Insurance people help with this scenario?

[1happyhacker]

Friend of mine has a horse that has been giving her some trouble for a couple of years it will go well for a few weeks then suddenly throw a wobbly and either bolt, get nappy or bronco it's rider off, to cut a long story short she now thinks it has a specific problem and wants it to go to a specialist vet for treatment. She hasn't told her insurance company about the problem/s as she thought it was a behaviour related issue not physical. So would the insurance company refuse to pay for the treatment if she says the problem has been on going for some time, e.g. over the year in which the horse is insured for any specific illness or condition?

I know this seems a bit vague as I obviously have to be careful what I put and it's not my horse so I don't know all the facts, but having heard of insurance companies managing to wriggle out of things for minor reasons I am just wondering how she should approach them?

 

[Foxglove]

From a general insurance point of view you can only be expected to disclose what you honestly knew. If she thought it was a ridden issue, she was honest in her belief that it was not physical. You do not say whether she had the vet when the trouble started, this may affect things.

As things stand, the point of claim will probably be when the vet actually finds something wrong, but it may be worth checking the policy wording or speaking to the vet before informing the insurance company.

 

[1happyhacker]

She honestly thought it was a ridden issue, she has had the horses back checked on several occasions by 'specialists', rather than a vet, it's teeth done and saddle checked, she even sent it off for 'training' at an instructors but unfortunately the horse didn't do any of it's tricks while there.

She has been researching an idea on the internet and looking at forums like this one for a couple of weeks and has come to the conclusion it's a physical condition. Therefore she hasn't had a vet look at the horse in the time she has had it for this specific issue. She has to have her vet check the horse anyway before it can be referred so suppose she will have to discuss it with him as you have said.

 

[Foxglove]

From what you have said, it would appear difficult for the insurance company to avoid the claim, particularly as she will be asked when the problem surfaced as she will be able to say the date the vet referred her - that would be when she 'knew' it was a physical problem. As a lay person, you would not be expected to know something that a professional, in this case, the vet, would know - that is a general insurance principle, not just equine policies.

Generally the Financial Ombusdsman comes down on the side of consumers in cases such as this if there was a dispute.

Hope this assists in some way