Has anyone made a succesful appeal against an insurance company?

[BuzzyBea]

I don't what to go into details here as my appeal is ongoing but wondered if anyone could tell me if all the stress and heartache that goes into persuing the appeal is worth it or am I likely to get nowhere??!! Am happy to private message if anyone would like more info.

 

[fishy]

I tried, I lost my mare in a freak accident in January and made a mortality claim. This was refused so I challenged it in writing. Insurance company rang me to ask questions then asked for a written statement from the attending vet (who was not my vet as accident was miles from home) Insurers then sent me another letter with the report stating that the euthanasia still did not meet their guidelines. This was 2 weeks ago and I haven't the heart to fight it any longer as I've found the last few months very hard. I would still make the same decision tomorrow as I believe it was the right thing to do for my mare. Good luck with whatever you decide. X

 

[trickivicki]

Ombudsman service. It's what you pay your taxes for

 

[NikNak1]

A long time ago we found our horse dead in the field the vet suspected a heart attack or brain haemorrhage. He was only about 10 at the time. The insurance originally refused to pay out as there was no post mortem carried out. Fortunately my dad was a solicitor so wrote to them threatening legal action, funnily enough they paid quite quickly after that! So I would say it's definitely worth trying

 

[kathantoinette]

I got in a bit of a pickle about a claim I made and got the 'injury not pre-disclosed line', letters went forward and backward until I finally threatened to involve the Ombudsman and then they settled.

 

[glamourpuss]

I had a claim refused a couple of years ago. The insurance company had wrongfully put inaccuracies & exclusions on the horse's policy. Despite my arguments & proof that they were wrong they still refused to pay the claim (this was also after insuring the horse with the same company for 14 years & them admitting I'd never claimed before).
I took them to the financial ombudsman, within 48 hours of me submitting my grievance with the FA they'd paid the claim in full, given me a full apology & compensation.

 

[BuzzyBea]

Thank you. That's given me heart to continue the fight.

I had a letter yesterday from the insurance company refusing to consider the appeal despite supporting letters from the attending vet, previous vet and surgeon. Next stop is the ombudsman.

 

[LeannePip]

I wish you good luck BuzzyBea - Insurance companies are the worst for making you feel awful at an already (probably) very bad time!

We fought with our insurance company for months over a claim for my horse, it didn't get us anywhere but looking back on it, we should have gone to the ombudsman, although the vet was on our side it was very hard to pin them down to get any help from them so we gave up

 

[crabbymare]

It is possible if you have the backing of the vets. a lot of them save paying out because they know a good percentage of people will not persue the appeal or go down the ombudsman route so it makes financial sense for them. problem is (especially after losing a horse) people are often understandably to upset or worried to want to keep going after them

 

[Emma_H]

So sorry for the loss of your girl.

I had a battle with mine and did win eventually. When my old horse died of a lypoma my insurance company refused to pay his death benefit as they said I could have had it operated on. My vet had told me that he wouldn't operate on a 21 year old horse as the chance of success was less than 10%.

I was so distressed at the time of receiving the letter as they were basically telling me my horse has been pts for no reason.

My vet wrote to insurance co explaining his decision and they paid eventually.

Go to the ombudsman for sure

 

[Cortez]

Insurance is a business. They are basically betting against the odds of people claiming, and pursuing claims if they put obstructions in the way. I would imagine that there are enough people who give up when presented with difficulties to make it worth the companies while to take that route. Heartless, but never forget: insurance companies do not exist for your benefit.

 

[eggs]

Wish I'd thought of going to ombudsman when the insurance company refused to pay out when I found my 3 year old dead in the field as the post morten (showing she had a massive malignant tumour in her abdomen) was not carried out by an approved vet.

 

[Buddy'sMum]

I did battle with E&L for months after they refused to pay a claim for vet fees, despite having absolutely no grounds to do so. When I called the Ombudsman to ask how to go about starting the complaints procedure, they said they'd send me the forms etc I needed and also they'd write to E&L to inform them that I'd contacted them and was planning to make a complaint. Settlement cheque arrived from E&L 2 days later!
So, yes, definitely worth taking a case to the Ombudsman.

 

[smellsofhorse]

I did.
Took 6 months but they paid out.
Initially they had refused so I appealled.

 

[Elbie]

The thing with the ombudsman is, if you make a complaint, the insurance company gets charge by the FOS, whether the result goes in their favour or not. Therefore, it normally make sense for them to just pay the claim if threatened as they may be paying out less money that way. Its not a case of them getting scared, its just more financially sensible that way.

However, this also contributes to premiums rising as companies are having to pay out for claims that should be declined for not meeting the policy terms and conditions. I'm not saying though that if you feel your claim has been wrongfully handled you shouldn't take the matter up.

The Consumer Insurance Act is coming in to force which means Insurers can't put barriers in the way of people making claims. My advice would be make sure you read the policy booklet cover to cover and understand exactly what you are signing up for.

OP - you have gone down the right route of appealing to the insurance company first. If you are still unhappy with the decision then next step would be FOS.

 

[marble]

I am in the middle of dispute with well known insurance company, not about an animal thank goodness, but has been going on some time, when I finally woke up, phoned omsbudsman then phoned insurance company saying I had done so, things have very quickly happened. I am now fairly sure this will be sorted out. That was just a phone call, and yes I feel my claim is valid.

 

[BuzzyBea]

Thank you for all of the very interesting replies.
I was planning to write to the Ombudsman with supporting letters from the vets and surgeon involved but from what you have said it might be worth a quick call initially.
You are all very right when you say that they appear to try it on at a time that is stressful enough without them adding to it. I am adamant though that I am going to continue fighting, especially when the professionals that have dealt with him through his illness all think that the insurance company is in the wrong. They have made me so angry that they haven't been there to support me as I had assumed they would. Also agree that everyone with insurance needs to be fully aware of all the wording in their policies as I have totally lost faith in the value of them.
...and this is with one of the biggest and supposedly best companies out there!!

 

[Elbie]

As someone who works in the insurance industry, feel I need to defend my profession a little bit! I don't agree that insurance companies "try it on" at a stressful time. Unfortunately the nature of the business is dealing with vet fee and mortality claims. The nature of the claims will be upsetting, however, clients need to submit them in order to have the claim assessed. It's just unfortunate that due to the nature of the claim if the insurers don't agree with it then it would add more distress to the client.

OP - good luck with your case and hopefully you get an answer soon