Insurance rant!

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BlytheBerry

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Sorry to make my first post such a ranting one (I’m really not a horribly angry woman usually!), but am hoping for some advice or experiences.
I will try to keep this short :o.

About 18 months ago my tb mare came in lame from the field with a swollen fetlock.
The vet examined her, nerve-blocked, Xrayed and diagnosed mild arthritis. He injected the joint and a few weeks later she was back to her old self again.
I put in a claim for the vet bills with NFU and they were brilliant. They paid the vet directly and everything went smoothly.

Back to present day; last week my mare became lame again and her joint swelled (this time more around her pastern area).
The vet repeated the exact same process as before and we are hoping the injection helps her again.
The xray showed it was her arthritis flaring up, but also that the arthritis has significanty worsened since her last lot of xrays.

To today; I have just got off the phone with NFU who have said they will not cover me for her latest vet bill due to arthritis being a pre-existing condition.
I did presume there would be some sort of ‘cap’ on ongoing tests and treatments, but if they’ve notified me of this at the time of her last claim then it must have been in the very very very small print!

I insured my mare with NFU long before she ever suffered/ was diagnosed with arthritis. She is 13 and otherwise fit and healthy. They paid for her initial arthritis treatment and tests, so surely they accepted that she either developed arthritis *after* being insured, or they accepted that I didn’t know about it before buying her (but that I exercised due caution when doing so and as such wasn’t acting negligently). Surely this is what insurance is for? The unforeseen. And if they’ve accepted that I didn’t/ couldn’t have foreseen it then you would think some sort of cover would be offered (or AT LEAST the lack of it in these situations be made crystal clear to you at the time)?

I asked if they would pay for any part of this bill given that we only reached the arthritis-flare up diagnosis after performing the tests (ie; up until the results were seen, it could have been anything causing the problem). My mare had presented with several bits of ‘false’ information (her hoof was very warm, she responded to pain tests in the sole of her foot and occasionally would not weight bear on the affected leg) so without the nerve block and xrays the cause was not automatically obvious.
They have said no.

I've been a loyal customer of NFU for a long time and (thankfully) this is the first time I’ve had to make a claim of this nature, so am quite shocked by their response.
It has really got me wondering what exactly I am insured for. For example, what if my mare now has an accident and requires extensive, costly treatment on that leg? Are they going to argue the arthritis has weakened it and therefore I’m no longer covered for it?
Or what if (god forbid) in a few years my mare’s arthritis becomes unmanageable and she’s too uncomfortable to even be a non-ridden pet? If I have to have her put to sleep, are they going to not pay out her full purchase price because ‘technically’ it would be her arthritis as the cause?

It's all very fateful, morbid thinking I know, but given I pay nearly £100 a month to insure her, today I just feel incredibly disheartened by the whole thing. I'm seriously thinking I will be changing insurance companies (not that I expect others to be any better - but that I shan't be giving NFU any more of my money!).

Has anyone else encountered this? Or have I just been incredibly stupid and missed this little detail in the fine print?
 
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I don't know any horse insurance companies that will cover a single claim (including reoccurences) for any period over 12 months. At that point the usual procedure is to place an exclusion on the specific joint/injury. It is not a 'lifelong' payout, although I do believe you can get those terms (at a vastly inflated rate) for some small animals now.

It should be in the original contract you signed with NFU.

Sorry :(
 
It's pretty standard I think, first incidence will be covered but the leg/condition will be excluded from then on

It should have been in your renewal documents

Check what the exclusions cover as it could be that if something goes wrong with that leg eg tendon trouble it may not be covered

Don't shoot yourself in the foot if you can avoid it, ask for exclusions to be tweaked to cause minimal risk if you can as if you go elsewhere you will have to declare the pre existing condition and so may end up with worse exclusions
 
In addition; it depends on the individual circumstances whether the whole joint - or indeed leg - is excluded. Any 'accidental' injury should still be covered anyway, and for any other condition it would depend on whether the vet thought that the arthritis had any impact. Your vet may need to write to your company if a full exclusion is put on.

Mortality insurance is separate - you would still get the sum your horse was insured for (or the percentage/current value) as the reason the horse is PTS is not relevant, as long as it either meets the BEVA criteria for immediate humane destruction or your insurance agrees that PTS is the best option.

It's a minefield.
 
You only ever have a year from the date of your 1st vets visit to claim per condition. That is the industry standard with horse insurance. I'm insured with NFU and have been for a long time and last time I claimed they made that obvious when they sent me a letter when I received my payment from them.

NFU have a good eclusion policy in that they do not just exclude the whole joint. So if your mare cut that fetlock badly, they would pay out and it would be deemed a seperate problem to the arthritus she is suffering in that joint.
 
Thanks for replies - It doesn't really matter in the sense that if she needs something, she will get it - regardless of insurance.

I'm not suggesting they've lied to me, I'm sure they haven't. Just that it does seem a bit of a daft system :-/
 
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NFU have just paid up for hock injections to my mare with bone spavins. They will continue to meet vets' bills for any further treatment up to 52 weeks from first diagnosis. My policy clearly states that after that period it will be regarded as a pre-existing condition and no further claims will be met. I would
read your policy again very carefully, it is quite clear.
 
OP - when they say the condition is "pre-existing", they are referring to your current policy year, not when you first took out cover with them. Really, they should have explained that better, rather than just saying it's pre-existing.


rhino said:
Mortality insurance is separate - you would still get the sum your horse was insured for (or the percentage/current value) as the reason the horse is PTS is not relevant, as long as it either meets the BEVA criteria for immediate humane destruction or your insurance agrees that PTS is the best option.
Click to expand...

Rhino - The reason a horse is PTS is relevant as similar to vet fee cover, they will not cover conditions which started before the policy
 
Sorry but all insurance companies have a time limit of 12 months from when a condition first manifest in terms of payouts.

They may extend that in very rare situations but that would be where they would save them money e.g. postponing a op that may or may not be needed.

An exclusion will be placed on that, some insurance companies may exclude the leg, NFU has a general exclusion under preexisting conditions and it should be in your yellow and black policy doc under General Exclusions.
If I recall rightly arthritic conditions get a special mention. I was looking at it closely recently as I had 2 different conditions on the same leg that needed splitting into two claims.

Sometimes exclusions can be lifted with your vets help but that wouldn't apply to anything degenerative like arthritis.

With some conditions 12 months really isn't very long to be sure of the outcome but if you were going to claim say for loss of use you would have to do it within that time.
 
Sorry, just wanted to add:

OP - regarding if the arthritis got to a state where unfortunately your horse had to be PTS, the insurance company wouldn't cover it as they only cover for 12 months from the date the arthritis started. This 12 month cover would apply for vet fees and mortality and will be stated in the terms and conditions of the policy.

You may be able to take out cover with someone else to get lower premiums, however, they would definitely exclude arthritis as it is a chronic condition.
 
rhino said:
It is not a 'lifelong' payout, although I do believe you can get those terms (at a vastly inflated rate) for some small animals now.
Click to expand...

Yep - you have to pay a much higher premium and still have to pay an excess on each policy year, but definitely worth it to cover for illnesses like arthritis or diabetes. Doubt they will ever do this kind of cover for horses and it would just cost far too much.
 
I'm afraid this is fairly standard. In fact NFU have a condition in their policy that once you claim for something in one leg they won't cover that leg or any other legs for that condition. This and other things have made me wonder if it is worth insuring at all.
 
Elbie said:
Rhino - The reason a horse is PTS is relevant as similar to vet fee cover, they will not cover conditions which started before the policy
Click to expand...

Thank you, you are correct. I was out of date :D I now only insure for public liability; when I did fully insure, mortality and vets fees were treated separately for my policies. OP - ignore my previous statement please :o
 
I think my post might have been misread a bit. I'm not suggesting NFU have lied or been decietful - just that it seems a bit of a daft setup.

In terms of not knowing about it, I suppose having never had any problems with my insurance and horse cover before, I just scanned the documnts and have got a bit 'comfortable' with them for want of a better word. So I take on full responsibility of that, but neither would I say it was made crystal clear to me at the time of my initial claim.

It does say about pre-existing conditions in my policy documents (wasn't denying it did), but in terms of my claims document (my last claim related letter) the only thing it says relating to further claims is that they have to be made within a set time period, or the claim has to be classed as a new, additional claim. There's nothing specifically about them not covering it. In retrospect I should have related back to my policy documents, but we live and learn. . .

The fact the chap on the phone was rather rude (which in fairness I've never had from NFU until today) did not help matters. But let me just be clear, I'm not suggesting NFU have been decietful, just that one really does need to be vigilent and that it's a bit of a minefield.
 
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If I still have my beast next year I don't think I will bother with insurance, it's getting to be a pisstake, I will go the BHS gold membership route to get the public liability cover.
 
Sorry, but you don't seem to know how your insurance works. I'm insured with NFU, too, and I knew that you'd have a problem claiming for the current bill before I got to the point where you say they rejected your claim. When you got your insurance pack, you really should have read it. It's there... not just in small print, but fairly clearly.

They do not hide the fact that they pay for any one issue for a period up to 12 months. Your first problem occurred 18 months ago. They paid for it, so that's fine. Your mare went lame again. Had it been for any other reason other than the arthritis they found the first time round, they would have paid for the new treatment again. It just so happens that the vets only said her arthritis worsened... meaning it's not due to anything new. It is due to an EXISTING condition.

There aren't many insurance companies that will pay out for the same thing for years on end...

To be honest, your vet should have warned you, too. My old vet used to ask all the time about insurance stuff, and he wouldn't push the envelope after a year...
 
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