Insurance exclusions

[BBP]

Just wondered if the following is typical and if it’s worth arguing: pony ruptured his superficial digital flexor tendon above the hock in January, thanks to a downward impact from another horse. Insurance company was great and paid out for his hospital stay, scans, X-rays etc. Pony is 2 years old.

Policy is now up for renewal and has excluded tendons and ligaments in both hind limbs. So basically wouldn’t be covered for any investigations into any hindlimb lameness in future unless clearly bone related. Do you think it’s worth trying to discuss this with them to see if the exclusion can be more targeted, or in your experiences would I be banging my head against a brick wall?

 

[Britestar]

Sounds fairly standard excluding both legs.
You'll maybe have success getting it removed in a year or two after showing there have been no issues in that time.

 

[BSL2]

Always worth talking to them. My horse had an allergic reaction one year. So skin conditions were excluded. He then, a couple of years later, developed a melanoma and sarcoid and needed surgery. After discussions with vet, the insurance company agreed to cover the surgery. I was very surprised but very happy.

 

[SEL]

I'd argue that because it was an external injury. I've usually won when it's things like that because they ask their in-house vet consultants to take a look and they have more knowledge than computer yes/no

 

[HashRouge]

It sounds fairly standard, but I would still go and argue it as I think sometimes they just do these things automatically. You might have a little more trouble getting them to back down on the injured leg, as they will be thinking about possible future repercussions. My mare busted her knee falling years ago, and the insurance paid out a fortune for a four week stay at Leahurst and all the follow up. Once our insurance was up for renewal, they excluded that entire leg from the knee down, but it was fairly simply to get them to reconsider. I just had to get the vet to come out and watch her trot up, then sign something to send to the insurers. The leg was then re-included, and in fairness, she never had a single other issue on that leg (she's now 29, and she must have been about 11 when she had the accident).

 

[Barton Bounty]

This is the reason I just pay for anything under £600, seems bizarre to some people but a superficial wound that needs one course of antibiotics and treatment for a week costs around £300 whereas I pay the excess through insurance and they exclude a limb, its not worth it. J was surprised that E & L did not exclude colic when he had that.
I would definitely try to reason with them ?

 

[Pearlsacarolsinger]

This is the reason I just pay for anything under £600, seems bizarre to some people but a superficial wound that needs one course of antibiotics and treatment for a week costs around £300 whereas I pay the excess through insurance and they exclude a limb, its not worth it. J was surprised that E & L did not exclude colic when he had that.
I would definitely try to reason with them ?

But you should declare the incident and vet treatment even if you don't claim, under the terms of your insurance.

 

[scats]

This is the reason I just pay for anything under £600, seems bizarre to some people but a superficial wound that needs one course of antibiotics and treatment for a week costs around £300 whereas I pay the excess through insurance and they exclude a limb, its not worth it. J was surprised that E & L did not exclude colic when he had that.
I would definitely try to reason with them ?

You are meant to declare the incident at renewal, and you may well get exclusions as a result, so in my mind it’s always worth using the insurance money.

OP, I think that’s fairly standard. Insurance companies operate on proposed risk.

 

[Barton Bounty]

You are meant to declare the incident at renewal, and you may well get exclusions as a result, so in my mind it’s always worth using the insurance money.

OP, I think that’s fairly standard. Insurance companies operate on proposed risk.

Why would I if I am not claiming?

 

[scats]

Why would I if I am not claiming?

Because they ask at renewal if the horse has had any accident, illness or treatment in the last 12 months, regardless of whether you claimed or not. You are committing fraud if you don’t declare it.

 

[Lamehorses]

Why would I if I am not claiming?

The insurance company will ask your vet for any history when you open a claim. If you have had any treatment vaguely relating to what you are claiming for the the condition will be counted as an exclusion. It's easier to be upfront.
On a recent claim my insurance company even contacted a vet who had once flu jabbed my horse asking for full veterinary history.

 

[scats]

The insurance company will ask your vet for any history when you open a claim. If you have had any treatment vaguely relating to what you are claiming for the the condition will be counted as an exclusion. It's easier to be upfront.
On a recent claim my insurance company even contacted a vet who had once flu jabbed my horse asking for full veterinary history.

This. Or, in the case of a person I used to be on a yard with, they did not declare an incident requiring vet treatment earlier in the year and at renewal stated the horse has had no veterinary treatment other then routine jabs. When the insurance company asked for vet history for the claim (unrelated to the earlier incident), they saw the horse had indeed had veterinary treatment and the declaration by the owner had been false. Insurance void, refusal to pay out, friend with huge bill.
It happens. Be very careful of lying to insurance companies!

 

[poiuytrewq]

My horse was excluded both front legs tendons and ligaments. I did argue and the undamaged leg was removed from the exclusion so it’s worth a try.

 

[Polos Mum]

For a young horse not in work and a (hopefully) rare event, I would leave it for this year and then in 12 months talk to them about what evidence they needed to prove that there had been no issues for 12 months. Most are more amenable to the conversation if there is evidence it's not recurring or caused any longer term problems. You might have to wait 24 months but it shouldn't be there for ever.

 

[BBP]

I’ll give it a bash and try to talk to them, at least to find out if there is a holding period to then see if I can get them lifted later on. It’s always that decision isn’t it on whether you bank that £500 premium and add it to your vet fee fund rather than insure, especially once you start getting exclusions added on.

 

[BBP]

Bah, no luck, they said it’s due to risk of compensation injury on the opposing leg and that it’s unlikely the affected limb would ever have the exclusion lifted, and if in a year or two I wanted to have the other leg reviewed I would have to get it scanned and cleared by a vet (and that’s whole leg all ligaments and tendons from above hock down scanned). Was worth asking.

 

[Lady Jane]

Bah, no luck, they said it’s due to risk of compensation injury on the opposing leg and that it’s unlikely the affected limb would ever have the exclusion lifted, and if in a year or two I wanted to have the other leg reviewed I would have to get it scanned and cleared by a vet (and that’s whole leg all ligaments and tendons from above hock down scanned). Was worth asking.

And with a young horse worth getting the exclusion lifted in a year or 2 if you can

 

[AShetlandBitMeOnce]

Bah, no luck, they said it’s due to risk of compensation injury on the opposing leg and that it’s unlikely the affected limb would ever have the exclusion lifted, and if in a year or two I wanted to have the other leg reviewed I would have to get it scanned and cleared by a vet (and that’s whole leg all ligaments and tendons from above hock down scanned). Was worth asking.

I actually think that's fair enough, sorry to you as it's not ideal but we are all aware that it's a risk and at the end of the day they are a business.

My horse has cellulitis on his vet history when I bought him and I was stunned when they agreed to then pay out on a lymphangitis claim - he did then have the full circulatory and lymphatic system excluded, plus anything relating to skin and any virus due to his sarcoids so I knocked it on the head and insured for external injury only and saved up for other potential vets fees

 

[SEL]

Oooh I don't think the healthy leg should be excluded irrespective of whether a compensatory injury "might" occur. I'd seriously take that further and probably with a good foot stamp too.

It could be argued the opposite foreleg might show a compensatory injury - it's more common to happen across the diagonal - but then they'd start to sound really petty.

But for the poster above who doesn't declare - it isn't worth it. They will call your horses records for a large claim and if, like mine, there's a comment about a right fore lameness from 18 months before they will retrospectively exclude

 

[BBP]

I actually think that's fair enough, sorry to you as it's not ideal but we are all aware that it's a risk and at the end of the day they are a business.

My horse has cellulitis on his vet history when I bought him and I was stunned when they agreed to then pay out on a lymphangitis claim - he did then have the full circulatory and lymphatic system excluded, plus anything relating to skin and any virus due to his sarcoids so I knocked it on the head and insured for external injury only and saved up for other potential vets fees

Oh yes absolutely, I can see why they do it from their point of view, I’m not complaining but was worth checking. (I complained more when Petplan excluded my other pony’s whole head just because the vet recorded on a routine dental that he had a small ulcer on his cheek)

 

[AShetlandBitMeOnce]

Oh yes absolutely, I can see why they do it from their point of view, I’m not complaining but was worth checking. (I complained more when Petplan excluded my other pony’s whole head just because the vet recorded on a routine dental that he had a small ulcer on his cheek)

Oh absolutely, worth an ask. The head is pretty comical (or not) logic!! I hope they removed the exclusion when challenged!

 

[BBP]

Oh absolutely, worth an ask. The head is pretty comical (or not) logic!! I hope they removed the exclusion when challenged!

I had a strop and cancelled it (up to that point his head had become just about the only thing that wasn’t excludable!)