Has anyone successfully disputed an insurance companies decision?

[05jackd]

Firstly I have to clarify that this isn't a rant on my insurance company. They have actually been pretty good over the past year and have paid out on time (mostly). However, we now have a slightly sticky situation and just wanted to see if anyone had dealt with something similar.

Horse had nasal discharge back in October. On X-ray vets identified a loose tooth and removed. This tooth is not connected to the sinuses . Discharge went away for a few weeks but then returned.

Horse referred to specialists who did a CT and identified sinusitis due to teeth that are in he sinuses being diseased. These have been removed and sinuses flushed. Both local and referral vets are saying the first operation should be separate from the second in terms of claim as the first tooth actually had no baring on the sinusitis as it is not connected to the sinuses. I have raised this with the insurance company but they insist it should be one claim which puts the vets fees about £2k above the payout threshold. The vets have written a letter to them explaining their opinion but as the discharge has been a symptom since the outset the insurance say that it should all be under the same claim.

Does anyone have any experience of something similar?

 

[9tails]

I would agree with the insurance company. It seems the vets may have misdiagnosed/partly diagnosed with the first tooth and missed the other diseased teeth.

 

[ihatework]

I agree with the insurance company, from my experience that kind of thing would be a single claim

 

[Ossy2]

I’ll be honest from the info you have provided I’m on the same page as the insurance company unfortunately. The discharge disappeared after first tooth was taken out. It sounds connected to me and the vets missed the additional infected teeth first time around.

 

[dorsetladette]

I would agree with the insurance company. It seems the vets may have misdiagnosed/partly diagnosed with the first tooth and missed the other diseased teeth.

Me too.

The horse was referred for the same symptoms so a continuous issue and claim.

 

[criso]

I have had 2 claims on the same leg. Horse had injured suspensory, course of shockwave, rest, lots of scans. When he started getting worse, more investigation and bone scan revealed a bone cyst in the shoulder. Insurers agreed to a separate claim. I only bothered as the bone scan and op, were well over what was left for a single claim, if it had been under I wouldn't have bothered.

In this case it seems like the original investigations are part of the claim as the discharge was not resolved by removing the tooth. I suppose you could argue that while carrying out these investigations they found an unrelated damaged tooth which was removed. However I would then think you could only split off the tooth removal, not the diagnostics as they were investigating the discharge.

In which case, is it worth doing given you will then have to pay 2 excesses.

 

[Birker2020]

My vet disputed my insurance company when he found coffin joint arthritis in one foot and the insurance company wanted to exclude all three bones in all four feet. The vet won and only the affected foot was excluded from further insurance cover after the 12 month cover had ended.

 

[eggs]

Unfortunately I agree with the others and can see why the insurance are treating it as one claim.

 

[alsxx]

I have successfully disputed and tbh it was an utterly hideous process doing so with thousands of pounds at stake, but quite different circumstances whereby the insurer acknowledged separate claims but then retracted.

From what you have said though, I'd put that under the same claim, sorry.

 

[05jackd]

Thanks for the opinions guys it helps to have some impartial views.