Insurance clause

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Jacksie

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Sharing this in case others aren’t aware of the implications of the small print in some insurance policies, I’ve been told it’s becoming more common.

I’ve had months of ongoing investigations for my horse and had felt reassured that at least my insurance (SEIB) would pay out given the horse hospital were clear there were two separate and unrelated issues with different symptoms and concerns. However what I hadn’t anticipated was this clause. I’m now £5k out of pocket and have a ridiculously long list of exclusions for my renewal -

For the purposes of this Section, the following will be treated as one claim:

(b) lameness of any limb or Symptoms reported to Us that are subsequently diagnosed

as lameness of one or more than one limb or separate Accidental External Injuries,

Injuries or Illnesses;

(c) if during the investigations of the original cause of the lameness, Symptoms,

Accidental External Injury, Injury or Illness it becomes apparent that there are

multiple problems, then these will be treated as one claim whether the lameness,

Symptoms, Accidental External Injury, Injuryor Illness are related to each other or not

We appreciate these are 2 conditions, however, all costs will be assessed as one claim only in line with the above noted policy terms.
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I’m seriously considering cancelling and self funding since I can’t be assured insurance will payout if and when and as the exclusions are getting silly.

Does anyone know if the general terms and conditions are set by SEIB or is it all down to the underwriter? I’d be very disappointed if that’s the case as I’ve always thought of the underwriter positively
 
It’s no help to you but I had an issue with SEIB previously. I had a horse vetted for LOU so had every inch of him x-rayed. I’d been paying for 3 months when they came to me and said they had looked at the x-rays and decided they weren’t within their limits so were excluding every part of the horse that had been x-rayed. So the only part of him covered was pretty much his head and his tail. They wouldn’t cover him for injuries either.
They refunded me the money I’d paid up to then but the vetting I’d had was out of date to use with any other insurance company and I’d then also paid for a specialist vet to look at the x-rays in case there was something wrong.
I tried to fight them on it but ultimately having got some legal advice from the BHS they told me not to bother.
 
Jacksie said:
That’s terrible Ceifer! Wonder what took them so long to reach that conclusion and surprised they can change a contract part way through the agreed period. Seems very unfair.
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It was a complete headache. They apologised but refused anything other than the refund. The BHS advised I could try and claim for the vetting (circa £780 with all the x-rays) but it’d be a long fight.
I tried to argue and ask what exactly what they didn’t like on the x-rays but they never got back to me.

Hilariously the SEIB agent said I could still keep the policy and pay the agreed premium I asked her why would I do that? She was completely silent for about 30 seconds before saying she didn’t know 😂
 
Jacksie said:
Sharing this in case others aren’t aware of the implications of the small print in some insurance policies, I’ve been told it’s becoming more common.

I’ve had months of ongoing investigations for my horse and had felt reassured that at least my insurance (SEIB) would pay out given the horse hospital were clear there were two separate and unrelated issues with different symptoms and concerns. However what I hadn’t anticipated was this clause. I’m now £5k out of pocket and have a ridiculously long list of exclusions for my renewal -
Click to expand...
I just Dumped SEIB first for the horsebox - then my car. Then my mare got colic June 25 and thought she was insured as no colic before. I called them and said she is covered they said NO because she had a bout of laminitis in 2019 they put on veteran policy which it is not covered. so had to pay vet and RVC out of my money. now i just pay money into her account instead. Mine had just renewed but I told them to cancel my policy and they did. no issue
 
Hmm sneaky. I had one recently where horse was scoped and myself and vets were almost 100% convinced horse had ulcers due to being a recent import after a long journey. But because scope was clear I had to pay the full amount as they will only cover the cost of scoping if grade 2 or higher are found..
 
I have just had similar. Maxed out a claim for hock bone chip removal (investigations took up a LOT of it) Surgery was successful but horse still not quite sound at 10 week follow up. Gait analysis was showing possibly front right but no improvement on any blocks so thought it may be compensatory movement pattern from a hind end issue. 2nd opinion vet found bi-lateral stifle issues on examination, and scans showed mild cartilage deformities. Stifles were treated. Insurance (KBIS) wouldn’t pay as the claim that was open was for undiagnosed front right lameness (sound on front with stifles blocked) I had a letter from insurers which I read to understand was retrospectively excluding stifles and fetlock's from the previous years cover? I thought this was because I was saying the start date of the condition was at the 10 week follow up therefore whilst he was still covered. They also said that stifles were part of the hind leg claim, which was already maxed out, so wouldn’t be a new claim (I didn’t really note this at the time). So I paid for all that and the many vet visits following. Renewal excluded basically everything so I swapped him onto catastrophe cover as he was moving to a suitable yard, in the hope of rehab/hacking. Devastatingly for my gorgeous boy treatment exacerbated his joints. I took him home to give him field time to monitor for improvements but his decline was rapid and the heartbreaking decision (between me and my vets) to pts on welfare grounds was made. When I phoned to cancel his insurance they told me there was mortality cover on him (10 months from start of hock claim) I said I didn’t think it would be payable as it wasn’t his hock and they informed me the claim that was still open was basically for all leg joints! They advised me to put a mortality claim in so I did, not really expecting pay out but as it was their suggestion thought it worth a try. They agreed with the decision to pts but their terms to pay out was that they had to agree the decision before pts in cases of planned euthanasia. I knew that was the usual way of going about things but I didn’t realise the open claim included his stifles!
So yes - read the small print, if it doesn’t make sense phone the insurers and get them to clarify. I didn’t understand the letter I received adding extra joints to his hock claim retrospectively, I didn’t study it, I was too stressed and heartbroken looking after my poorly broken horse 💔 Nothing can bring him back but a mortality payout would’ve certainly softened the financial hit. I also need to add that he had already previously had sarcoids removed, been diagnosed with and treated for ulcers successfully, so had had 3 (3K) maxed out claims during his period of insurance cover, so for him it was definitely worth having!
With my new youngster I’ve gone with Agria lifetime in the hope of having more clarity in regards to what will be claimable 🤞🏻 hopefully this one won’t be a walking vet bill.
 
Billabongchick said:
Hmm sneaky. I had one recently where horse was scoped and myself and vets were almost 100% convinced horse had ulcers due to being a recent import after a long journey. But because scope was clear I had to pay the full amount as they will only cover the cost of scoping if grade 2 or higher are found..
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My vets warned me that if no ulceration was found or less than grade 2 insurance wouldn’t pay. They have scoping clinics though with a set price of £180 which is less than most insurance excesses so it seemed reasonable to go ahead.
 
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