Can insurance company insist on a post mortem?

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Superhot

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Hi. My friends horse was diagnosed with heart failure nearly 6 months ago, and the vet said she probably wouldn't live for another year. It is obvious the horse is deteriorating, and rather than put her through the winter months, and waiting for her to be struggling for breath etc, my friend thinks it would be kinder to have her horse pets, sooner rather than later.
She has told the insurance company everything, but they insist she must have a PM carried out, to prove the horse did indeed have heart failure. Surely a vet report should be sufficient. Can the insurance company insist on this before paying out? We're not talking vast sums of money here, £1000 for the horse and £200 towards disposal. My friend finds the idea of a PM upsetting, plus of course, she would have to bear the cost. The insurance company, who she has been with for 15 years and never claimed from, have told her she could always cancel her policy!!!! I bet they'd love her to... the company is a reputable one, and I am shocked by their insensitivity at such a time.
 
Yes.

Had my mare PTS 2 years ago due to a slipped disk in her back. Insurance wouldn't pay out unless she
a) was travelled to Edinburgh (2hrs away) to be investigated
b) had a post mortem.

I didn't think it was fair to travel her as she couldn't be buted because they didn't want it in her system when she arrived there, I had arranged for her to be buried on the land around my house.

They wouldn't pay out despite 2 independant vet reports. (My vets were absolutely brilliant, fighting my corner without us even asking, they were amazing!)

I forefitted the money and had her PTS.

Thought I would add in the 4 years I owned her I never claimed and she was insured for LOU, (Insured for competition.) Vets fees and her value of £1500 (The amount I bought her for) etc. They wouldn't even pay out for LOU as she could only ever lightly hack if I hadn't had her PTS and wouldn't pay for the vets bills and call outs. So I lost over £2000 on her. But to put her out of her misery I forefitted it.
 
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Superhot said:
Hi. My friends horse was diagnosed with heart failure nearly 6 months ago, and the vet said she probably wouldn't live for another year. It is obvious the horse is deteriorating, and rather than put her through the winter months, and waiting for her to be struggling for breath etc, my friend thinks it would be kinder to have her horse pets, sooner rather than later.
She has told the insurance company everything, but they insist she must have a PM carried out, to prove the horse did indeed have heart failure. Surely a vet report should be sufficient. Can the insurance company insist on this before paying out? We're not talking vast sums of money here, £1000 for the horse and £200 towards disposal. My friend finds the idea of a PM upsetting, plus of course, she would have to bear the cost. The insurance company, who she has been with for 15 years and never claimed from, have told her she could always cancel her policy!!!! I bet they'd love her to... the company is a reputable one, and I am shocked by their insensitivity at such a time.
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How dreadful sounds like direct line?
 
I'd read carefully through the contract.

It may be a clause for a value over X amount but no-one can comment on it without the paperwork, only she can read the small print.

If there's an out insurance companies will take it. I watched an advert on tv this morning, can't remember who it was but an insurance company showing how great they were, smallprint on the bottom of the screen showed them following through on a whopping... 35% of claims...!

If it isn't required in the contract I'd get a vet letter stating it and any test results copied (ie scans etc) and send as proof and note that the contract does not require a pm.

Pan
 
If the policy terms state a PM must be carried out then unfortunately, yes they can refuse to pay as your friend would have breached policy conditions. Exceptions to the rule would be if the horse had colic surgery and when they opened it up and they saw the extent of the damage they decided to PTS, or if it had an obvious injury, such as broken leg where the bone is on the wrong side of the skin.

The fact your friend has never claimed is irrelevant to them. As far as the insurance company knows, the horse could have a number of issues.

However, as this is a planned planned PTS, and the vet can verify the issue with a vet report I'm suprised they are still insisting on it.

I would also be concerned that although the vet says the horse probably wouldn't live for another year, the insurance company may not pay out as the horse does not warrant immediate humane destruction.

Bit hard to comment without knowing her policy details but it is possible the insurance company will have a referral vet that your friend's vet can discuss it with
 
The vet would have to confirm the horse met with BEVA guidelines to have the horse euthanasied, unless she had LOU in which case she can elect to have the horse PTS and claim even if it doesn't fit with BEVA guidelines.

The thing is, if the horse can live for another 12 mths then the insurance company will exclude the existing heart issue and then she would not be covered if she has it PTS. Basically, in order for her to claim she has to have the horse PTS within 12 mths of the discovery or the condition - sounds harsh but that's how it works as insurance companies do not insure for the inevitable. IF your friend and the vet feels the horse warrants being PTS on humane grounds now then the vet has to put this in writing to the insurer and, unless they have already does so, they are likely to request a 2nd opinion from their vet. If this vet agrees that the diagnosis is correct and the horses needs to be euthansed then they should then agree to proceed and I don't think really they would need a PM in this instance.

In my mind, a PM is generally requested if the cause of death is not 100% known and if there's a possibility the horse died or was PTS due to a pre-existing/excluded condition (ie colic). In this case the reason for euthanasia, and one assumes a fair bit of evidence is there to support this, is known s i wouldn't have thought a PM is necessary. However, sadly insurance companies vary greatly so what one is happy to accept in terms of vets documentation may not be the same for another!
 
If it wasn't in the terms and conditions I would be telling the insurance company you want it you pay for it or accept my vets word (written).

Having had a quick read at my T+Cs from KBIS I don't see a mention of PM but as I said quick scan. I am actually going to read through this now and check for other things. My old boy is inury and colic only as he hasn't even coliced in nearly 12 years of me having him. But illness I'm not insured for.
 
Years ago I had a horse who was killed point to pointing, broke her neck and was dead before the vets could pts....my insurance company still insisted on a pm even though she was dead ! They wouldn't have paid out without a pm or proof of her value.
 
Thank you all for your advice, it has really helped. The vet came out again this week and then rang the insurance company explaining how the horse had deteriorated, and that it was better for the horse to go sooner rather than waiting for her to collapse in the field etc, and the insurance company have given the go ahead, without the need for a post mortem. Why on earth did they have to put my friend through this added stress at such a very difficult time?
So please spare a thought for us tomorrow, when we are both carrying out the final loving thing that we can do for our beloved horses...
 
Yes they can. However the primary concern has to be the horse, and if its in the horses best interest to be put down - then that's what should happen. Claiming on the insurance is incidental and shouldn't influence the decision.
 
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