Insurance Company refusing to pay claim

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Tommy Tucker

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I have today been notified by my Insurance Company - NFU - that they will not pay out for my claim in relation to my horse having to be euthanised. I fully intend to dispute this as two vets have advised that he should be put down. He has an incurable and deteriorating condition - spondylosis of the lumbar spine. He is still in pain despite having over £5000 worth of veterinary treatment and he is now having difficulty in getting up when he has been lying down and is stumbling when being led. In the last week or so he has pulled a shoe off 3 times due to tripping and is now lame despite being on bute. Despite all this they say that he does not fall within BEVA guidelines so they will not pay out (even though, according to my vet, there is no question that he will fall within BEVA guidelines in the not-too-distant future)
Has anyone had a similar experience with NFU, or another insurance company? I fully intend to fight this as hard as I can and would appreciate any advice/info. Many thanks
 
Had a very similar issue when my horse was PTS, because he was 6 they disputed that we PTS too quickly and he was young and 'fit' enough to fight the condition he had.

It took us 5 months to get the money (around £6000.) We threatened to leave them and never insure a horse with them again and this didn't bother them then we said we would take them to court. At first we were bluffing and they got a little scared so paid the vet but still owed us £5000 for the cost of our horse. We did start speaking to solicisters and gathering lots of evidence (luckily I had pics of my horse healthy and an hour before he passed away so lots of evidence) including vet reports, post mortems of horses who had the same condition which has a 85% mortality rate.

We got in touch with the company and told them our plans and the information we were collecting and our solicitor sent them a letter, funnily enough the money arrived a few days after they received the letter.
 
You need your vet to provide written proof that if the horse is left alive any longer than X time, that the vet will be acting outside BEVA guidelines and that the owner of the horse, coupled with the vet, could be put in a tenacious position with regards to the law and causing suffering to an animal.

Perhaps your insurance company might like to deal with current legislation themselves with regards to euthanasia within BEVA guidlines?
Perhaps they might take more interest if you told them you were already writing to your MP and also the national press and also the insurance ombudsman?

Get names of persons at top level with insurance co too.

Perhaps a senior partner at vets can fire off a fax and email asap?

Otherwise, get your vet to get 2nd opinion from large respected practice (asap) and then with all medical evidence to hand, have the horse put out of its suffering & then continue to fight insurance co after.

Horse comes 1st, I know its hard but if he is as bad as you have put above, lean on your vets tomorrow & insist that there is a resolvement within 24 hours with the insurance co.

Good luck
 
Do NOT put the horse down in advance or you will be on sticky ground re a claim!! Your vets have to write to the insurance company and say that they have advised that the horse be put down because his condition is painful,and will continue to get worse - therefore he DOES fall within BEVA guidelines. They should demand agreement to this course of action within 7 days to prevent further suffering!
 
Why would you keep the horse alive? It's welfare has to be the overriding concern, surely? Not any financial recompense from an insurance company....
 
Thanks all. My vet is one of the top tier veterinary practices (they are the consultant vets for KBIS insurance - wish I had known this before I insured with NFU!) Two of their vets have seen the horse and both recommended euthanasia. One of them has faxed and spoken to the NFU vet but they still won't agree to pay out. I have told them that I will fight this in any way possible. I will be contacting the Insurance Ombudsman first thing in the morning and I have told them this too.
 
South Essex refused to pay out on my mare when I had her pts because I didn't ask them first, even though the poor mare was in a great deal of pain due to mastitis. I didn't pursue it (beyond writing to them to question their decision), it was probably my fault, but at the time I was completely and utterly devastated and having made the decision and and arrangements, I just didn't want to delay (which would have been cruel anyway).
 
Have the horse put to sleep now.

Fight the insurance company afterwards.

I had a fight with E&L. Short(!) story: my vet wrote to them; we both spoke to their vet; I told them it was happening no matter what they said. My horse, my responsibility.

They paid out in full.


A note re the Insurance Ombudsman: if I remember right, it will take weeks. From the moment you put the complaint in, the insurance company has six weeks to respond, so basically everything will grind to a halt for up to six weeks.
 
I know someone who had their horse put down on vet's advice and after a lot of hospital intervention. NFU refused to pay out despite their horse having a number of issues which were not getting better after several months. However on disputing the claim and getting veterinary backup, they paid out. Good luck.
 
How long is it since the condition was first notified to the company? Have they had their own vet look at the horse and reach a different conclusion from your attending vet?
 
Tommy Tucker said:
he will fall within BEVA guidelines in the not-too-distant future)
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your problem is entirely that your vet has said the above.

Your horse HAS to meet the BEVA guidelines to be put down (and from your description i'd say he does, but I'm not a vet), not just will soon....

Go back to your vet and ask why he doesn't meet the guidlines now.

My horse was ill for months and suddenly went downhill. Vet said he would colic in the next 24/48 hours and there was nothing they could do so I had him PTS. Vet then rang NFU first thing the next working day and told them it met BEVA guidelines and they paid out. No questions asked.
 
Insurance companies will use any excuse not to pay out.

Get the vet to fill in the form and to write his genuine opinion of the diagnosis. If they ask for a cause get him to put "Act of God" and they will pay out.
 
Agree with Galaxy, you need the vet to change their wording so that you can go ahead.

I'd also proceed with action by getting the ombudsmen involved. A friend of mine recently did this with NFU and got her payout shortly after they backed her up. It's opened the floodgates for lots more claims too so I'd say they'll be a bit wary of having the ombudsmen take them to task yet again!

Good luck. I hope you get a resolution soon. X
 
The BEVA guidelines exist to guide decision making in emergency situations where the insurer cannot be contact prior to euthanasing an animal. They clearly state that if it is not an emergent situation then the insurer should be contacted first, and they will advise what action is necessary to ensure the claim is settled fairly.

Unfortunately the staff answering the phones at insurers are fairly poorly trained in this regard, and will tend to parrot back the line about BEVA guidelines. It is imperative that you do not accept this from them and explain to them that the BEVA guidelines are not applicable to this case as it is a degenerative condition rather than an acute injury. More often than not this means you will need to speak to their supervisor or the insurance company vet.

Once you are speaking the right person, then they will be able to advise you what is needed in order to fairly assess the claim. Usually this is either a second opinion from another vet (different practice) or a post-mortem examination. When you know what is needed then you stand a chance, so don't let them hide behind guidelines that were not written with this situation.
 
I had a 6 month fight with petplan when my 8 month old foal had to be put to sleep with a broken back and dislocated ribs. You have no idea the heartache it caused. They wrote to myself and my vet countless times asking why his condition meant he had to be put down, i mean come on the wee soul had been xrayed at the glasgow vet hospital and on the advice of their senior vet was pts. My vet phoned petplan countless times and eventually it was only when he lost his patience with them that they suddenly paid out. I hope i never have to go through all that stress and heartache again for the small amount of £500 that i had insured him for :(
 
Perhaps H&H would be interested in running an article about insurance, I don't suppose this would reflect well on NFU and others!
I would put the animal down and send them a claim plus a claim for stress to yourself.
 
We had a fight with petplan years ago as they were not undertsanding why my vet wanted to put my 12 year old mare down due to cushings/Laminitis.In the end my vet spoke to their vet & explained in no uncertain terms that her pedal bones were about to pop out the soles of her feet.My vet did have to get quite stroppy with thier vet & after being quite rude to her,she stood her ground & it was agreed we could pts without having any further hassle from petplan & they would pay the treatment costs etc. I wonder whether nfu have a simular set up where your vet can actually speak to their vet & get this sorted for you or indeed invite their vet to come out & see your horse for themselves!I wish you all the best & hope you can get this sorted asap
 
I am becoming increasingly disgusted at the way insurance companies are working, writing of limbs etc for ridiculous things like a splint or a wingall ffs.
Next time round i think i'll join a credit union and pay money into that every month instead then let it build up, if i need to cover for vet bills before it builds up i'll borrow against this account at a much lower interest rate than a bank to pay it off.
Sorry rant over
 
when NFU wrote and told me my pony was 'cured' of laminitis and refused to pay any further vets fees relating to the claim, we stopped using them for insurance for cars and horses, eventually after many letters from my vet and myself and one very irate call from my vet, they eventually paid the outstanding amount to my vet
 
thatsmygirl said:
Put the horse to sleep, keeping it alive to make sure you are able to claim is disguesting janetgeorge
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If you did it for any length of time - or if you did it when the horse was acutely suffering I would agree. But this horse is deteriorating but - according to the OP's own vet - is short of BEVA guidelines so while he IS in some pain, it's probably no more than a horse who could be cured would experience during his treatment.

I don't insure my horses so I only have my own conscience and my vet's advice to worry about - but there is absolutely NO point in insuring your horses if you don't follow their rules. My advice suggested setting a 7 day ultimatum - so this wouldn't go on too long - and the OP HAS to get her vets to fight for the horse. But if insurers can cop out of paying because you haven't done it right, they will!
 
Just like Echo Bravo this is also why I don't insure, just have a vet bill saving account instead. Don't think I could put up any kind of battle if I was dealing with what you are OP.

Wish you all the best & hope they see sense pretty soon xx
 
Echo Bravo said:
And this is why I don't insure.
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Thats great if you can afford to take the risk. I've just in the middle of making my first claim which will very likely go to the max £5k for his treatment and then I'm thinking looking at his very poor prognosis to ridden work that I'll then claim for loss of use (£8k). The £8k will go towards simply looking after my horse in his retirement which is helpful considering I cant afford to potentially buy another horse otherwise.

Tinap555 - Im very grateful that I did choose to insure him even though I've easily already spent about £6k on insuring him over the years, purely because I (and I assume many others) dont have this much cash just sitting about. Its very easy to say to pay it into a vet bill bank account but once you drain that in one go, then what? It takes months/years to build that back up again so for a while you won't have much in there should anything happen...

Good luck OP in fighting this, but please please do whats right for your horse meantime (ie. being PTS), dont hold out for approval if he is suffering.
 
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Iv found as well in the past the horses treatment seems to be related to " if you have insurance"
the vets are more than happy to run up high bills but if you aren't insured the bills can be so so much lower.
 
thatsmygirl said:
Iv found as well in the past the horses treatment seems to be related to " if you have insurance"
the vets are more than happy to run up high bills but if you aren't insured the bills can be so so much lower.
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Of course this is the case. Any vet has to work within a budget. If that budget is a £5k limit then they'll work to that. If uninsured then they'll work to your individual budget. The fact is that modern veterinary medicine has some advanced (and expensive) diagnostics and treatments, so if the option is there to use them then why wouldn't you?
 
I had a similar situation with my horse after he was euthanised due to Grade 2 wobblers.
He had received £10,000 of veterinary care over seriously injuring himself on his legs due to his instability.
BEVA guidelines state that they only pay out of the horse is grade 5 (collapsed/unable to get up)
My vet and I agreed that the injuries were seriously affecting his quality of life and we didn't want him to get to the stage of complete collapse.
My vet spoke to the chief vet at NFU and they agreed euthanasia in this case was the correct course of action.
NFU paid everything (including loss of use) and I have to say they were very good too.
I would push for your vet to speak with the chief advisary vet at NFU and really push your claim.
Good luck.
 
had argument with pet plan a few years ago, in the end despite my vet emailing and calling insurance refused to give me 100% of the claim. they offered 50% lou. we disputed as horse was suffering and they agreed 75% of the claim, i pts and never got the other 25%. it was awful and then they had the cheek to take the next months payment out of my bank! dont like insurance at all but unfortunately i wouldnt be able to pay a huge vet bill in one go if i ever needed it x good luck but i would do the best for the horse before anything else x
 
I think it very much depends on the value of the horse is questions to weather they dispute PTS. I am insured with KBIS and my horse at 11 was diagnosed with OCD and there was nothing we could do so I wanted to distroy and would have done even if they would not have paid out but the head vet at KBIS called me and agreed it was the best option for him and they paid in full. he was not isured for a lot though. Good luck with NFU I have heard some horror stories but if you fight you should get a possitive outcome. xx
 
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