insurance exclusions - can i negotiate?

[digitalangel]

My old boys Left Hind leg is excluded - i never made any claims with the insurance company , but once did mention that i wasnt sure he was sound on his LH and i was honest and mentioned a bone chip in his fetlock when i insured him ( was a problem i paid out for it myself, it was before he was insured ) Since then hes been dxed with mild OA in his hock and ive paid out for injections.


anyway today he has been kicked in the field and is showing all symptoms of a fractured splint bone.
As it is a kick and not an illness does anyone know if i have any chance of arguing the case with his insurers?

 

[Marydoll]

You can try, its not the existing condition, but youd have been better arguing the case when the document came through

 

[WelshD]

I agree. The time to negotiate was when the renewal documents came through. As it is you will probably be deemed as accepting the clause by your continuation of payments

No harm in trying though and do see if you can get the exclusion made more specific on the next renewal

 

[Elbie]

You can argue to have exclusions removed/reviewed after the renewal. I worked as a claims assessor for one of the big equine insurers and sometimes we would personally request and review vet history's to get the Underwriters to remove exclusions.

If there was an exclusion we physically couldn't pay the claim, however, if we could see it was unrelated to the current injury we would ask them to review it.

I would send them a full vet history and get your vet to write a statement to advise that your horse has had no issues with the splint and previous lameness was due to OA in the hock and fetlock bone chips. Then ask if they can amend the exclusions to fetlock bone chips and OA. Hopefully then you should be able to claim for the splint fracture. Doubt they can relate that to the OA as one is an injury and the other an 'illness'

 

[digitalangel]

I agree. The time to negotiate was when the renewal documents came through. As it is you will probably be deemed as accepting the clause by your continuation of payments

No harm in trying though and do see if you can get the exclusion made more specific on the next renewal

thanks guys - called them this morning and they said they would consider the claim provided i get the vets report on the OA and they exclude the hocks instead.

My poor lad is off to the vets today.

 

[stencilface]

I think you are covered for accidents regardless of exclusions afaik, depending on the policy? So you might have had a tendon injury on a hind leg, but if the same leg gets a huge wire cut on it it is still covered as not relating to the original injury? My horse has 3 (yes, 3!) legs excluded now, although I disputed at renewal and instead of each leg being completely excluded they are excluded for only the things I have claimed on each one, which is fair in my mind. Really hoping next year he doesn't exlude his only insurable leg! :rolleyes3:

 

[ladyt25]

The insurance company should only exclude something that is as a direct result or attributable to the previous condition they paid out for/the pre-existing condition. Because OA is excluded this should not mean that an unrelated condition (ie kick/cut/abscess etc) is also excluded just because it occurred in the same leg. They could potentially repudiate say a subsequent tendon issue if it was considered this was attributable to the existing condition.