Insurance Question?

[Roberto14]

Hello all


I'm trying to find the answer to this from my insurance company but i don't seem to be having much luck.

Basically my horse has a couple of exclusions on his policy that i didn't notice (DUH! silly me) I questioned them today but as I have opened a claim they won't review them until he has been sound and in work for 6 months.

My question to them was what the exclusions actually mean as per what is actually covered and what isnt as they are very blanketed and vague.

One being Excluding all losses arising directly or indirectly from or attributable to conditions associated with the positive flexion on both hind limbs. ( to me this could mean anything )

And the other Excluding all losses arising directly or indirectly from or attributable to the soft tissue to the spine.

I have emailed and keep asking but I'm not getting an answer so can anyone shed some light?

Thanks

 

[be positive]

Have you bought him fairly recently? it sounds to me as if he showed slightly positive to flexion tests and had a slightly sore back when vetted, probably not enough to concern the vet but enough for the insurance company to cover themselves by excluding both areas. It is fairly common to review after 12 months and remove the exclusions if nothing has shown up.
If your current claim is related to either of the exclusions in any way then be prepared for it to not be paid by them, the hind limbs exclusion will probably mainly be arthritic hocks, suspensory issues but could include most of both hind legs, the back will be a bit more simple, KS may be excluded and any soft tissue muscular issues which are not really that common, often due to poor saddle fit and are normally resolved with a bit of physio, a correctly fitting saddle and proper work.

 

[Roberto14]

No I have had him for 8 years!!

He had an xray to his back in 2011 that showed nothing wrong I cant remember a time he had flexion tests apart from at his vetting that he passed so its all very strange

Im going to talk to the vet about it Monday when they come but the fact im getting no response from them is really irritating

The one thats confusing me is "the soft tissue to the spine" is that going to include all the joints in his spine or just the muscles? He had a fair amount of physio over the years would that be why that is excluded?

 

[be positive]

That seems odd with the hind leg exclusions ask your vet if there is anything recorded on his history that may have suggested an issue, the regular physio will account for the spine exclusions as the visits will be recorded on his history and there must have been a reason you had the back xrayed.

 

[Red-1]

I hope it all becomes clear to you when you have spoken to the vet, but I suspect it will be the office staff who will be able to help with the records, not the visiting vet.

In the mean time i would have a look at previous years' policy documents. Is it possible he has been excluded for all 8 years of ownership, since his purchase vetting?

If the back was X rayed there must have been a problem, and most likely he reacted to a flexion test at that time? So, that would show as having exclusions from 2012 onwards?

It is also possible that his records are wrong. I had a horse have a knee arthroscopy added to her records, when she was fit and health and had been subjected to no such treatment. I found it to my surprise when her knees were excluded!

I could prove she was competing BE shortly (as in a week) after the supposed procedure. The vets still would not remove it from her records, and they insisted she had the procedure. I was quite cross, and demanded to know exactly how I had paid for such treatment? Cheque? Bank transfer? Credit card?

I received an apology, the vets contacted the insurance company, and the exclusion was removed.

I do know that they did not entirely clear her record though as the next year I received a vaccination reminder letter...

Dear Red-1,

I am writing to inform you that your horse NOT HER HORSE is due her annual vaccinations.

Please contact our office for an appointment!