Has anyone had their insurance claim refused?

3Beasties

3Beasties

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Am feeling rather p!ssed of today as I have just heard that my claim for my horses diagnosis and ongoing treatment has been refused by the insurance company (3 guesses which one ;) ). It is partly my fault as I stupidly ticked one little box that I shouldn't have for a question that I misread/understood. I don't really want to go into all the details but basically I ticked that he does an activity that he actually doesn't and never has done, but he isn't insured for that said activity.

So my question is have you ever had your insurance claimed refused and did you successfully dispute it?

I will be emailing them back to try and dispute it, is there anything I should include that could help win my case?

Sorry I know that's a bit vague but hopefully you will get the gist!

PS - No need to tell me what a numpty I am and that it is my fault.....I already know that!!
 
was he doing ' that activity ' at the time of his injury? Because if he was then I can see why you wouldn't be covered.

However in answer to your original question. No, I have never had a claim refused but then I always make sure that I inform my insurance company the minute the horse has a problem and don't over estimate my horses abilities!

Good luck

ps is it that well known wE'll take your money & it's your Loss type of insurance company?
 
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Nope he wasn't and never has done, I ticked that he hunter trialled but he's never actually competed in anything due to one thing or another.
 
If it is the company which is EasiLy identifiable ;) go straight to the insurance ombudsman. Don't mess about with them. Then change insurers, they are cheap for a reason!
 
Yes THAT insurance company refused to pay out on a claim because I hadn't informed them of a totally unrelated and minor problem that my horse had and which was so insignificant that I hadn't bothered to claim for two years before. I mean, I was saving them money! Anyway, after six months of chasing them and arguing with them and getting nowhere, I told them that I was in a process of writing to Watchdog and that I had gathered a group of thirty other dissatisfied customers of theirs over the internet and all these people would go on record on the programme. (All fictional but I was intending to do it). I got my cheque two days later. :)
 
Sorry to hear they won't pay up :-(
I have to say that that insurance company have been fantastic with me, one of my ponys had laminitis so had X-rays and on going blood tests etc and they have payed up no problem, the bill is well over £1000 now and they have been fine! Payed the full amount minus the excess :-)
 
3WiseBeasties said:
Yes it is that well known company :cool:

Should I bother emailing them or would I be wasting my time?
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I have dealt with them many, many times (working at an equine vet practice) and they do tend to try and wiggle their way out of paying most claims. You really need to get on their case, send a recorded delivery letter stating your case and insist on a response within a set time. They usually give in after a bit of a fight :rolleyes: but I think they leave people hanging in the hope that they will just give up.
 
Thanks Rhino that's good to know. I spoke to them today and they said I could email them my argument so need to work on that this weekend, obviously need to get my case across in the best possible way!
 
send them a hardcore e-mail backed up by a copy registered letter. Dont let them mess you about. Threaten them with the insurance ombudsman if you dont get satifsaction!!
 
My insurance company (not the one here) refused to pay out for my horse to have a tooth out as they said it could have been broken when I bought him 6 months earlier. My vet got involved and wrote to them saying it needed to be done and I couldn't afford it so in the end the insurance company paid half of the £1500 bill. In fairness they had just paid out for a £2000 bill for a kicked hock! I have stayed with them for 4 years now.
 
Just go back to them and say that was an error - in fact write to them and say that and then ring to ensure they have received your letter/email. IF you have never taken part in that activity and it's a genuine error on your part in completing the claim form then there is no reason they will no reopen your claim. IF they continue to turn it down then I would ask to speak to the manager and explain to them. you may have to get something in writing fron your vet to confirm you have not taken the horse hunter trialling.

Honestly, it should not be an issue - everyone makes mistake (especially THAT company!) so they should be understanding, so I would keep at them. Read the claim and complaints procedure and DO take it to the ombudsman if needs me (you won't be the first with this company!!). I worked in equine insurance for many years and it never ceases to amaze me how this company is (a) still trading and (b) continues to be as unhelpful as they are!!!

Pursue it!!
 
Yes I've just had a claim turned down to, it's gutting! I had 2 vets say that the problem with the eye wasn't linked to something picked up in the vetting but they're not having it and also have said that because he had a slight skin problem he was probably itchy and rubbed him self on a hay net which caused the eye problem. Vets are writting a letter for me. I'm most annoyed as I called them at every stage of the process and at no point did they say there might be a problem. I sent him to Liphook after calling them and being made to think all was ok. If I'd known there was going to be an issue I'd have had him treated at home.

I'm going to fight, I can't afford not to. Would be interested to hear which company you're talking about so if somebody could pm me that would be great.
 
That same company tried to refuse my one and only insurance claim that i have ever had in over 40yrs, they said my then veteran was only insured for accidental external injury and didn't want to pay out for a horrendous case of choke that ended up with a stomach pump.

They said it was an internal injury so i argued that if he had been kicked and broken a rib then would they pay out to which they replied 'yes' so my argument back was that the choke was caused from an external force in the same way that a kick was external.

Had to go right to the top but eventually won, they paid out and i cancelled my insurance with them immediately.................
 
THAT insurance company have been really good with my familys claim, aftermy beautiful horse got PTS following a kick in the field. They payed for everything she was insured for and all vets .

Therefore if you are not insured for that activity then why should they pay out as your not insured for it? Any insurance company would including the best knownones.
 
fornema said:
Therefore if you are not insured for that activity then why should they pay out as your not insured for it? Any insurance company would including the best knownones.
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Because she has never done the activity! She made a simple mistake and 'the company' are using this as a technicality to avoid paying!
 
3WiseBeasties said:
Thanks Rhino that's good to know. I spoke to them today and they said I could email them my argument so need to work on that this weekend, obviously need to get my case across in the best possible way!
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You need to ignore most of the advice you have been given so far.

The fact is that they have in their possession a form on which you have indicated that your horse hunter trialled.

They rejected the claim on this basis because you were not insured for that activity.

You are now saying that it was an error on your part and the horse has never hunter trialled.

I am sorry, but you cannot expect them to simply accept that you made a mistake. This claim will not be paid, and you will be wasting your time going to an ombudsman or fighting it at all unless you can now produce PROOF that your horse has not hunter trialled during the insurance period. It is going to be exptremely difficult to prove a negative.

Two suggestions would be to get someone in authority, eg the Yard Owner, a JP or a Police Officer who knows you extremely well, to write a letter confirming that they know for certain that you have not hunter trialled the horse, or trained for hunter trialling, and stating how they know this and how long they have known you.

Another possibility would be for you to go to a lawyer and get a sworn statement that you made an error in filling out the form.

Unless you can do this, I do not think your claim will ever be paid. It is not their responsibility now to prove that your horse has hunter trialled, it is yours to prove that he did not (and neither did he practice for competition even if he never took part in one).
 
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rhino said:
Because she has never done the activity! She made a simple mistake and 'the company' are using this as a technicality to avoid paying!
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I am no fan of the company. My own vets will not deal with them because they are so difficult.

BUT, this is not strictly true. The claim has been refused on the basis that the claimant confirmed that the horse had been engaged in an activity for which it was not insured.

With the amount of fraud in insurance these days, they are perfectly within their rights to refuse the claim and to continue to refuse it until the claimant produces some strong evidence that she did indeed fill the form in incorrectly.
 
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Santa Paws said:
You need to ignore most of the advice you have been given so far.
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Some of us were speaking from experience ;)

This is not an unusual problem and I know that this company has paid out before in near identical circumstances..

ETA Santa Paws - any chance you could edit out the company name in your post or the whole thread may be deleted :)
 
Mmm I have avoided that particular company like the plague as have heard terrible things about them. Having said that, I think many insurers will try and windle their ways out of paying! I am insured with another company and put my first claim in last month. My horse came in with a kick injury and had to be sedated (she's an absolute wuss!) for it to be cleaned etc. She then had to have the syringe paste antibiotics as she refuses to eat the granules, which cost £90 for 5days, along with bute as well. She had an alpha-2 reaction to the sedative and colicked that night so resulted in another emergency call out and more jabs! Total bill from one superficial kick wound was £500. My excess is £120 so I paid that the other week, then recieved a letter from insurers saying they will pay £175 for kick wound and meds, but not the rest for the colic. This was due to me forgetting to put on renewal that she had suffered flatulence colic two years ago. B
 
Santa Paws said:
You need to ignore most of the advice you have been given so far.

The fact is that they have in their possession a form on which you have indicated that your horse hunter trialled.

They rejected the claim on this basis because you were not insured for that activity.

You are now saying that it was an error on your part and the horse has never hunter trialled.

I am sorry, but you cannot expect them to simply accept that you made a mistake. This claim will not be paid, and you will be wasting your time going to an ombudsman or fighting it at all unless you can now producte PROOF that your horse has not hunter trialled during the insurance period. It is going to be exptremely difficult to prove a negative.

Two suggestions would be to get someone in authority, eg the Yard Owner, a JP Police Officer who knows you extremely well, to write a letter confirming that they know for certain that you have not hunter trialled the horse, and stating how they know this and how long they have known you.

Another possibility would be for you to go to a lawyer and get a sworn statement that you made an error in filling out the form.

Unless you can do this, I do not think your claim will ever be paid.
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Totally agree with this, and posting this on the internet was a bad idea as it is your matter, you may find that the insurance company will look for online records which mean they dont have to pay up.
But if you wer'nt insured for the activity then the likliness of paying out is poor as it is an error on your behalf not theirs.
 
I recently put in a claim when my horse came in with a kick injury (a different company). She had to be sedated for it to be flushed and cleaned (she's a real wuss) and then had an alpha-2 reaction to the sedative and colicked that night resulting in two emergency call outs and over a £150 worth of meds in the end. Total bill from one little superficial kick wound was £500. Paid my excess of £120 to vets and then recieved letter from insurers saying they will pay £175 for kick wound, but not the colic. This was down to me forgetting to tell them on renewal that she had suffered flatulence colic two years ago. Even though it was purely down to a reaction from sedative which the vets confirmed, and nothing to do with her being prone to it, they will not pay it. Haven't argued it to be honest because I should have declared it so my own fault!
 
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