Insurance paying out!

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Horselover2010

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Has anyone that has ever been insured with allienze/pet plan/seis(Scottish equestrain insurance) that has had to make a claim for illness within the first 14 days of cover?
Currently having an issue with them paying out.
 
As Tiddlypom says, most insurers don't cover anything within the first 30 days or so of you taking the new cover out (even accidental injury surely because you could then just insure if your horse had just had an accident...). Basically look through your policy details and if you think they're wrong then ask them their reason for not paying out?
 
I don't think any insurance covers for illness for at least 14 days and some as mentioned don't cover for 30 days so you need to check your policy but I have never heard of a company that pays in the first 14 days for an illness but many cover for accident from day one.
the reason being the horse could have knowingly been exposed to another animal that is ill so owners rush out and buy insurance that starts immediately
 
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Illness is covered from 14 days my horse became ill 13 days into the policy under 12 hours before I was able to claim :(! Just wanted to see if anyone's managed to get them to pay as now I owe the vet 4,000 and they won't pay out for his death as they said it was related to kissing spine (the original claim) because he went for the op and died of a freak accident during the recovery :(!
 
If it says it is not covered for 14 days then they wont p[ay out, they would argue it was a pre-existing condition even if it was within a month and they would be right kissing spines does not happen over night.
 
Sorry, as said, kissing spines will have been a pre existing condition so although this didn't kill him, the recovery from the op for it did. No insurance company would have covered him for that so soon after the start of the policy.

Only thing is, was he vetted? Even if he was, and passed without endorsements, I doubt you'd get a pay out this early. Unless the vet missed something obvious, in which case you could possibly claim against the vet?

So sorry for your loss.

ETA. When I buy a new horse, I have the policy all set up and ready to run as soon as the horse passes a 5 stage vetting. Even so, I'm only covered for accidental injury for the 1st 14 days, but at least I know if the new horse gets injured on the journey home or when turned out at its new home, I'm covered (I'm with SEIB).
 
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It was back in December we treated it as muscular and it went away. Came back in July and got officially diagnosed told the insurance and over the phone they agreed to pay, and the op was 3 weeks ago. On the policy in the small print it says he's covered for death by illness or injury from the first day of the policy. So my own vet and the vet that operated are writing letters and I'm writing a complaint as my vet said they aren't getting away with not paying for his death
 
But that's death by illness or injury only if not related to the original condition which they've already paid out for (the op 3 weeks ago?) so I very much doubt you can make them pay for this. I guess it could depend on exactly what happened, but I assume they'll say it is linked as it was during his recovery. However, I'm unsure - did you take out a new policy with someone else and a different insurer paid out for the op? If so, and it did happen within the 14 day period (even if it is 1 hour before the 14 day period ends) then they are within their rights to say no I'm afraid. Sad to hear about your loss OP, its horrid when it happens and then you have to worry about this.

Why do you owe vet £4k? Was this purely from the accident or did you end up paying for the operation?
 
Ok, this sounds rather tricky.

I would 'expect' your lad's policy to have excluded kissing spines and any complications from them (based on my own experiences with SEIB and other pre declared veterinary conditions.). If you pre declared the kissing spines on taking out the policy, and were led to believe an operation for them would be covered, that would surprising (to me), but I have no knowledge of what was said on either side.
 
your posts don't make it very clear (to me at least)..
what I am thinking is you bought the horse last year and within 14 days a back issue was treated and diagnosed as kissing spines, the insurance would not pay for the surgery in July as it was on the pre-existing condition of kissing spines?
He had surgery which is what your 4k vet bill is for and during recovery he had an accident and died?
If this is the case I don't understand why your vets are thinking the insurance will pay out, my understanding is that if he did not have the pre-existing condition of kissing spines he would not have needed the surgery and would not have been in recovery to have the accident so it is all linked to a preexisting condition.
There is never any harm to present a claim but I doubt they will pay as I could not see a court supporting your claim so they have nothing to loose by saying no.
HUGS for the loss of your horse though
 
I read it that within the 14 days a back issue was discovered, thought to be muscular and treated as such, not that it was diagnosed with KS at that point?

I don't know if they would argue in that time scale that the KS was pre existing even if you hadn't had the vet out on day 13? Or did you just say that was when it became apparent?
 
Tiddlypom said:
Ok, this sounds rather tricky.

I would 'expect' your lad's policy to have excluded kissing spines and any complications from them (based on my own experiences with SEIB and other pre declared veterinary conditions.). If you pre declared the kissing spines on taking out the policy, and were led to believe an operation for them would be covered, that would surprising (to me), but I have no knowledge of what was said on either side.
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He didn't have any symptoms of kissing spine before I took out the policy 13 days into the policy he suddenly went lame and I got the vet out straight away and we treated as muscular and if not better would be kissing spine. :(
 
ester said:
I read it that within the 14 days a back issue was discovered, thought to be muscular and treated as such, not that it was diagnosed with KS at that point?

I don't know if they would argue in that time scale that the KS was pre existing even if you hadn't had the vet out on day 13? Or did you just say that was when it became apparent?
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If I didn't have the vet out on the 13th day they would have covered :(! He wasn't diagnosed till 8 months later as he was fully sound. And in July had totally different symptoms to that in December :(!
His very first symptom was day thirteen of my policy when he suddenly became lame :(!
 
Have to say Scot Equestrian has insured my horse for 12 years and have been very good. My horse had KS op 9yrs ago, initially they said wouldn't pay as he would be comfortable/not in pain in field so could live out his life & they would only cover operations if life threat. I looked at the wording document and indeed it said he was covered for operations in life preserving circumstances, because he was so dangerous to handle, the vet recommended PTS if I choose not to have operation and wrote to them stating that diagnosis and they paid out for op & related costs covered on policy.

Since then apparently they have changed their policy and have become much more helpful. My horse needed a bone scan last year to see if his hocks had issues and they agreed the claim straight away, they were unbelieveably good given his history, but I did ask for agreement before instructing the vet to go ahead. I would ask for a copy of the conversation where they agreed it was ok to proceed with treatment. They tape the phonecalls and on that basis you have proof unless they suggested there could be exclusions and you went ahead anyway. Was he insured for accidental death? This the bit you need the vet to clarify & if they admit it they could be made liable so is a tricky area. I think you need to be very careful with the way you word your claim to make it relevant to the section of the policy you are claiming on. The 14 day thing does indeed make it more complicated as they will be much more careful with a new client.
 
I wonder if they would have a good case for claiming it was pre existing even if it wasn't identified until 6 months into insurance, I wonder if they have a standard time for progressive conditions like that? - and I guess the 13 day situ sort of gives them the heads up that it might have been there then.
 
I didn't realise their phone call was recording! I'll have to phone them again and request a copy! Doubt I'll get anywhere as they refused to tell me where to put in a complaint and put the phone down on me yesterday! He was insured for accidental death and death due to injury and illness. Both my vets are fuming and their exact words are 'they aren't getting away with this we won't let them'
What actually happened was when he woke up he panicked and when getting up didn't position his feet right and flipped over breaking his neck and killing him instantly so was a complete freak accident :( vet has confirmed that on time of death he was kissing spine free. He is willing to write a letter and so is my own vet too!
 
The vet letters are vital but also read your wording document to see if recovery under anaesthetic is excluded. Did you buy the policy through a broker as if you did they may have experience of this sort of thing and if they received commission for selling you the policy, they may know how to tackle the company having dealt with them before. Fingers crossed, keep at it until you have exhausted all avenues - your poor horse, what a horrid time for you.
 
I think you should spare yourself any further stress and accept that the insurance company are not liable. I'm very, very sorry for your situation, but as I understand it you were sold a horse by someone which was probably drugged to hide serious issues. At thirteen days he was lame and you called a vet, and the diagnosis was to treat for muscular issues and if that did not work, then investigate for kissing spines. Kissing spines were later found and operated on under general anaesthetic. General anaesthetic in an animal as big as a horse carries about a one per cent risk of death, and much of that risk is due to exactly the kind of thing your horse did in the recovery phase. Thus is why recovery rooms are padded, often with the corners removed, and no-one is allowed to be in with the horse as it is too dangerous.

Is quite straightforward, if your horse has not had the anesthesia, he would not have been at risk in the recovery room. The insurance company, whatever your vets say, is simply not liable. You might, though, ask them why they gave a general anaesthetic to do an operation which has been done under standing sedation routinely for several years now, precisely to avoid that kind of risk.

This is causing you enormous stress, and is likely to cause you even more, and possibly lose you even more money, if you fight it any further. For your own sake, please give up.
 
Based on my own recent insurance issues and from what I can see that you have said they will not pay out!! I took my case to the Omudsman and although they fully appreciated and agreed (along with 3 vets involved that wrote to support my claim) that 2 incidents were not connected the insurance company refused to pay as they were water tight on their policy wording.
They paid nothing - my £5k insured vet fess, my £800 PTS sleep costs or my £5k insured sum.
I am now left with no horse, £10k down plus the substantial sum that I need for a new horse!! My new insurance policy will be very different as I now know what is not worth paying for!!
I wish you a more positive outcome but all I would say is that if their wording covers them I wouldn't waste your time and energy fighting them as you won't win!!
I was with a different company to the ones you mentioned.
 
BethH said:
The vet letters are vital but also read your wording document to see if recovery under anaesthetic is excluded. Did you buy the policy through a broker as if you did they may have experience of this sort of thing and if they received commission for selling you the policy, they may know how to tackle the company having dealt with them before. Fingers crossed, keep at it until you have exhausted all avenues - your poor horse, what a horrid time for you.
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No where in the small print does it say excluded for GA :(
 
Horselover2010 said:
He didn't have any symptoms of kissing spine before I took out the policy 13 days into the policy he suddenly went lame and I got the vet out straight away and we treated as muscular and if not better would be kissing spine. :(
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Horselover2010 said:
It was back in December we treated it as muscular and it went away. Came back in July and got officially diagnosed told the insurance and over the phone they agreed to pay, and the op was 3 weeks ago.
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Horselover2010 said:
vet has confirmed that on time of death he was kissing spine free. He is willing to write a letter and so is my own vet too!
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I'm getting confused. On what basis was the horse 'officially' diagnosed with kissing spines? X rays? Scans? But subsequently no sign of KS on PM?

What exactly was the operation for?
 
ycbm said:
I think you should spare yourself any further stress and accept that the insurance company are not liable. I'm very, very sorry for your situation, but as I understand it you were sold a horse by someone which was probably drugged to hide serious issues. At thirteen days he was lame and you called a vet, and the diagnosis was to treat for muscular issues and if that did not work, then investigate for kissing spines. Kissing spines were later found and operated on under general anaesthetic. General anaesthetic in an animal as big as a horse carries about a one per cent risk of death, and much of that risk is due to exactly the kind of thing your horse did in the recovery phase. Thus is why recovery rooms are padded, often with the corners removed, and no-one is allowed to be in with the horse as it is too dangerous.

Is quite straightforward, if your horse has not had the anesthesia, he would not have been at risk in the recovery room. The insurance company, whatever your vets say, is simply not liable. You might, though, ask them why they gave a general anaesthetic to do an operation which has been done under standing sedation routinely for several years now, precisely to avoid that kind of risk.

This is causing you enormous stress, and is likely to cause you even more, and possibly lose you even more money, if you fight it any further. For your own sake, please give up.
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Actually I've had the horse for 5 years so he certainly was not drugged! It did work he was fine for 6 months then got totally different symptoms to the ones in December. He was under GA as he was too dangerous to do under stabbing sedation and would have injured himself, my vet is the top othropedic surgeon in Scotland so knew exactly what he was doing. I will certainly not give up I will be fighting this all the way. Just for the money my horse was worth!!
 
Tiddlypom said:
I'm getting confused. On what basis was the horse 'officially' diagnosed with kissing spines? X rays? Scans? But subsequently no sign of KS on PM?

What exactly was the operation for?
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He had X-rays to officially diagnose then steriod injections which did not work. Then surgery was the only option to fix him. He had a mix of the trad op and lig snip which on X-ray just before he was woke up, showed no vertebrae touching.
 
Tiddlypom said:
I'm getting confused. On what basis was the horse 'officially' diagnosed with kissing spines? X rays? Scans? But subsequently no sign of KS on PM?

What exactly was the operation for?
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I think vet is saying KS was not cause of death because he had fixed them in op... therefore death not linked to KS?!

OP what did the insurance say when you told them horse was going to have op? did they indicate then that it wouldn't be covered? I think your only option will be to go to the ombudsman but that you might not win.
 
ester said:
I think vet is saying KS was not cause of death because he had fixed them in op... therefore death not linked to KS?!

OP what did the insurance say when you told them horse was going to have op? did they indicate then that it wouldn't be covered? I think your only option will be to go to the ombudsman but that you might not win.
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I phoned them and they said it was fine to go ahead with the op
 
Oh ok, so the surgery was successful, in that the the vertebrae no longer touched.

So sorry about the accident in recovery.

Try and get that transcript, but tbh, if your vet mooted KS as a possible cause of the original lameness 13 days into the policy, I doubt you will end up being covered.

I'm very, very sorry for you, you tried your best for him.

ETA Barring emergencies, it is prudent to get written confirmation of cover for a procedure.
 
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