Insurance - don't get caught out!

Wagtail

Wagtail

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Insurance companies seem to be doing more and more to avoid paying out these days, so I thought it would be useful to have a thread warning others of any pitfalls we've encountered. It used to be only one company that we really had to watch out for. (That company whose name we dare not speak but which inserts its leaflets in most of the horsey mags.) But there are others too. Just a couple of examples I recently encountered:

Case 1

Mare with performance issues. Basically refusing to go forward, tail swishing and looking round at flanks. Owner at first had few problems as South Essex paid for local vet and referral to Sue Dyson at AHT. Both found nothing wrong with the mare. But when she got back she was still obviously in pain and unridable. Insurance refused to pay for second opinion but said they WOULD pay if something wrong was found. So owner took the mare to Rossdales, who found a small amount of bone spavin and injected her hocks which temporarily cured the mare. So obviously something found and so insurance should pay, right? Wrong! They argued that it was normal wear and tear and refused to pay! After 4 months the mare was bad again and so had further injections which again worked for a short time. Then again at owners expense, she had Tildren, which did not work and the mare got worse. Finally, owner paid for a bone scan at the Royal Veterinary college at Hatfield. They found lamenes (missed by AHT and Rossdales) and gastric ulcers. Owner contacted her insurance who have now informed her that they won't pay up and refuse to renew her policy next month!

Case 2: Gelding bucking going into canter. Owner thought it was behavioural, but after months of reschooling etc, there was no improvement, so vet recommended a full set of diagnostic tests at an equine hospital. Owner did the right thing and contacted Petplan who tried to wriggle out due to the fact that he had always been a bit sprightly and said owner should have told them. What?:confused: Eventually however, they agreed he could go. But then he got a foot abcess and so the owner decided to postpone so that it did not confuse things. The foot took 4 months to come right and owner phoned the insurance again. They said they would no longer pay because the policy had gone into the next year and that they had now excluded anything which could be to do with the horse going into canter! :eek: WTF! ANYTHING could be put down to this. Grrr! Now owner can't even change companies as she would have to admit to the exclusion, even though she has NRVER made a claim in 4 years with them.

So anyone else have any insurance horror stories?
 
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Cases like the 2 you've mentioned make me wonder why anyone would insure horses at all, I think we are on a slippery slope with vets investigating everything, making alot of money from unnecessary tests and insurance companies having to foot the bill......
 
bonny said:
Cases like the 2 you've mentioned make me wonder why anyone would insure horses at all, I think we are on a slippery slope with vets investigating everything, making alot of money from unnecessary tests and insurance companies having to foot the bill......
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Things have noticably become more difficult in the past few years. Yes, I agree, sometimes there is no point in being insured.

But, we can learn from the second case, at least. Don't talk to your insurer until all the arrangements have been made and it is definitely going ahead (you can always cancel). Don't give them any inkling that something may be wrong until you know for sure. It's a shame it has to be like this, but unfortunately, honest and considerate customers are the ones who are being penalised.
 
It's very true, you do need to also look at the flip side of the coin too. My hubby is a farrier and he has seen several cases where the horse clearly should have been pts, but the vets insisted on trying everything under the sun, just because it was insured and to satisfy theemselves, causing the poor horses prolonged suffering, giving the owners false hope for them to be pts several months and £000's later.
It's the first question the vet asks 'are you insured?' The latest diagnostic equipment is just so expensive to use and the price of some of the drug treatments....Gastrogard for a start, how can they justify the cost??
It's rotten because the genuine claimants are the ones being penalised. I had an argument and left my insurer of several years because they upped my excess following a claim for an accidental eye injury to my mare. It was my first claim for her, why should that mean she is now more of a liability?
 
bonny said:
I meant why anyone would have a business insuring horses !
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Obviously because it makes money. I was insured for ten years with one horse before making a claim. That is almost £7000.

I have recently made two claims and I have to say they have been excellent (also with South Essex). But they were both very straight forward injuries and nothing to wriggle out of. But they are still by far better off for insuring me.
 
On the other side of the coin... for everyone who comes on here and posts a "horror story" about their insurer, how many people submit a claim and have it paid up quickly? My bet is probably most people, in fact.

If I looked at the horses at the yard I'm on, not a single person has ever had problems getting a claim approved. I had issues with Amtrust Equine years ago saying that something was a pre-existing condition (it wasn't) but a phone conversation between them and my vet resolved that, and AE paid every invoice with 48 hours of receiving them. I also had problems getting Equine First to process my invoices last year but they are just plain difficult - the claim itself was approved pretty quickly, IIRC, it was just a nightmare getting the invoices paid after the first one.
 
It always surprises me to hear these horror stories. NFU have been fantastic to me, my gelding had begavioural issues that was put down to stomach ulcers after scoping. They paid up for all the scopings and the gastro gard as well as homeopathic therpaists and bowen therapy.

Then the behaviour continued and we continued to investigate and discovered his RER...again they have paid with no questions. Whilst this second claim was going through the same horse gashed his leg severely and had to be on box rst. A/B's for weeks and lots of money spent on wound consumables....they paid up with no question.

I claimed the full £5000 for stomach ulcers, leg was £1600 and the RER will be getting on for £4000 by the time the claim goes through....never once been questioned.
 
I have to say that I have had no problems with the NFU except they are slow to pay.

They have paid out on both my horses problems no trouble and were great about one being destroyed on humane grounds.
 
Hmm, I am a little confused by the two examples given as, from the sounds of it they bothe should have been fairly straight forward conditions that an insurer should have paid out for unless there were existing exclusions in place or the claim was submitted more than 12 mths after the onset (most companies give you 12 mths to claim for a condition/injury from the date it occurred).

I certainly know the company i worked for (I was an equine underwriter for nearly 7 years) would have looked to have paid both of those claims. They certainly should not be able to get out of paying for bone spavin stating it as being "wear and tear", that is ridiculous. However, did they have a clause in the wording stating they won't pay for arthritic conditions on horses over a certain age?

Unfortunately horse insurers expecially have to be more and more careful about paying claims due to the huge amount of fradulent claims that are submitted so they are heavily to blame I'm afraid. Also, horse insurance does NOT make money, that is a BIG issue as, at the end of the day an insurance company is a business and they do want and need to make money. The average premium is approx £300 but the average claim is around £1500 and claims are pretty frequent so it is easy to see how hard it is to make any money.
 
I had awful trouble with a claim but not because of the insurance company, because of my vets.

My dog got diagnosed with a digestive complaint that is chronic, this time last year.I put in a claim for the blood tests etc and they paid out but I realised the vets had only submitted half the cost of the bill. When I queried this with the vet they apologised and said they would resubmit the bill and explain the mistake.

They (vet) phoned me to say do you want us to claim for his food and an episode of an upset tummy 18 months ago :eek:
I said no just for the last bill.

The upshot is they tried to claim for the previous upset tummy and then told the insurance company he was diagnosed with the digestive complaint 2yrs previously .:mad:
There followed a few very heated discussions with the vets as they tried to make out they had diagnosed him earlier ( didn't have an answer when I asked why I was not informed of this diagnosis)
They changed their story twice to ins company who eventually wrote to me and refused to pay out because of the vet giving them conflicting information.
Sorry if that doesn't make sense but I tried to be brief.:)
 
Wagtail said:
Obviously because it makes money. I was insured for ten years with one horse before making a claim. That is almost £7000.

I have recently made two claims and I have to say they have been excellent (also with South Essex). But they were both very straight forward injuries and nothing to wriggle out of. But they are still by far better off for insuring me.
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Oh so true. I just re-done my insurance with another company because of the totally ridiculous renewal premium I received from NFU. The actual premium had gone up 37%, without their "mutual bonus" it would have gone up 54%. In over 16 years of insuring with NFU I have only ever made two claims for a total of around £4000 but in that 16+ years they have had somewhere in the region of £10,000 from me. I had to smile at their tag line of "we reward loyalty" in the renewal folder . . er . . . if hiking up my premium by 54% is rewarding loyalty . . . . .
 
ladyt25 said:
Hmm, I am a little confused by the two examples given as, from the sounds of it they bothe should have been fairly straight forward conditions that an insurer should have paid out for unless there were existing exclusions in place or the claim was submitted more than 12 mths after the onset (most companies give you 12 mths to claim for a condition/injury from the date it occurred).
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The mare concerned is only eight years old. The problem was that a renowned speciaist found nothing wrong with her. They paid her £1500 bill without a quibble. But it was when the mare's problems were just as bad as soon as she returned, that the owner wanted a second opinion. That is when they became difficult and even though slight bone spavin was found they said it was just wear and tear. TBH I think they are acting unlawfully and the owner is not going to let the matter go. She has now paid out around £4k of her own money and finally we know what is wrong with the horse. All this has been within the 12 months time limit.
 
Wagtail said:
The mare concerned is only eight years old. The problem was that a renowned speciaist found nothing wrong with her. They paid her £1500 bill without a quibble. But it was when the mare's problems were just as bad as soon as she returned, that the owner wanted a second opinion. That is when they became difficult and even though slight bone spavin was found they said it was just wear and tear. TBH I think they are acting unlawfully and the owner is not going to let the matter go. She has now paid out around £4k of her own money and finally we know what is wrong with the horse. All this has been within the 12 months time limit.
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Well, in that case i certainly think she should take it up with the insurance company as, unless they have a cap on diagnostics then I don't see why they would not pay for a 2nd opinion if the horse was still suffering problems plus they should pay for the treatment for the spavin up to the 12 mths time limit (or whatever it is for said company) or when the vets fees limit has been reached. Seems odd to me and I would be looking to speak to the claims manager about this. I would check the policy wording and cover carefully to ensure the claim is valid. If you are still not happy then I would take it to the financial ombudsman to be honest. Hopefully it won't have to get that far though. I don't know whether the claims handlers at this company are actually horsey people - that can often be the problem when they have the insurance knowledge but not the horse knowledge. Thankfully where I worked the claims handlers who dealt with the majority of horse claims had their own horses and therefore had better knowledge of these conditions and treatments. It all helps at the end of the day as far as the customer is concerned.
 
Our horror story EVENTUALLY had a happy ending!

After Koko died we were un-doubtedly get the pay out as there was no way they could wriggle out of paying. Were we wrong! After every excuse in the book to your vet hasn't sent report, we lost the report, please fax the report and vet report lost in post (we eventually sent the report 6 times at our expense!)

We were then told that we should have contacted them before making teh final descion to PTS (the fact that the poor guy was in excrutaiting pain as his organs were slowly failing wasn't taken into account)

They eventually recieved the report but then said it was wrong as we didn't sign in right place so sent it back. We then went through original problem with them recieving the report all over again. They were so desperate not to pay out and their customer service was disgusting!!

I will never insure a horse with them again (or cat and dog at that matter.)

We got our cheque through the other day, and even that arrived late!

So after a 4 month battle we got our money and tbh I think we are one of the few lucky ones.
 
I really wouldn't advise having the vet round to look at something and not reporting it to your insurance. This is breaching the terms of the insurance policy and they are perfectly within rights to revoke. Everything is disclosable whether you make a claim or even get treatment. Also when you eventually do make a claim (on anything) they will ask the vet for their records and will discover that they came out to see them for X or Y.

I had a very clumsy youngster who kept shoving his face in thorn bushes ripping open eyelids and cheeks etc. Each time I had to have the vet out to stitch/staple it back together. I was always around £130ish which was around my excess. I chose not to claim (would have just sent premium sky rocketing) but I had to disclose each incident. As they were just little bumps and scrapes they noted it down and it was fine. I subseqiently had a nightmare with lameness issues and had 3 claims (back and one on each leg) and they paid out the max each time. Still insured with them (NFU) but have heard that they aren't as efficient as they have been in the past because they have sub-contracted some of their claims handling procedure to a third party call centre.

With respect to the mare, I would have been tempted to put that in as a separate claim(they may have excluded legs but that has nothing to do with stomach ulcers!)
 
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I had my horse PTS last year after making a two large claims relating to two different lameness/ligament problems including check ligament surgery. I was surprised to find that when I bought a new horse and got insurance quotes how much this affected the insurance premium. The fact that I had made claims within the last last couple of years for my old horse made me a higher risk therefore massively increased the insurance on my new horse.

I sort of understand the logic but how can they assume that because my nutty thoroughbred managed to damage herself twice (once during turnout and the second different injury whilst on box rest!) my new horse, a chunky cob cross, was more likely to have problems. Completely different horse in every way.

I didn't claim for loss of use only vets fees.
 
This is exactly why we don't insure. We prefer to pay any necessary vet's fees ourselves. It definitely works out cheaper in our experience and we don't have to bother with a load of time-wasting bureaucracy.
 
I am with petplan.

Submitted a claim to them regarding my horses fracture to his leg. He was at the vets for 11 weeks (livery costs not covered but nursing costs were)

Total bill came to just over £3000. 2 weeks later I had a letter letting me know it had been paid in full to my vets - no hassle or problems at all.

So insurance = not all bad :)
 
Having had my mare PTS instead of putting her through the trauma of broken leg surgery/pins/x-ties/year of box rest etc and keeping the insurance informed ALL through this i then found they wouldn't pay out for the actual cost of drugs to put her to sleep & disposal because I wasn't putting in an insurance claim for her-never mind I'd saved them thousands in treatment/care.

I informed them before she was PTS that it was being done at my request with vets agreement & so I understood I would not receive a payout for her & did ask about disposal fees & was told not to be concerned it would all be covered but after contacting them it about it they totally backtracked.
Will all the hassel/upset of her being PTS i just couldn't be bothered haggling with them so let it lie but my new horse is now insured elsewhere!!
She was PTS in November and last week i had a letter from them asking if i had any more bills to submit for another (different) claim- I think not!!
 
Kokopelli said:
Our horror story EVENTUALLY had a happy ending!

After Koko died we were un-doubtedly get the pay out as there was no way they could wriggle out of paying. Were we wrong! After every excuse in the book to your vet hasn't sent report, we lost the report, please fax the report and vet report lost in post (we eventually sent the report 6 times at our expense!)

We were then told that we should have contacted them before making teh final descion to PTS (the fact that the poor guy was in excrutaiting pain as his organs were slowly failing wasn't taken into account)

They eventually recieved the report but then said it was wrong as we didn't sign in right place so sent it back. We then went through original problem with them recieving the report all over again. They were so desperate not to pay out and their customer service was disgusting!!

I will never insure a horse with them again (or cat and dog at that matter.)

We got our cheque through the other day, and even that arrived late!

So after a 4 month battle we got our money and tbh I think we are one of the few lucky ones.
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I think I can probably guess which company it is. :rolleyes:
 
When my last horse was PTS after finding her with surgical colic, I had nothing but praise for NFU. I was at the time claiming for LOU after nearly a year treating ringbone for which they paid all the bills. My vet rang them to explain the situation ie LOU claim going on, found horse with colic and they said they were happy for me to decide whether to PTS or send for surgery and if successful they would pay for surgery and also pay for LOU. If I decided PTS then they would pay sum insured.
I dont think I could have asked for more. They even paid half towards her cremations costs.
 
I'm going to be very, very careful about what I say here, and keep this factual.

Petplan have paid out on all vet bills claims I have made to date. In my experience, they have been relatively quick to pay vets bills if the claim is covered. However, they have added exclusions each time, which are wider than the original incident. They have also added exclusions where no claim was made but the vet visit was disclosed as required. For example, a small cut that unfortunately got infected and needed one single vet visit and some antibiotics but was completely healed (and the infection gone) in less than a week has led to the complete exclusion of any injury of any description to that particular leg and the complete exclusion of infections and diseases of any description.

They have not paid out for saddlery theft. Three months and still counting...
 
Feel sorry for the op - it must have been very difficult. You have to be very careful what you say to the insurance companies and make sure that you and your vets dot very I and cross very t, and chase chase chase. I used the aforementioned E&L and they were veryngood at paid out over £4k very quickly and without problem following diagnostic investigation and treatment for navicular in my lad Inc remedial shoeing. They did exclude the front feet completely after that but I was expecting that. Having insurance on that particular horse was worth it for me
 
i had insurance on my horse but they put so many exclusions on it was pointless to renew. because he had blown his hind leg tendon they said that it would have affected his other hind leg and the diagonal front leg and also his back. so all that was excluded. i then had to have a liver biopsy done on him and they then excluded anything to do with his liver and that included colic and gastric ulcers because the 'trauma' of having a liver biopsy could have triggered either of them illnesses.
by the end of the year it felt like he was only insured for his ears and tail which i'm sure they would have found a way out of paying so i cancelled my insurance and just put money aside each month for vets fees and have gold membership with the BHS.
 
I've never had a problem when making claims with my insurance company - and neither to my knowledge have any of my friends.

At the end of the day it's about understanding your policy, doing what is required when a problem arrises with the horse - and above all not having unrealistic expectations of the company you insure with.

My experience is if you follow the rules then there's no problem.

(Also with NFU.)
 
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I have never personally had a problem with a claim for a horse. The examples given were a friend and a sister. Both the examples I gave were clear breaches of the contract and were both against people who had never claimed before. I had terrible trouble once with E&L regarding a dog. They only paid up after eight months when I threatened them with Watchdog. I am waiting for the exclusions that will no doubt come on renewal of my policy. My gelding had surgery on his hock and they found bone spavin in both hocks so I am expecting that at least both of his hinds will be excluded and thatis quite understandable. My mare had a broken shoulder and also an injury to her flank this year so I don't expect she will be worth insuring next year, especially as she is also 17 and retired. I will just have to meet the bills as they come myself. My largest claim to date was for a dog (needed chemo) and that was £8k! I had to pay 10% excess but he had to be put to sleep after ten weeks, bless him. He was only four. But More Than settled everything (except the drugs to PTS) without a quibble.
 
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