Insurance refusing to pay

[Udall]

Hello

I'd be grateful for any experiences / opinions on the below

My horse with diagnosed with ulcers back in April. We noticed that she didn't seem herself for a while and after quite a few weeks of trying to convince my vet to scope for ulcers, she was scoped and did have them.

We put in claim into our insurance and they have just advised us (after taking 3 months to process our claim) that we are not covered.

My horse had colic surgery 5 years ago and they have said we are excluded for this reason. She has not had colic since.

We have disputed this and they have asked our vet to write a letter to state that the ulcers are not related to colic, I just wondered if anyone has had this happen to them and what the outcome was?

They have also just backdated our new policy to exclude gastro intestinal disorders, which I can see in the small print they are allowed to do!

Thank you in advance

 

[BlackRider]

Unfortunately that is insurance for you, they're usually pretty swift at adding exclusions following an ailment...

 

[Udall]

Sadly they added the new exclusion within 4 days of putting in the claim, shame they took 3 months to tell us we were not covered!

I think I'll just scrape the policy when it's next due and put some money in a savings account in future.

I just hope the vets letter will be enough to get them to pay out, as it's a pretty big bill so far!

 

[Marydoll]

If the exclusion was added after the claim went in id take it to the ombudsmen

 

[Udall]

We are technically claiming under last years policy (where we only had the colic exclusion).

We put the claim in once the new policy had literally just started, but because the symptoms were noticed prior to the new policy staring it should still be covered under the old policy (although they are disputing this due to the colic exclusion). The new policy was sent in advance (without the gastro intestinal disorder exclusion), but 6 days after it started they sent a revised new policy backdating it with the new exclusion, I checked the small print and they can do that.

 

[Udall]

So under the old policy they are excluding the ulcer treatment under the colic exclusion, but are now making a specific exclusion for them under the new policy as gastro intestinal disorders.

 

[Marydoll]

Sounds like youre stuffed then :-(

 

[Udall]

I hope not!

We did ask the vet at the time if the ulcers were in any way related to her colic surgery and they said no.

Hopefully the vets letter will convince them and they will pay out.

I don't see how they can exclude ulcers under the colic exclusion, but knowing insurance companies I'm sure they will try to find some way!

 

[irishdraft]

I dont have any experience for you as I dont have insurance for this very reason but i would query why they feel the need to now add a specific exclusion for gastro disorders if this is already excluded under the colic exclusion, seems to me they are aware colic exclusion is not the same as ulcers but are hoping you will go away quietly

 

[L&M]

This is why I no longer insure, bar third party via BHS....

 

[Red-1]

I dont have any experience for you as I dont have insurance for this very reason but i would query why they feel the need to now add a specific exclusion for gastro disorders if this is already excluded under the colic exclusion, seems to me they are aware colic exclusion is not the same as ulcers but are hoping you will go away quietly

I suspect this too. Good luck with the vets letter.

 

[Louby]

I had a claim refused recently by a respected company. To be fair I had an exclusion from about 8 yrs ago for a remotely connected issue, so a bit iffy really. I rang to ask about claiming just to see if I was or was not covered and they couldnt tell me?? They said because it was years ago, it should have been lifted anyway?? but to treat it as if I wasnt covered just in case. Not much use at all. Anyway to cut a long story short, despite having supporting vets letters, they wouldnt pay out. My horse on vets advice was eventually pts and they said it wasnt under DEFRA guidelines even though the vet said it was the humane thing to do. I now have a new horse who is insured by a different company, but once I get any exclusions, I think I will sack insurance. I pay for it mainly to cover vets fees as they add up so quickly but it seems nowadays, if it isnt cut and dry then you arent covered anyway. Good Luck.

 

[Moomin1]

I don't bother insuring for vet's fees anymore. I insure public liability and death/theft etc, and I have a credit card on hand for the rest.

 

[annhemming]

My mare fractured her pelvis and initially her insurance said they would not pay as she had back pain (sore muscles) over a year before. My vet wrote a letter to say she had been sound for over a year since her back pain and the conditions were unrelated. They lifted the exclusion and paid out in full for her treatment. You have the right to appeal the exclusion.

 

[loopylucifer]

Always ask for exclusions to be reviewed after a year with a supporting letter from your vet. If for what ever reason they will not lift an exclusion get it as specific as possible that way it is clear for all parities. unfortunately for you I would imagine the wording of the exclusion would be something along the lines of losses arising form colic and related/attributable condition.
I speak from experience when I say always look at your exclusions if you are unsure of an exclusions ask your vets they will know if it is fair or not

 

[Udall]

I just wanted to say thank you to everyone who had offered me advice.

After receiving the letter from my vet, my insurance company have finally agreed to pay out today.

I'm a bit disappointed with the company (who have always been pretty good in the past), as I think they were trying it on a bit and they took ages to initially tell us that they wouldn't pay out (4 months), but at least they got there in the end!