Arthritis Investigation and Insurance

J

Jiminey

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18 February 2013
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Hello.

A bit of background....my 22 year old pony was lame for two weeks. I then called our vet who agreed he was lame and suspected the knee. He then suggested we take xrays to look for damage (there are occassional hijinx in the field).

After the xrays had been taken it was discovered it is arthritis. For which I have decided on corticosteroids.

My question is where do I stand with my insurance (I intend to phone them as the policy documentation says "injury" is covered)?

At the point right up until I had the xrays processed I had no idea it was arthritis and could have been anything. Can I expect the insurance company to pay for the investigation as it could've been easily a knock in the field up to that point? I am happy to pay for everything from the point he was diagnosed with arthritis as it isn't an injury but just wanted to know thoughts and experiences.

Thank you.
 
Normally the small print on veteran cover defines injury as something along the lines of visible external accidental injury only so you need to check your policy in more detail but it would be very unusual for a veteran injury only policy to cover those sorts of investigations unfortunately.

Always worth a quick call to your insurers to check though, you could be lucky!
 
Always worth submitting. Depends on how they are defining injury but as long as it isn't specified as accidental external injury they may pay for the investigations
 
Thank you for replying. I think I will plonk in the claim and will post the response I get in case anyone has an issue in future.
 
I agree with ihatework on this one. Years ago P went badly lame in one hock. Insurers said yes, go and have x-rays done and we will pay. When the diagnosis came back as spavins they refused to pay even though they'd given me the go ahead. Their excuse was that he had his birthday between the go ahead and the claim being submitted so he would then be on their veteran policy under which such investigations were not covered.
 
3OldPonies said:
I agree with ihatework on this one. Years ago P went badly lame in one hock. Insurers said yes, go and have x-rays done and we will pay. When the diagnosis came back as spavins they refused to pay even though they'd given me the go ahead. Their excuse was that he had his birthday between the go ahead and the claim being submitted so he would then be on their veteran policy under which such investigations were not covered.
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Now that is naughty and I would have fought that. They should have paid out if investigations were done prior to birthdate and during a valid insurance cover
 
If it is an injury only veteran policy you are not covered for internal issues like arthritis. You would need a full policy for that. They won't pay for the investigation as it wasn't a knock in the field. The cause was identified.
 
ihatework said:
Now that is naughty and I would have fought that. They should have paid out if investigations were done prior to birthdate and during a valid insurance cover
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I did indeed fight it - but nothing doing. They lost out in the end, I had three policies with them and I cancelled all of them. So although I ended up out of pocket on one side, they ended up even worse off as the combined premiums on all three across the year were more than the investigation cost - it would have been cheaper for them to pay up and to have kept the business.
 
3OldPonies said:
I did indeed fight it - but nothing doing. They lost out in the end, I had three policies with them and I cancelled all of them. So although I ended up out of pocket on one side, they ended up even worse off as the combined premiums on all three across the year were more than the investigation cost - it would have been cheaper for them to pay up and to have kept the business.
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I don't think they could do that as essentially they are changing your policy cover and terms mid-term. That isn't what you agreed to and paid premium on. Did you go to FOS?
 
No I didn't go to FOS, I didn't know about that at the time (big sigh). I just paid up, I hate not having my vet account up to date, and told them to get lost. Needless to say it was one of those companies that make vets go 'oh no' when they hear you are insured with them.
 
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