Help With Insurance Battle

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Exracey

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Dear H&H Forum

I am desperate for your help.

My lovely 11 year old ex-racehorse 'Pete', TB has recently been lame - after veterinary investigations it seems it could be as a result of a traumatic injury where scans have revealed a tiny bone fracture to the apical section of his sesamoid bone in his right hind fetlock. The vet suggested it could have been a result of a kick from another horse or such like. The vet suggested the best treatment for him would to have the bone chip removed through keyhole surgery which is a relatively straightforward operation with a good prognosis for his future.
He has been insured with our insurance provider from the first day we bought him and we have had no veterinary attention before now - therefore I had only registered him recently when I called the vet out to examine Pete.

Unfortunately the insurance company has rejected our claim for them to pay for the surgery and its reasons seem very unfair; they want me to prove that we haven't had any veterinary attention before now, which is almost impossible to do. They have also pulled me up on his 5 stage vetting - whereby the vets that did the vetting were his current practicing vets at that time, so they were able to prove information unrelated to his vetting; about a period of lameness in his left hind leg (lasting for only 2 weeks) before going sound - the previous owners decided to get a scan done anyway unfortunately scans at that time revealed very minor left hock changes which you would expect in most horses ages 9 years who have been raced. But the point his the changes were in his hocks not fetlocks and it was in his left leg not the right (as injured currently). For this reason I really feel the insurance company is trying its best to squirm out of paying for a necessary surgery.

I am very distressed by this news and feel deeply devastated for my lovely horse who has been an absolutely joy to have. I cannot possibly afford to go ahead with surgery without funding from my insurance.

Please could you offer me some advice in how to improve the outcome of this battle?

Many thanks

Jenny
ps please feel free to PM if you think you could help in any way
 
OK Claims Manager's hat on here and you might not like what I say :-(

Firstly asking for a complete veterinary history from purchase is pretty much standard practise when you make a claim - I had to provide 7.5 years worth from three vets practices and it's a simple matter of contacting your vets who will provide a printout of all calls made to your horse in the time you've been registered with them.

Regarding the vetting - if you knew he'd had a previous lameness issue including arthritic changes to his hocks then this is a material fact and if it wasn't disclosed at the time of insuring him then they could in fact void your policy altogether due to failure to disclose information. They would at the very least exclude his hocks.

I do think they are being exceptionally harsh in refusing to pay out if it's a different joint, in a different leg and your vet is confirming it's down to accidental external injury.

So you need to get your vet to write a letter / report confirming this is his opinion and that it cannot be connected to his hocks or previous lameness - and if you get no joy from this contact the insurer and ask for their complaints procedure - usually writing to a specific person who will assess the evidence and should give you a response within a given time frame. If after following their procedure and if your veterinary evidence is sound you still get no joy then contact the insurance ombudsman and present the case to them

It's a bit of a faff especially if they dig their heels in, but if you can prove its unrelated then you're in with a good shout if you want to fight them.

Good luck
 
Dear Twirly
Hi There

Thank you for your response. Do you mean I have to phone up every veterinary practice that may or may not treated my horse for any problems even before I gained ownership of him to get a full medical history?

Presently I have only recently registered him with my vet practice upon being concerned about his lameness/swelling. I've owned Pete for 2 & 1/2 years and have never had a problem with so, therefore never had to call a vet out, therefore never had to register him before. So I have only been registered with one vet - and the first time they have ever seen my horse was 4 weeks ago when this problem arose.

I understand your point about disclosing the information about the lameness to our insurance company, but I genuinely did not see his very short spell of lamenss as a medical illness or injury - most horses are lame for short spells in their lives as a result of knocks, scrapes etc. And when I discussed these minor changes in his hocks with my yard manager, she did not seem concerned and said that most horses of his age would have slight changes in their hocks etc from general wear and tear. My bottom line arguement here is they never requested a 5 stage vetting certificate in order for them to insure the horse - but nevertheless he passed.

Thank you for your further suggestions and help - and I will be following these up and keep my fingers crossed for the week ahead.



GreedyGuts: I've owned him for coming up three years in June
 
surely as you have had him for 2 and a half years your current vets can verify that they havent seen him except for yearly tet and flu? or havent you bothered to keep his vaccinations up to date? do you still have the 5 stage vet certificate issued to you on purchase? and what is his insurance value? sorry how much have you insured him for? and your insurance company? ( i would take an odds on its e and l)
 
Exracey said:
Dear Twirly
Hi There

Thank you for your response. Do you mean I have to phone up every veterinary practice that may or may not treated my horse for any problems even before I gained ownership of him to get a full medical history?
Click to expand...


no, look in his passport for previous owner, ring them and aswk what practice they had for him, bobs you uncle :)

I know its all a bit of a faff but if your in the right (which i think you are) you need to make alot of fuss so the insurnce company deal with it.

as for EandL i know they have a bad reputation but ive had the same problem with two of my horses (from extreme bad luck) one was insured with EandL... the other with petplan.

The one insured with EandL is still alive :), the other insured with petplan.. sadly not- we couldnt afford the treatment without the insurance pay out :(



also, look on his vaccs sheet, the vets listed there will give you a good idea of what practices hes been at has they have to stamp the sheet with name and address.

hope this helps :)
 
Thank you for your above response
I absolutely don't mind about the faff - my horse is definitely worth it! :)

I am waiting to hear back from the insurance company today, after a constructive battle over the telephone this morning - to hear of any movement on this matter.....If they are still refusing, I will definitely be contacting all the vets that have come into contact with my horse to give me his previous veterinary history.

Fingers crossed

I'm not going to disclose the name of insurance company just yet - but is linked with Pet Plan!
 
I can understand your insurance company questioning this as it is very unusual for a horse owned for that long not to be registered with any vet practice. The difficulty for you will be proving that he was not registered anywhere. Also you may find that your insurers try and get out of it on the basis that his vaccinations were not up to date as this is a condition of many policies and they do sometimes invoke it when a claim is made.

Did they see the vetting certificate when you bought him? Had the vet made any reference to his history? This is why I do my best to avoid vetting horses belonging to clients; it is often a bit like opening a can of worms.

I would have a chat with your insurance company again as there may be some way you can get around the situation. They may be able to advise you of some means by which you can satisfy them that he has no other medical history, but as others have said, technically you have breached the T&Cs by not telling them about the hock problem and they may just not play ball.

Good luck, it's a salutary lesson for us all, and I hope you manage to sort things out.
 
Sorry, perhaps I've misunderstood your post- I read it as you having owned your horse for 3 years but him never having seen a vet prior to this lameness, is that correct?
What about vaccinations etc?
How long was he lame for before you called the vet and how long then before you told your insurance company that there was a problem?
And ditto GreedyGuts, did they not see a copy of the vetting certificate when you took out the policy?
One last question (sorry I didn't mean this to sound like an interrogation, just don't want to try to offer advice without knowing the full circs!), but you said

Exracey said:
after veterinary investigations it seems it could be as a result of a traumatic injury where scans have revealed a tiny bone fracture to the apical section of his sesamoid bone in his right hind fetlock.
Click to expand...

Does that mean it might not have been the result of a traumatic injury? If so it might well be that that is making your insurance company suspicious, coupled with the other minor irregularities. Have you asked your vet to write to them to argue the new exclusion?
 
Hi Legend - thank you for your response

Yes that is correct, I've owned Pete for coming up three years and he has never been seen by a vet for any lameness or had any lameness in the previous 3 years.

In those three years he has not been vaccinated - he has not left the yard in all the time he's been there, apart from his recent trips to the vet and the other horses on our yard do not leave the yard either. If they do, there is a strict isolation period they have to undertake when they return. So most horses on our yard don't get vaccinated (being my first horse, there would definitely be things I'd do differently next time).

Pete was lame for four days before I decided to call our Vet (but weren't officially registered), they were happy to give advice on the phone but we had to register him first, which I did. I telephoned the insurance company that day, because I wondered how I would go about making any claims if I felt I wished to. They recorded this telephone call - whereby I said he was slightly lame in the hind right leg and may seek veterinary attention.

No they did not require/request to see a copy of our 5 stage vetting certificate, even thought I stated I had had one done when I filled out the insurance application form online.

With regard to his injury - from my own research, discussions with ex-racehorses trainers and of course our vet, where Pete has sustained his injury is fairly uncommon which is why the most plausible explanation for it would be due to a traumatic accidental injury - however, without actually witnessing the injury one can not be sure.

Our poor vet has been asked many requests - the goal posts keep changing daily, each time they have failed to receive what our vet has sent them. The first was to state they had never seen Pete before this current lame period and to the best of their knowledge he had been sound in the past three years (which is almost impossible for them to know, nevertheless they kindly obliged), next they were to state that the injury was most likely an accidental one and would not have been predisposed by the changes in his left hind hock. Now our vet is having to call up Pete's previous vets to get a full medical history of him whilst he was with the previous owner.

I can see why our insurance company are suspicious of this unusual case, however they have given me more reason to be suspicious of them - countless claim forms going missing, countless faxes not being received, and after telephoning them 8 times yesterday to get hold of one of the representatives we spoke to for one hour yesterday morning we were told she was a) not at her desk b) on the phone with clients c) at a department meeting and d) she had gone home at 3.48pm! We then emailed her again this morning to ask her to call us back and as yet we have had no response. Twice now Pete's operation has had to be cancelled because the insurance company failed to tell us that information was missing (because their fax machine wasn't working) and therefore they could not agree to financing it. The second time it was cancelled they had internally rejected the Proforma - but hadn't even informed us or the vet - the whole situation has been humiliating, upsetting, frustrating and the customer service has been appaulling.

And all this time, who suffers, but my lovely boy who's cooped up in his stable 24 hours a day.

Apologies for the rant - the insurance battle has been going on for about two weeks now and I don't know what to do.
 
i have been battling for since january now for my loss of use claim -believe me its not quick or easy and my horse is on bute 2 x daily and is still 4/10lame. hopefully i will be sorted out in the next week (so i am told) so i hope you get what you need x
 
If you are not satisfield with your insurance companies decision, contact the Financial Ombudsman who are there to help you, free of charge.

Tell your insurance company you are making a complaint to the Financial Ombudsman. The FO will look at your case and make recommendations, which usually the insurance company, if it goes in your favour, will abide by. Good luck. Persistency pays off!
 
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