Insurance exclusions - WWYD?

Caramac71

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This is going to be a bit long winded, I apologise!

Bought horse June 2014 after having her vetted by my own vet. Vet noted that horse coughed during exercise, probably due to dusty hay. Cough went away without any medical treatment within a few days and horse has had no respiratory problems since.

Vet also noted that horse was mildly positive to right fore flexion test, but lunged fine on 10m circle in trot (which in his opinion was a more accurate test). Horse has had no forelimb lameness until recently.

We claimed on insurance in June 2015, when horse was diagnosed with facet joint arthritis in her spine. At this time, the insurance requested her history and the vetting details were included as part of this (insurers had not wanted a copy of her vetting report previously).

My insurance renewed in May this year and I was told she has been excluded for the following:

(1) Any back conditions (understandable)
(2) Any arthritis / DJD (understandable)
(3) Weight loss (this relates to my phone call to the vets in April 2015 when she was first showing reluctance to go forwards, kicking out in canter etc, I mentioned she had dropped weight over winter amongst other symptoms - ironically we have the opposite problem now!)
(4) Respiratory Conditions
(5) Right forelimb

My vets have emailed the insurers on points 3-5 above. They have said she has always been of good weight and has never been seen for respiratory conditions. They said she has never had any forelimb lameness until she was seen in April 2016 when they noted she was mildly lame in both forelimbs.

My insurers have refused to remove any of the exclusions. They have started the 12 month period for the exclusions from the date they received her report (June 2015) rather than when they actually occurred (June 2014 for no 4 and 5, and April 2015 for no 3).

Following our appointment in April this year, my vets have referred me to another vet for acupuncture. I have tried (and failed!) to get her opinion on the lameness. Horse is currently not ridden, but she is worked on the lunge. I struggle to see the lameness - occasionally I see a short stride on the left rein in trot, but once she has cantered and loosened up she looks fine to me. Neither vet has suggested a need to investigate any lameness. Acupuncture vet has only ever mentioned her not being right on the inside fore on the left rein - but this is the rein she's usually lunged on first so it could be that she's bilaterally lame but vet is only mentioning it when she first sees it.

Neither have mentioned any lameness when she has trotted up on the hard ground. It is only when she's on a circle on a surface that they've noted anything. And first vet said that the lameness only showed on the lunge, not when ridden.

Both vets have suggested putting front shoes on to see if it improves. I'm quite happy to do this but from the little knowledge I have, I dont understand how it would make a difference. She's not footy, she's been unshod for 18 months or more and the subtle lameness has only shown up very recently.

First vets are saying to get her shod, bring her back to clinic for examination and they will write a report to insurers. As I no longer have transport, this is going to cost me a couple of hundred pounds for transport and vet at a guess. As I cant see the lameness myself it could be a complete waste of money if vet declares her still lame.

I have no plans to see acupuncture vet as she's been really happy with progress so has left it that we will slowly get back to riding horse over a long period of time, and just contact her if/when needed.

So my options are:

1) Get horse shod and examined, and report sent to vet.
2) Wait til we next have vet at our yard and ask them to see horse and determine if they think she's still lame. And see if they will write a report to remove the respiratory and weight loss exclusions at that time.
3) Get vet to look at horse and if she's still bilaterally lame, see if they will investigate left fore as this isn't excluded at present (and its only ever on the left fore that I've noticed short strides).
4) Give up on trying to get exclusions lifted.

Because of horse's back condition we are only working towards her being able to hack comfortably. We have no expectations of competing her. The acupuncture has been done to ensure she is as comfortable as she can be before my daughter gets back to riding her. She's just started riding again, in walk for 5 mins at a time.

I do dispute the fact that the insurers have started the "12 month period" from the date they learnt of the vetting report rather than the date it took place - as my vet can verify the horse had no lameness between June 2014 and April 2016 (ie more than 12 months). But insurers are classing it from June 2015. Can I appeal against this, and if so, how?

Insurers also want to know that the horse is not only sound but in full work - which is impossible to prove currently as she's not (and may never be). Unless full work could be counted as lunged/worked daily on the ground?

I have already downgraded my insurance from PC activities and aff dressage to hacking only, and her value has reduced because she's basically unsellable. But my premium has gone up £10 a month despite this, along with a list of exclusions.

Whats the best way to deal with this?
 
I queried some exclusions on my policy renewal and was told that some conditions can never be removed from the exclusion list but some can and some can be made more specific. For example, my mare had a fetlock issue which resulted in all injuries to that same leg being excluded (as she had a few exploratory scans to identify the cause) but the insurers told me they could make it more specific after 6 months with a vet report confirming that the problem was indeed restricted to a specific joint. It's not clear from your email whether you've explored the possibility of a vet examination in X months time from the initiation of the exclusion being acceptable for the insurers to remove or restrict the exclusion?
 
Nothing to add but I remember your posts about her back condition and sorry to see things haven't improved xx
 
You have been so unlucky with this mare, I would cancel the insurance, get 3rd party through the BHS or similar and save the premiums in an account, in cases such as this they will find a way to not pay out if possible and you will not always know until you have committed to treatment, if no insurance is involved the vets may take a slightly different approach and you can make any decisions without pressure from the insurance co.

Putting shoes on will not solve the problem, if she is lame she is lame, if it is due to thin soles shoes will reduce the lameness but not the reason behind it, if for any other reason they will do nothing to help other than mask a potential issue so to me it is pointless shoeing her unless you really think it will help to remove the exclusions, chances are even if it does but she goes lame in front at a later date they may still refuse to pay out based on their original reasoning.
 
I queried some exclusions on my policy renewal and was told that some conditions can never be removed from the exclusion list but some can and some can be made more specific. For example, my mare had a fetlock issue which resulted in all injuries to that same leg being excluded (as she had a few exploratory scans to identify the cause) but the insurers told me they could make it more specific after 6 months with a vet report confirming that the problem was indeed restricted to a specific joint. It's not clear from your email whether you've explored the possibility of a vet examination in X months time from the initiation of the exclusion being acceptable for the insurers to remove or restrict the exclusion?

The back and arthritis are permanently excluded, which I accept.

I'm happy to have a vet examination, which I could have now, and I think it would remove the respiratory and weight loss exclusions. However I'm not sure about the lameness as I cant see it myself, I'm not sure how shoeing her would improve it and I'm also not sure that it wouldnt be related to her back condition. So I could be spending a lot of money and still not get the exclusion lifted.
 
I would find a vet who does not own a hospital and get the horse assessed at home. I moved practice partly because I was sick of my vet forever trying to get my horse into their hospital for things that could be done at home.
 
So exclusions 3 &4 they will only remove if the horse is in full work?

I don't quite understand why if those are now at the 12 month stage even taking the fact that they are saying june 2015 not 14 why if she has had no treatment for those they wouldn't be removed?

Also my other thought is that if you have her worked up then for the most part the only diagnoses they can give without MRI will be boney and therefore likely under the insurance's 'arthritic' banner anyway? Although if on the soft on a circle it is more likely soft tissue.

Sorry if I have any of that wrong!

I think it depends what scenarios you want the insurance to cover and given her now reduced ambitions whether it is worth insuring her at all or just sticking that money into an account elsewhere?
 
You have been so unlucky with this mare, I would cancel the insurance, get 3rd party through the BHS or similar and save the premiums in an account, in cases such as this they will find a way to not pay out if possible and you will not always know until you have committed to treatment, if no insurance is involved the vets may take a slightly different approach and you can make any decisions without pressure from the insurance co.

I have literally just done this, my premium went up by £120 per year this time so paying £72 a month, I have never made a claim on my policy. My horse is now 16 years old, he was only insured for £2k. I have cancelled my insurance, set up a standing order to a savings account for the same amount each month and took out NFU Horse Rider Insurance at £88 for the year.

I wouldn't put my horse through an expense surgical procedure just because he is insured and feel I can make a better decision about any treatment rather than just 'chuck the insurance money at it and see what happens'.

If I don't use the money for vets fees, then hopefully I will have enough money to purchase a new horse should anything happen yo my boy.
 
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Nothing to add but I remember your posts about her back condition and sorry to see things haven't improved xx

Thank you.

You have been so unlucky with this mare, I would cancel the insurance, get 3rd party through the BHS or similar and save the premiums in an account, in cases such as this they will find a way to not pay out if possible and you will not always know until you have committed to treatment, if no insurance is involved the vets may take a slightly different approach and you can make any decisions without pressure from the insurance co.

Putting shoes on will not solve the problem, if she is lame she is lame, if it is due to thin soles shoes will reduce the lameness but not the reason behind it, if for any other reason they will do nothing to help other than mask a potential issue so to me it is pointless shoeing her unless you really think it will help to remove the exclusions, chances are even if it does but she goes lame in front at a later date they may still refuse to pay out based on their original reasoning.

Thank you, it has crossed my mind that I'd be better off cancelling the insurance but I really dont like the thought of an uninsured animal - especially the way our luck has been. Having said that, I'm spending £160 a time on the acupuncture vet and I don't even want to think of what I've spent on physio, chiro, supplements etc over the last year that haven't been covered on insurance. And when I did need a vet to treat a cut earlier this year, the cost was less than my insurance excess so I didnt claim.

However, I'm not sure I can get out of the insurance now I've committed to the year. I need to find out about that. I posted separately about the problems I have had with the broker who took 2 weeks to forward me the letter from the insurers saying that they were unable to remove the exclusions - this took me into my next insurance year (and outside of their 2 week cooling off period). I'm not sure if this now means I'm committed to the full year's insurance or if I can cancel the monthly premiums without any extra cost.

Regarding her feet, my farrier says they are good. Frogs were poor over winter but have recovered now. I got a second opinion from a barefoot trimmer recently and he also said she has good feet. Neither think there is any benefit in putting shoes on. I'm not averse to the idea if it would solve the problem (at least enough for the insurers to remove the exclusion!) but I'm not convinced it's going to be a cure. And then, do we go down the road of getting the lameness investigated - and as you say, if the insurers can link it to any of her other issues they wont pay out.
 
I would find a vet who does not own a hospital and get the horse assessed at home. I moved practice partly because I was sick of my vet forever trying to get my horse into their hospital for things that could be done at home.

They would send a vet out to the yard, in which case I'd only pay call out (which is about half the price of transport hire) - but the orthopaedic vet we see if based at the hospital.
 
you should be able to cancel if you haven't claimed yet this year.

Over the years for each of our horses we have been glad to be insured once (one suspensory, and frank's willy cancer issue :p). But that was over 10 years so the insurance were probably still better off than us and neither are insured anymore due to exclusions/premium cost.
 
So exclusions 3 &4 they will only remove if the horse is in full work?

I don't quite understand why if those are now at the 12 month stage even taking the fact that they are saying june 2015 not 14 why if she has had no treatment for those they wouldn't be removed?

Also my other thought is that if you have her worked up then for the most part the only diagnoses they can give without MRI will be boney and therefore likely under the insurance's 'arthritic' banner anyway? Although if on the soft on a circle it is more likely soft tissue.

Sorry if I have any of that wrong!

I think it depends what scenarios you want the insurance to cover and given her now reduced ambitions whether it is worth insuring her at all or just sticking that money into an account elsewhere?


You are correct. They want the vet to state she is in full work, she has not shown symptoms (of weight loss, respiratory and right forelimb lameness) in the 12 months since June 2015. Because my vet last saw her in April 2016 it wasn't a full 12 months - even though the conditions they relate to date back more than 12 months from when the vet last saw her!).

And yes, that's my worry. She had a full examination in April as my chiro felt she was lame in right hind (following bute trial). Vet couldnt see any hind limb lameness but did note she was bilaterally lame on inside fore when lunged on a surface. Did not note lameness when trotted up, nor when ridden (on a surface). Did not feel a need to investigate but suggested shoeing.

However, I had always thought that lameness worse on a soft surface is soft tissue and hard ground is bony. That's what a vet told me when our previous loan pony went lame. She was declared 1/10 lame when lunged on a surface and we were told she wasn't lame enough to nerve block etc.
 
Well that is ridiculous, even for an insurance company! Who on earth defines what full work is!

IIRC were you having a biomechanics person at some point? My vet is having fun with his system as a way to remove the subjectively on lameness evaluations and even decided to use it while vetting a horse on our yard - apparently he did pale slightly when horse dashed off while on the lunge with all his sensors attached.

yup, soft surface usually = soft tissue issue. In which case for the most part you would only be looking at rest for treatment anyway.
 
Well that is ridiculous, even for an insurance company! Who on earth defines what full work is!

IIRC were you having a biomechanics person at some point? My vet is having fun with his system as a way to remove the subjectively on lameness evaluations and even decided to use it while vetting a horse on our yard - apparently he did pale slightly when horse dashed off while on the lunge with all his sensors attached.

yup, soft surface usually = soft tissue issue. In which case for the most part you would only be looking at rest for treatment anyway.

Too true. If you are a happy hacker, full work might be a couple of 3 hour hacks and two 1 hour ones a week. A riding club horse would be totally different, and different again if your bent was jumping instead of showing.

Cancel the insurance asap and play them at their own game. I can guarantee that in a few years the insurers will be clammering to do pet cover again anyway. They could have asked for the vets comments at purchase and chose not to. I suspect the ombudsman might have something to say about that. You didn't withhold anything, they simply didn't ask for it - their error.

My vetting noted a filled hind leg which went down with exercise and that it was simply scarring from lymphangitis and in no way affected the tendons or ligaments, ie cosmetic only. That didn't stop the insurance from putting an exclusion on all the ligaments and tendons of BOTH hind legs though! Ridiculously though, she later developed epilepsy and I made a smallish claim for her examination at home and in horspital for that. I managed the condition successfully and made no further claims. Ten years later they removed the exclusion for epilepsy! I couldn't believe it.
 
Well that is ridiculous, even for an insurance company! Who on earth defines what full work is!

IIRC were you having a biomechanics person at some point? My vet is having fun with his system as a way to remove the subjectively on lameness evaluations and even decided to use it while vetting a horse on our yard - apparently he did pale slightly when horse dashed off while on the lunge with all his sensors attached.

yup, soft surface usually = soft tissue issue. In which case for the most part you would only be looking at rest for treatment anyway.

Yes she had gait analysis. Unfortunately the people that carried out the test are unqualified to diagnose from it. My acupuncture vet didn't understand it. I haven't shown the ortho vet but I did discuss with chiro who is very interested in gait analysis, and she said it just confirmed what we already knew. Report reads that the forelimbs were completely within normal limits. Hindlimbs showed slightly reduced extension in right hind compared to left, and high medial lateral movement in both hinds (slightly worse on right).

She's due to have the gait analysis repeated in a couple of weeks once she's finished the gut supplements. She's being used as a case study for the gut supplements as they feel her movement could be due to hind gut issues rather than the physical issues we are aware of.
 
Cancel the insurance asap and play them at their own game. I can guarantee that in a few years the insurers will be clammering to do pet cover again anyway. They could have asked for the vets comments at purchase and chose not to. I suspect the ombudsman might have something to say about that. You didn't withhold anything, they simply didn't ask for it - their error.

That is yet another issue I have with the broker! The reason I went through a broker in the first place was because the horse was offered to us on a month's trial and I couldnt find an insurers who would insure her for a month as a loan and then change the policy to ownership if we bought her.

When we went ahead with the purchase, the broker asked me to send a copy of the receipt to her. I offered to send the vet report as I wanted to know if there was anything on there that was being excluded from the outset. But she told me it wasn't wanted.

I think I am just too honest. If I ever bought a horse again (which I very much doubt!) I wouldnt get it vetted by my own vet, and then there is no history for the insurers to use as a get out.
 
Sorry to hear about the experiences you are having - I do hope that you can get your mare comfortable soon.

I'm afraid my experiences of insurance are not good. I have found (to my cost) that they will use ANY excuse to get out of paying (and it will be in the very small, tiny, print somewhere, so they are technically right, but morally... not so much). They will then 'exclude' the condition that they didn't pay out on in the first place AND put up the premiums. I then had a (different horse, different insurance) stressful end of life decision with my mare. My vets were fantastic, the insurers were a challenge. They wanted me to 'exhaust all options' before PTS - despite the vet recommendations that the available treatment and rehab would be stressful and with a very low chance of success. So I had the trauma of a difficult decision (what I wanted - keep her as a pet, versus what was right for her, end her ongoing pain) with an insurance company complicating things. They did pay out, but that was only due to the support of my vet. I have since decided to have BHS gold membership for liability insurance and save the premiums. It is a risk, I could end up with an expensive bill to pay (or a difficult decision because the treatment is too expensive), but for me, the ability to have complete control over my horses care and treatment is worth more than the possibility of financial support for expensive treatment.

A vet friend is of the view that equine insurance is borderline value just now (they still think dog insurance is worth it) - in their experience the exclusions and opportunities to get out of paying are stacked against the owner.
 
Hiya,
Sorry this is now adding to the upset of it all.

Have you thought about going down the loss of use route? - that way they would give you a lump sum which you could bank and not continue with policy and take out public liability and rider with BHS. and you could top up monthly with the difference you would be saving. The evidence you have shows she's not capable of doing what you originally intended her to.

This was going to be my plan with H if I got to this position.
 
Hiya,
Sorry this is now adding to the upset of it all.

Have you thought about going down the loss of use route? - that way they would give you a lump sum which you could bank and not continue with policy and take out public liability and rider with BHS. and you could top up monthly with the difference you would be saving. The evidence you have shows she's not capable of doing what you originally intended her to.

This was going to be my plan with H if I got to this position.

You can only try to claim LOU if they have that cover in place, the OP has dropped the horse down to hacking only and is a long way from being able to say she is not going to be able to hack.
LOU is very difficult to prove and claim for unless they cannot be ridden at all or are a high level horse that needs to drop down to light work only, even then it can take over the 12 month limit to prove LOU by the time you have exhausted all treatments available.
 
Hiya,
Sorry this is now adding to the upset of it all.

Have you thought about going down the loss of use route? - that way they would give you a lump sum which you could bank and not continue with policy and take out public liability and rider with BHS. and you could top up monthly with the difference you would be saving. The evidence you have shows she's not capable of doing what you originally intended her to.

This was going to be my plan with H if I got to this position.

You can only try to claim LOU if they have that cover in place, the OP has dropped the horse down to hacking only and is a long way from being able to say she is not going to be able to hack.
LOU is very difficult to prove and claim for unless they cannot be ridden at all or are a high level horse that needs to drop down to light work only, even then it can take over the 12 month limit to prove LOU by the time you have exhausted all treatments available.

I have never had LOU on her - at her purchase price (under £3K) it wasn't even a consideration and the premiums would have been sky high.

I'm paying £42 a month for her insurance currently, with a lot of exclusions, so that's over £500 a year. I have money in the bank from the sale of the horsebox and I've always kept an account with £1K in it for emergencies (which I hope would at least cover the cost to PTS and disposal). I also think there is a limit on what we'd put her through with regards to any surgery.

I just struggle with the idea of not insuring for the unforseen because I am very cautious by nature. But if removing the exclusions is going to be costly or not possible then it seems the sensible way to go.
 
You are insured for so little now I would consider what unforeseen eventualities you are covered for vs those that are already excluded and see how much safer you really feel with insurance. You then need to be diligent at saying to yourself 'I am insuring this horse for ALL future issues with no exclusions, so my premium will logically be more', then put away 50-70 per month (or as much as you can afford - afford as if it is a fixed cost and you make sensible cuts elsewhere to fund if necessary, not just what is left over each month) into a separate, instant access interest paying bank account to use only for real vet emergencies. The problem for most people is that they realise the insurance con too late when the horse is old and full of exclusions after they have paid £5k over 10 years to insure a horse that's had no claims.
My rough maths says you need £10k in the bank per uninsured horse to reflect an insured position. Due to payout caps and exclusions very few people will manage to get more than that out of a insurance company even with accident prone horses, but most of us will pay in more than we get out. Consequently if you can make the 10k work it's by far the cheaper approach, lets you determine your own care, and most crucially you will never get caught out by needing to pay out for 'excluded' stuff when your budget has all gone on paying insurers.
 
You can get insurance cover for accidents only which might be worth looking at in your situation, as well as reducing her insured value down to £200 or whatever the lowest amount is that they will accept
 
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