I don’t like mondays
Well-Known Member
Hi
I’ve got an issue with my insurance company refusing to pay a claim and landing me with a huge bill (I’ve already paid lots of vets bill myself for my late horse). Just wondering if anyone has any experience of this.
1) My horse had KS surgery in 2021 (pre existing so wasn’t insured, I funded the surgery)
2) 3 months after surgery I decided to call one of the big insurance companies to see if cover was worthwhile. I assumed they would exclude everything that could be connected to KS (Si/psd/hocks..) but thought it was worth researching.
3) spent ages on the phone while they spoke to underwriters and was told yes SI and hocks, neck, suspensories were all covered (he’d never been diagnosed with these) just the back excluded. I was shocked at this cover so decided to go ahead (at a high premium)
4) 3 months later (after taking out cover) my horse had canter issues which were totally new. Looked like Si. Called ins co and they said yes SI is covered as long as vet says it’s separate to the KS
5) spoke to vets and told them that I’m insured but not for the back so if any treatment/diagnosis looks like it’s the back that I don’t want to run up another huge bill and need to be very cautious (having already paid them £6k KS surgery myself).
6) Horse went in for work up. Before diagnostics the vet said “yes looks like SI”. I again explained I’m not insured for the back. She said “don’t worry it’s separate” she wanted to scan then inject so again I said are you sure you think I’ll be insured. She said yes. My friend who was with me said “can’t you just inject the SI to lower the cost” and the vet said she wanted to scan as should be under insurance.
7) Scan showed bony changes to SI joint and intertransverse joints and was injected
insurance company have now said they won’t pay because my horse has been diagnosed with “back pain” and the back is excluded. He didn’t go in with back pain, he had issues engaging the hind end.
So I feel like I’ve been left between a rock and a hard place really. The ins co didn’t tell me claims would be difficult to prove not connected to KS when I took out cover (I’ve paid almost as much in premiums as the SI vets bill!!). The vet kept reassuring me it was separate and would be insured and ran up a big bill doing every scan and treatment possible, now she’s told the insurance company the diagnosis is back pain! Had I know there were doubts about the cover I wouldn’t have taken it out and would’ve self insured and had I know I’d be paying this bill myself I would’ve asked to not to scan and just inject (cut corners for a cheaper bill rather than act like there is a blank cheque!!). The treatment wasn’t successful anyway and my horse was PTS anyway making this all so much harder (I’m £10k in debt for vets bills).
do I have any recourse with the vet or insurance co? I know ultimately this is my responsibility but feel a bit mislead on both sides. Thanks
I’ve got an issue with my insurance company refusing to pay a claim and landing me with a huge bill (I’ve already paid lots of vets bill myself for my late horse). Just wondering if anyone has any experience of this.
1) My horse had KS surgery in 2021 (pre existing so wasn’t insured, I funded the surgery)
2) 3 months after surgery I decided to call one of the big insurance companies to see if cover was worthwhile. I assumed they would exclude everything that could be connected to KS (Si/psd/hocks..) but thought it was worth researching.
3) spent ages on the phone while they spoke to underwriters and was told yes SI and hocks, neck, suspensories were all covered (he’d never been diagnosed with these) just the back excluded. I was shocked at this cover so decided to go ahead (at a high premium)
4) 3 months later (after taking out cover) my horse had canter issues which were totally new. Looked like Si. Called ins co and they said yes SI is covered as long as vet says it’s separate to the KS
5) spoke to vets and told them that I’m insured but not for the back so if any treatment/diagnosis looks like it’s the back that I don’t want to run up another huge bill and need to be very cautious (having already paid them £6k KS surgery myself).
6) Horse went in for work up. Before diagnostics the vet said “yes looks like SI”. I again explained I’m not insured for the back. She said “don’t worry it’s separate” she wanted to scan then inject so again I said are you sure you think I’ll be insured. She said yes. My friend who was with me said “can’t you just inject the SI to lower the cost” and the vet said she wanted to scan as should be under insurance.
7) Scan showed bony changes to SI joint and intertransverse joints and was injected
insurance company have now said they won’t pay because my horse has been diagnosed with “back pain” and the back is excluded. He didn’t go in with back pain, he had issues engaging the hind end.
So I feel like I’ve been left between a rock and a hard place really. The ins co didn’t tell me claims would be difficult to prove not connected to KS when I took out cover (I’ve paid almost as much in premiums as the SI vets bill!!). The vet kept reassuring me it was separate and would be insured and ran up a big bill doing every scan and treatment possible, now she’s told the insurance company the diagnosis is back pain! Had I know there were doubts about the cover I wouldn’t have taken it out and would’ve self insured and had I know I’d be paying this bill myself I would’ve asked to not to scan and just inject (cut corners for a cheaper bill rather than act like there is a blank cheque!!). The treatment wasn’t successful anyway and my horse was PTS anyway making this all so much harder (I’m £10k in debt for vets bills).
do I have any recourse with the vet or insurance co? I know ultimately this is my responsibility but feel a bit mislead on both sides. Thanks
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