Insurance exclusion question

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Daisy1905

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My horse has been lame for a week now and the vet has been out twice. The bills will be slightly higher than my excess. Would you claim?

Does this mean that the leg will be excluded in the future or would they exclude it anyway if they find out? :confused:
 
It depends on what the problem is and when the occurence is in relation to when your policy expires.

If it was a lameness with a known cause ie. from a kick etc and you have nearly a year until your policy expires then they may not exclude when you renew. However, if its a bit vague, they may place an exclusion on that leg. Its not the end of the world though - if the lameness isn't caused by something chronic like arthritis/DJD, and your horse was sound for a year (or near abouts) after recovery then your insurance company will most liekly remove the exclusion, provided your vet can confirm your horse has been clear of any related lameness probs in that leg for a year.

If they find out they will probably exclude anyway. You should really advise your company of any potential problems as it most likely states that in your terms and conditions.
 
even if you don't claim you need to advise your insurer.

They may well exclude the leg / type of claim unless your vet can write a letter stating why it won't happen again.

If you don't disclose it and a claim in future, the insurer will ask for your vet to supply the treatment history and if you haven't disclosed an illness / injury they can void the whole policy.
 
Has the vet diagnosed anything as yet? Is the lameness still ongoing and if so what treatment is being suggested?

It is entirely up to you if you claim but without any diganosis an insurance company would struggle to exclude anything as, realistically they can't just exclude the whole leg (although some try!). If the horse is going to have ongoing treatment then i would maybe contact your insurance company, let them know what's gone and and that you MAY submit a claim. On that basis you have informed them of a material fact (ie the lameness) so, should you have a claim in the future (certainly if it happened to be for the same leg) and have to submit veterinary records they could not pull you up on not having told them about this lameness.
 
Gluttonforpunishment said:
If you don't disclose it and a claim in future, the insurer will ask for your vet to supply the treatment history and if you haven't disclosed an illness / injury they can void the whole policy.
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In all honesty they are unlikely to void your policy on that basis as it is understood that horses can and do got lame on occasion and get cuts and scrapes that you may call the vet for. You do not HAVE to tell them of every little thing but it is advisable if the horse has a lameness say that goes on for a sustained period. Most insurance companies are pretty understanding, there are only the odd few (well one actually! Lol) who will use any little snippet of info you have no disclosed in order to try and not settle a claim!
 
ladyt25 said:
Has the vet diagnosed anything as yet? Is the lameness still ongoing and if so what treatment is being suggested?

It is entirely up to you if you claim but without any diganosis an insurance company would struggle to exclude anything as, realistically they can't just exclude the whole leg (although some try!). If the horse is going to have ongoing treatment then i would maybe contact your insurance company, let them know what's gone and and that you MAY submit a claim. On that basis you have informed them of a material fact (ie the lameness) so, should you have a claim in the future (certainly if it happened to be for the same leg) and have to submit veterinary records they could not pull you up on not having told them about this lameness.
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Thanks good idea.



yes the vet has been, he isnt sure yet as it might be the tendon. She has been on bute and Norodine and applying compagel.He also said that because of where it is and because it hasnt gone down much in past few days he would advise to have an ultrasound scan and xrays done.....
 
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ladyt25 - absolutely right that most insurers would not void the policy but they are quite within their rights to do so.

As you are obviously aware non disclosure of material facts allows the underwriters to void the policy if they so wish.

Agreed, no one tells their insurer of every small cut / lump & bump but in the case of lameness that has neccessitated a vets visit it would be wise to let the insurers know. No excuse for them not to uphold a claim in future if it should occur then.
 
If you read the nitty gritty of your T+C's it says about voiding the policy etc... but generally they only do that in the case of fraudulent claims, ie you say your horse has just gone lame when in fact it's been lame for years and its leg fell off.

I worked for one of the main companies and although we would say you should tell us, we always used to get claims in for things that happened months ago and this was the first we'd heard about it. Not that i should condone not telling them (claims assessor through and through!) but generally it isn't a problem if it's straightforward. It just gets tricky if there is a dispute over the onset date and your vet can't recall precisely all the details etc.

And some companies (ie the one I worked for) DO exclude the leg! Exclusions should always be as narrow as possible, however, if you were just coming up to renewal now and your vet doesn't have a diagnosis they may exlcude lameness relating to the left fore or right fore (or hind!) leg. But like I said, these exclusions are not normally permanent. If they do place an exclusion just ask them how you can or when you can get it removed.
 
Gluttonforpunishment said:
ladyt25 - absolutely right that most insurers would not void the policy but they are quite within their rights to do so.

As you are obviously aware non disclosure of material facts allows the underwriters to void the policy if they so wish.

Agreed, no one tells their insurer of every small cut / lump & bump but in the case of lameness that has neccessitated a vets visit it would be wise to let the insurers know. No excuse for them not to uphold a claim in future if it should occur then.
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Yes it would or could be considered a material fact but we would often get vet history reports in and they may well mention a visit previously that we would not have a record of. If it was not detailed as to what this was for then the claims handler would, more often than not just call the vet and ask what it was for. If it had no bearing on the current claim as was nothing that would be considered pre-existing from then on then it is highly unlikely a claim would be thrown out due to non-disclosure. They CAN do this but it doesn't happen very often and is normally if it becomes evident someone is trying to claim for a condition that has been going on for many years.
 
I would wait until you have at least a better understanding of what has occurred, and the outcome, and then advise insurer. Your vet should also be able to advise you on this they must be used to dealing with insurance companies.

If you are really unsure call your insurance company and ask them a few general questions without advising your policy details - they will give you their take on it. With insurance the duty lies with the insurer to disclose any and all relevant information.
 
jeeve said:
With insurance the duty lies with the insurer to disclose any and all relevant information.
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Not true under UK law - the onus is on the insured to provide any and all relevant information that may affect the Underwriters decision to insure the risk. You will normally find a paragraph in the policy that states the insured has an ongoing duty to ensure changes to the risk / material facts are relayed to insurers throughout the life of the policy and not just at inception or renewal.

The FSA has a "treating customers fairly" policy but as long as the insurer has provided you with the key facts, policy wording and hightlighted any unusal exclusions then they have fulfilled their role.

It is up to the insured to be sure they have read and understood their policy and that they are compliant with it.

As an insurer, yes it is usually very easy to spot deliberate attempts at non disclosure rather than genuine mistakes and omissions. Underwriters are normally very fair in the way claims are dealt with but we all know there are at least a couple that tread a very fine line with regard to sharp practice.
 
SORRY NOTE THAT I MADE AN ERROR MEANT to say insured not insurer - it is the same in Australia



Originally Posted by jeeve
With insurance the duty lies with the insurer to disclose any and all relevant information.

Not true under UK law - the onus is on the insured to provide any and all relevant information that may affect the Underwriters decision to insure the risk. You will normally find a paragraph in the policy that states the insured has an ongoing duty to ensure changes to the risk / material facts are relayed to insurers throughout the life of the policy and not just at inception or renewal.

The FSA has a "treating customers fairly" policy but as long as the insurer has provided you with the key facts, policy wording and hightlighted any unusal exclusions then they have fulfilled their role.

It is up to the insured to be sure they have read and understood their policy and that they are compliant with it.

As an insurer, yes it is usually very easy to spot deliberate attempts at non disclosure rather than genuine mistakes and omissions. Underwriters are normally very fair in the way claims are dealt with but we all know there are at least a couple that tread a very fine line with regard to sharp practice.
 
At renewel time I always get a form that I have to fill in with details of any vet visits for anything other than vacs. I am not covered by the insurers unless they recieve this form.

A friend of mine didn't disclose details of her horses long history of lameness (different insurance company) believing that if they didn't know horse had had problems then she could still claim. When she came to a point she needed to claim the insurers asked for a complete vet history from her vets. Claim was denied!
 
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