katie247
New User
Hi new to all this but i just wondered if anyone had experienced an insurance company refusing to pay out on a euthanasia claim due to BEVA guidelines?? I know it is a distressing topic but i am at a loss as to what to do. Thanks.
Insurance refusing to pay
- Thread starter katie247
- Start date
BigRed
Well-Known Member
I think you would need to provide more information. I had no problem, but my vet was able to speak to the insurance company before she was pts. They agreed with the vet, although they wanted the results of a post mortem.
katie247
New User
My horse had a fractured neck and although we tried everything to help him after 8 months he was obviously in pain - which the vet confirmed, he was becoming increasingly difficult to manage and when i asked my vet if there was anyting else we could do for him he thought that there wasn't - therefore i agreed to have him put down. Now the insurance company are saying that his euthanasia did not meet BEVA guidelines even though i was told by my vet that it was in the horses best interest. I did make a complaint to the insurance company to no avail and am now considering the Financial Services Authority.
Maesfen
Extremely Old Nag!
Sorry you're having this problem; do you mind saying which company as others on here might be insured with them too and can give you better advice?
FWIW, I've never had a problem with my company (KBIS) but in the event of a claim I had, they were told right from the start that I thought it would be a put down job (which it was) another mare died in the field, again, there was no problem at all even though she was sent to hunt kennels before they were even contacted. None of my claims have been for large amounts (£1000 - 1500), I don't know if that makes a difference.
FWIW, I've never had a problem with my company (KBIS) but in the event of a claim I had, they were told right from the start that I thought it would be a put down job (which it was) another mare died in the field, again, there was no problem at all even though she was sent to hunt kennels before they were even contacted. None of my claims have been for large amounts (£1000 - 1500), I don't know if that makes a difference.
abitrusty
Active Member
I have worked for horse insurance companies for many years and in cases like this there is usually a very fine line between what meets and what does not meet BEVA guidelines. As per the post above, I think you would need to provide more information in order to provide an opinion on your situation, however what I would say is that you need to be very careful that you get the insurer's permision prior to having a horse euthanased, except in real emergency situations such as during colic surgery or something. In most situations a horse can be kept comfortable with medication whilst you get insurers permision (if they can't be kept comfortable then it is a clear sign that BEVA guidelines have been met!). In these cases, assuming you are with a reputable insurer then they will not want to keep you waiting on a decision longer than they need to but they should be allowed to gather all the facts they need to in order to make an informed decision, including an opinion from their own vet if necessary, which will not be possible if you have the horse put down prior to gaining insurers permmision.
It is obviously a very emotional and stressful situation for anyone to go through if their vet says that there is nothing that can be done and euthanasia is the only option, however in many situations it can be easy to interpret what the vet is saying in a different way to how it is intended. If your vet is saying that your horse needs to be put down because they will be constantly suffering if they do not go down this route, then that is very different from the vet saying that the horse needs to be put down because the condition will degenerate further and may not be rideable again. It is a fine line between a mortality claim and a loss of use claim.
If you and your vet feel that this is definitely a mortality claim and not a LOU claim (and quiz your vet very closely on this to see if your insurers are being unreasonable or not) and the insurers are still being difficult then you do have other options available to you. First put your complaint in writing giving clear reasons as to why this situation meets BEVA guidelines. Provide veterinary evidence from your vet and if possible get a second opinion from a reputable source preferably unconnected to the situation and from a referral hospital like Rossdales or Newmarket Equine Hospital, that concurs with this - it may cost you more but could be worth it in the long term. If still no joy then take your claim to the Ombudsman - and tell your insurers in your letter that you will take this course of action if your do not get a satisfactory reply. The Ombudsman should be impartial and will look at it from both sides and at all evidence available. It could be a long process but if it truly is a mortality claim then I would hope you will get the right result in the end.
Sorry to hear you are having to go through this, it is a horrible situation to be in but make sure you are looking at all the facts with a logical head and not just emotional no matter how hard that may be.
It is obviously a very emotional and stressful situation for anyone to go through if their vet says that there is nothing that can be done and euthanasia is the only option, however in many situations it can be easy to interpret what the vet is saying in a different way to how it is intended. If your vet is saying that your horse needs to be put down because they will be constantly suffering if they do not go down this route, then that is very different from the vet saying that the horse needs to be put down because the condition will degenerate further and may not be rideable again. It is a fine line between a mortality claim and a loss of use claim.
If you and your vet feel that this is definitely a mortality claim and not a LOU claim (and quiz your vet very closely on this to see if your insurers are being unreasonable or not) and the insurers are still being difficult then you do have other options available to you. First put your complaint in writing giving clear reasons as to why this situation meets BEVA guidelines. Provide veterinary evidence from your vet and if possible get a second opinion from a reputable source preferably unconnected to the situation and from a referral hospital like Rossdales or Newmarket Equine Hospital, that concurs with this - it may cost you more but could be worth it in the long term. If still no joy then take your claim to the Ombudsman - and tell your insurers in your letter that you will take this course of action if your do not get a satisfactory reply. The Ombudsman should be impartial and will look at it from both sides and at all evidence available. It could be a long process but if it truly is a mortality claim then I would hope you will get the right result in the end.
Sorry to hear you are having to go through this, it is a horrible situation to be in but make sure you are looking at all the facts with a logical head and not just emotional no matter how hard that may be.
Lizzie66
Well-Known Member
You might find that as it wasn't an emergency situation, you should have contacted your insurance company prior to giving the go ahead to pts.
They probably have a clause regarding this and if you contravened it then you will likely be fighting an uphill battle regarding a payout.
The answer above is a lot better than mine ! (it wasn't there when I started mine)
Good Luck and sorry for your loss.
They probably have a clause regarding this and if you contravened it then you will likely be fighting an uphill battle regarding a payout.
The answer above is a lot better than mine ! (it wasn't there when I started mine)
Good Luck and sorry for your loss.
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JoG
Well-Known Member
I had my chestnut PTS at 14yrs as he had advanced DJD in all leg joints and in his spine.
There was an option of him being packed full of painkillers and left to rot in a field until the end of his days - my vet and I agreed that it was kinder and fairer to have him PTS. But because there was another (totally unrealistic IMO) option then there was no insurance payout....
There was an option of him being packed full of painkillers and left to rot in a field until the end of his days - my vet and I agreed that it was kinder and fairer to have him PTS. But because there was another (totally unrealistic IMO) option then there was no insurance payout....
abitrusty
Active Member
Sorry - have just seen that you have now given some more details. It's a difficult one because insurers will argue that the pain had been managed for 8 months therefore why now to have the horse put down? I assume the pain will have been getting harder to manage but you need to prove this to the insurers. It sounds like you tried everything and that does seem to be a rather extreme injury. I would be inclined to get all reports from your vet and send them somewhere impartial and ask them for a second opinion on whether there was anything else that could have been done, and whether the horse was in constant pain. Also, ask for copies of the reports that your insurers have received from their own vets - you should be entitled to see this and then your vet can reply to the comments from the insurers vet. Good luck.
MrsMozart
Just passing through...
Tiggy had chronic damage to both hind suspensory ligaments. I thought she was going to be a long term field ornament. It took me a few days to realise that she was not going to be with me for long. The decision was reached that pts was the only fair option for her.
The insurance company rang me the day before it was to happen, to question it (again! - as if I hadn't questioned it enough myself). The AHT talked to them and explained (again) that Tigs would not be able to walk soon, she was already having difficulty turning and staling. The insurance company wrote to me later. My vet wrote a stinging response. The insurance company paid up.
The insurance company rang me the day before it was to happen, to question it (again! - as if I hadn't questioned it enough myself). The AHT talked to them and explained (again) that Tigs would not be able to walk soon, she was already having difficulty turning and staling. The insurance company wrote to me later. My vet wrote a stinging response. The insurance company paid up.
chestnut cob
Well-Known Member
Echo what Abitrusty says. I would speak with the FSA and ask them to help you word a letter - that's what I've recently had to do (though thankfully not because of a PTS claim but because they have already taken 6 months to consider invoices I sent them, despite agreeing to settlement terms last year...). They will tell you what you need to put. They also gave me the guidelines which insurance companies must adhere to, explained how my insurance company were not acting within these and told me how to explain this to them. You need to write to them, tell them it is a formal complaint, state clearly what your complaint is, provide evidence and then state how you expect them to resolve the complaint.
The FSA told me that the insurer then has 8 weeks to either come to a decision. If they don't respond / don't come to a decision, or you are unhappy with the decision, you should then go to the Ombudsman. It is worth saying that the Ombudsman isn't there to stick up for you, they are there to mediate. I found the FSA very helpful but the Ombudsman (funnily enough, since receiving the letter from the Ombudsman, my insurer has suddenly agreed to pay up...) less so if I'm honest.
I think that if the terms of your policy state you must get the insurer's permission before PTS (and you didn't do this) then you may not have a case.
The FSA told me that the insurer then has 8 weeks to either come to a decision. If they don't respond / don't come to a decision, or you are unhappy with the decision, you should then go to the Ombudsman. It is worth saying that the Ombudsman isn't there to stick up for you, they are there to mediate. I found the FSA very helpful but the Ombudsman (funnily enough, since receiving the letter from the Ombudsman, my insurer has suddenly agreed to pay up...) less so if I'm honest.
I think that if the terms of your policy state you must get the insurer's permission before PTS (and you didn't do this) then you may not have a case.
katie247
New User
Thankyou everyone who has taken the trouble to respond, my case is very complicated as my horse was injured whilst under the care of someone else who I had sent him to to be professionally backed. The insurers were NFU who i must note are suing the person to whom he was sent - the plot thickens!!! The horse was very lucky or unluncky in some ways to have survived the injury in the first place and the insurers were informed all the way through the claim although not before I agreed to have him put to sleep. However it does seem to me that BEVA guidelines are too difficult to meet therefore making it easier for the insurance company to not pay out, the only people that really suffer as a result of this is us. The vets still get paid, we have still paid our premiums and we and the horses we insure are left to fend for ourselves.