuster who was on Watchdog (if I remember rightly), that company has renamed itself since the bad press but it pretty much the same, well just changed the two words the other way round. I threatened to use the Ombudsman as knew I was in the right. They then decided to accept the claim. The loss adjuster had no idea, I got my vet to ring them up to argue my case and they were shocked at their lack of knowledge considering they were the ones deciding to pay or dispute claims.
 
I had a huge saga with Petplan regarding a claim I made last year. At one point it did look like they were going to not pay out despite it being a genuine & covered claim.
I reported them to the financial ombudsman http://www.financial-ombudsman.org.uk
The FO contacted them stating that they were starting investigate my complaint. Pet plan immediately backed down & paid my claim (plus compensation & an apology )
After about 4 weeks the FO asked me if I wanted to uphold my complaint, I chose not to as I'd had the out come I'd wanted.
Supposedly the FO will whack a hefty fine on the insurance company if they are found in the wrong so as soon as they find out they are being investigated they pay out because it's cheaper ;)
 
Laafet said:
This happened to me with a NFU, they use a loss adjuster who was on Watchdog (if I remember rightly), that company has renamed itself since the bad press but it pretty much the same, well just changed the two words the other way round. I threatened to use the Ombudsman as knew I was in the right. They then decided to accept the claim. The loss adjuster had no idea, I got my vet to ring them up to argue my case and they were shocked at their lack of knowledge considering they were the ones deciding to pay or dispute claims.
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I have no idea if it's been a loss adjuster that's made the decision on the insurance company themselves. I just received a letter from the insurance company to say my claim has been rejected.

I'm going to wait and see what my PMd people that have the full story respond with then will get in touch with the Financial Ombudsman as I really feel that I should be insured for this.

Horrible feeling when you pay your money each month thinking you're safe in the knowledge that if anything did happen to your precious horse you'd be covered :(
 
glamourpuss said:
I had a huge saga with Petplan regarding a claim I made last year. At one point it did look like they were going to not pay out despite it being a genuine & covered claim.
I reported them to the financial ombudsman http://www.financial-ombudsman.org.uk
The FO contacted them stating that they were starting investigate my complaint. Pet plan immediately backed down & paid my claim (plus compensation & an apology )
After about 4 weeks the FO asked me if I wanted to uphold my complaint, I chose not to as I'd had the out come I'd wanted.
Supposedly the FO will whack a hefty fine on the insurance company if they are found in the wrong so as soon as they find out they are being investigated they pay out because it's cheaper ;)
Click to expand...

Will PM you glamourpuss as sounds like i'm in the exact same boat that you were in x
 
About 6 months after I bought my horse he was found to have a broken tooth. The insurance company weren't going to pay out for it as they said he could have had it when I bought him. My vet wrote them a letter saying that it needed to be taken out and that I couldn't afford the £1500 fee. The insurance company then agreed to pay half. Better than nothing.
 
Insurance companies only exist becasue you pay them more than they pay you - they aren't fair and will do everything and anything to stack the odds in their favour.

If you are going to deal with them you have to play by their rules, read the small print and adhear to their rules to the very last t. No matter how silly it feels.

I have just insured my new purchase - one of the questions the NFU asked when I called them for a quote was 'have I ever called a vet to discuss an issue about any horse I have owned' - I clarified and the time period was ever, and it was irrelvant of whether there was an insurance claim or not.

I've owed horses for 20+ years , up to 6 at a time, I couldn't possibly remember all the times I've spoken to them about bits and bobs. I asked them how that could possibly be relevant but the lady wasn't horsey so she didn't really understand what an insane question it was!
 
asmp said:
About 6 months after I bought my horse he was found to have a broken tooth. The insurance company weren't going to pay out for it as they said he could have had it when I bought him. My vet wrote them a letter saying that it needed to be taken out and that I couldn't afford the £1500 fee. The insurance company then agreed to pay half. Better than nothing.
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When I was given the initial quote by my vet for the potential works needed I called the insurance and asked how much longer it would be before my pro-forma claim was looked at as I couldn't afford the treatment and my horse was standing on box rest waiting and they said that I needed to go ahead and get the treatment and pay for it myself and just hope i'm insured :s

I do have the money in my savings to pay this large bill but i'm so sure i'm covered that i'm going to try hard to get this sorted out.
 
Polos Mum said:
Insurance companies only exist becasue you pay them more than they pay you - they aren't fair and will do everything and anything to stack the odds in their favour.

If you are going to deal with them you have to play by their rules, read the small print and adhear to their rules to the very last t. No matter how silly it feels.

I have just insured my new purchase - one of the questions the NFU asked when I called them for a quote was 'have I ever called a vet to discuss an issue about any horse I have owned' - I clarified and the time period was ever, and it was irrelvant of whether there was an insurance claim or not.

I've owed horses for 20+ years , up to 6 at a time, I couldn't possibly remember all the times I've spoken to them about bits and bobs. I asked them how that could possibly be relevant but the lady wasn't horsey so she didn't really understand what an insane question it was!
Click to expand...

The more I hear the more I think you're totally right in that they'll do everything in their power to get out of paying out :(
 
Hi, I'm just going through the same thing. Had a claim rejected, but the vets feel my claim should be covered. Currently the vet has sent further reports and I've had to provide further evidence.
Interested to know the next step if they reject it after my appeal. How do you find out who rejected the claim?
Thanks
 
nuttychestnut said:
Hi, I'm just going through the same thing. Had a claim rejected, but the vets feel my claim should be covered. Currently the vet has sent further reports and I've had to provide further evidence.
Interested to know the next step if they reject it after my appeal. How do you find out who rejected the claim?
Thanks
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You can make a formal complaint to the complaints dept (details will be in your T&C booklet) then if they uphold the rejection you can appeal by the financial ombudsman
 
Polos Mum said:
It isn't becasue they are mean or nasty - it's their job, their purpose is to not pay you and make a profit for their shareholders.
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Exactly. Insurance companies aren't the NHS, they are profit making businesses. And insuring, except in a few regulated areas, is essentially gambling. Both sides are playing the odds. That's not a criticism, it's just how it is.
 
Nfu refused my claim.
I kept on at them, my vet debt further reports and their consultant vet looked into the case.
I was about to go to the ombudsman
But they paid out in full.
Even sending me flowers and a separate cheque for £100 for the emotional turmoil id been through.
It took 6 months but dont give up.
If you are sure you are covered they should pay and shouldn't get out of paying.
 
Hi, just wanted to say I also pushed back to the NFU regarding my rejected claim. Had to send further vet reports and submit evidence (I'm claiming for OCD, horse was lame previously, unrelated field accident) I'm pleased to say today I had my claim accepted! I'm glad I went with my gut and stuck by my vets' opinion. Good luck!!
Ps it has taken 5 months to get it accepted!
 
E and L refused my claim years ago when my horse had cancer. I had declared on the form that he had had wolf teeth removed but the vet just put no previous problems (as it wasn't relevant to the cancer). They said they wouldn't pay as our forms didn't say the same thing. I wrote and complained as I had been truthful and luckily they did pay before I went to the ombudsman. However, the amount they paid out was less than the amount I had paid in premiums that year as they excluded lots of things from his treatment and put the premiums right up (£70 a month about 18 years ago). They also excluded cancer form his insurance even though I had LOU on him - at the end of the day we both knew what he was going to die from. I decided then not to insure but save instead. I am about £15k in front at the moment!
 
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