insurance will not pay

csb

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Hello everyone,



My 21 year old daughter has been dealing with her insurance company, PET PLAN, and my feeling is that they see that she is young, foreigner and not very experienced and are taking her for a ride.



They need to pay a 6000 pound vet bill and each time she calls them they ask for another document.



Her mare developed a splint first in left leg then in her right leg. This went on for some time, but nothing was done as it was clearly a splint each time. A retired vet had a look at the mare each time he came to dinner to the yard, but in an unofficial capacity.



As it was taking too long, my daughter’s employer called the Okham’s vet and got an appointment for the mare. They did x rays, ultrasound and MRI and found that she had a fracture on the splint bone and a vertical fracture on the canon bone.



My daughter paid the excess of her insurance and the mare was operated on. Since then she cannot get the insurance to pay anything.



Every time she calls about the payment they ask for something new.



A bill of sale. She has told them that she doesn’t have one. Her horse only cost 350 pounds. She got the horse from her boss. She has been told it is common not to have one in cheap horses; none of her friends have one. She pays 33 pounds monthly for the insurance. We know it is a lot for such a horse but we have always insured our horses, whatever their price.



Asked her for the full vet history of the horse prior to her buying the horse. She has said she does not have it; the horse was at her employer’s but belonged to an owner. She did however do a full 5 stage vetting before buying the horse which she has sent to the insurance.



A report by the retired vet who had a look at the horse in a non-professional capacity when coming to the yard to see the yard’s owner.



The exact date she first saw the problem. When she couldn’t give it, they really pushed until she gave a date that is approx. and now she does not remember the day she gave and is afraid they will use that against her.



We will appreciate any help you can give us. We do not know how it works in the UK. I am thinking of getting a solicitor. O you know any who deal with these issues?



Thank you.
 

AmyMay

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It will have nothing to do with her age or ethnicity and everything to do with details and dates. Pet Plan are usually highly recommended.

However, they don’t have to pay out if they feel the requirements for payment haven’t been met.

At this stage you may be wise to retain the services of an equine solicitor to assist in your claim.
 

teddypops

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They won’t pay out without the required information. They also won’t pay out if you aren’t covered for that specific issue. Also it will depend on when the issue was first noticed as you only have a year in which to claim. Petplan are very good and I have made claims for £1000’s and they have always paid out. So, what I would do in your position is get everything they have asked for and get it sent off. If you still have an issue, ask your vet for advice/ help. If you still have an issue then speak to the insurance ombudsman.
 

ihatework

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They are fairly routine requests for insurance. All except vet history before ownership (push back on that).

No need to go to a solicitor yet. Respond to questions, provide what you can, keep pressure on them. If they reject claim or drag it out much longer go through formal complaint process and wave around the words ombudsmen.

Im however assuming the onset of the splints and the start of the claim is within the timeframe of the policy.
 

Melody Grey

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It sounds like regular questions they’re asking to be honest. There needs to be a start date for the claim, which will be when you first noticed the problem. It sounds like using a retired vet in an unofficial capacity may have drawn things out. The insurer needs to make sure the problem isn’t pre-existing and that you’re still within the time limit (usually 12 months) from the problem first becoming apparent.
 

Melody Grey

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On re- reading, you might find the splints to be a sticking point- from the insurer’s perspective these could have been caused by the same trauma that caused the fractures and lie outside the claim period? Assuming it’s the same legs! If the insurer challenges this, You may need your vet to write to the insurer stating that they’re unconnected. At this stage however, it all just sounds routine just keep in mind it might not be straight forward.
 

dixie

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I’ve always found PP very good. Those questions are regular routine questions.

with regards to a bill of sale, presumably you can get a copy of this or perhaps an email from the seller.

I always find the date first noticed tricky for the same reasons as sometimes the problem is treated as something minor. I’ve not had any problems with the dates I’ve settled on in the past, so don’t worry about it too much unless the timeline doesn’t work.
 

csb

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Thank you so much for your kind replies. I will now step in myself as I have arrived in the UK and start by calling the insurance and doing a recap with them. Okham were the first vets to see her and I belive it is within the time lapse. Is was only a couple of months between the first splint problem and Okham seeing the mare. Good to know that is is all standart practice. It just fell very strange that each time they asked for something new. Did not know about the insurance ombudsman. In the nean time will find out more about it.

It really makes all the difference to be able to post in a forum such as this. Once again thank you all. Will keep you posted.
 

Sossigpoker

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Also most vets will bill the insurance company directly so they would deal with queries of medical nature.
Next time, just ask the insurers to pay the vet directly (although you are always liable if for whatever reason the insurance company won't pay)
 

csb

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I wouldn't call them I would speak to them via email you then have everything in writing incase you ever do decide to take it further if they won't pay out.

Most insurance companies have a 90 day cut off point from the onset of any condition you try and claim for so you will need to take that into consideration.

Could you please explain this. What happens if the vet sent the bill after?
 

OrangeAndLemon

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Hello,

The Vets billed the insurance first and when this didn't pay they sent us a bill.
Have the sent you an invoice or a statement? While my insurance claim was going through the vet sent me a statement confirming the balance remaining outstanding?

Email the insurance and ask for an update on your claim.
 

csb

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Hello,

The Vets have sent me a letter saying the payment was overdue. I was waiting for your answers to contact the insurance.

I will e-mail them today saying I have received the letter from the Vets and asking them why they haven't paid and see what they say.
 

Melody Grey

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PP are very good and £33/month sounds cheap. I would read the policy thoroughly to make sure you are actually covered.
I agree- maybe it depends on sum insured? I’m paying around that with E&L who are known to be cheaper for my son’s pony, although there is a co-payment on any claims, no loss of use and value at £1k, so quite a stripped- down package.
 

criso

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Most of what they are asking is standard paperwork and they won't be able to progress the claim until you get it.

I have always had to send my bill of sale when taking out the insurance as well as full vets history. You won't be able to get info from before the horse was yours but sending a printout of all treatment while it has been in your care including routine stuff like vaccinations is usual.

It's standard to have to give a date when it started which can be a little more tricky if there isn't an incident you can point to, I've always had to fill in a form and kept a copy. It won't count against you but it will be a hard cut off date in terms of what can be claimed in the 12 months. It's never counted against me to give an approx date but you have to be prepared to justify why there was a gap between when it started and when you called the vet.

I have had a claim with a big gap but I had had my own vet out and we initially treated with rest and physio, so I said this in the claim form. It wasn't a problem but tricky in your situation as you got an unofficial diagnosis from a retired vet.

They will need a report from all vets that have been involved. From their point of view, they need to check, he has been treated correctly as there was more going on than just a splint. So the retired vet is now involved and will need to send a report.

Have petplan said they are not paying. When that happens, you usually get a letter saying they are not paying and why. I've had this happen and been able to appeal and change the decision but you can only do this once they give you an official reason why not.

My vets continue to send statements out even when doing a direct claim as the accounts system does it automatically and the statement will say overdue. If I call they say don't worry especially if the delay is vets needing to send more info. I have also found with Covid, insurers are taking longer to process claims.
 
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Gamebird

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Depending on whether the retired vet has maintained his RCVS registration in his retirement (most don't, as it's pretty expensive) you may find that getting him involved becomes a sticky issue. Whilst he looked at the horse in good faith (and it would be very hard not to help someone out, after a lifetime of vetting), assuming he is not still registered he is probably in a bit of a pickle now. He certainly won't have professional insurance cover (which is a requirement) and you may find that he realises that he shouldn't have done it and is unwilling to commit to a report as he is not legally in a position to be writing one.
 

criso

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I did wonder about what the status of the retired vet would be. Problem is that from the original post it seems the retired vet looked at the horse several times, not just a one off and they were the only professional that did look at the horse until the yard felt it had been going on too long and got Oakham involved. Now with a big insurance claim, the insurers are wanting more information about what was done prior to Oakham.

I have on occasion asked an opinion from an off duty vet but it's always been alongside follow up from the practice we're registered with.
 

Gamebird

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I have on occasion asked an opinion from an off duty vet but it's always been alongside follow up from the practice we're registered with.

You would be fine with off duty as they would presumably still be registered and insured. It's the retired bit that may throw up issues. I guess the only issue with an informal look (from a registered vet!) is the lack of records. However with insurance that may well work in your favour!
 

TreeDog

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Sorry if you've already said, but when were the insurance company informed? Before or after the investigations/surgery?

I'm pretty sure my insurance has a clause that they must be notified before treatment, unless in cases of emergency which the vet would be able to argue for you if that was the case.
 

criso

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You would be fine with off duty as they would presumably still be registered and insured. It's the retired bit that may throw up issues. I guess the only issue with an informal look (from a registered vet!) is the lack of records. However with insurance that may well work in your favour!

And it was alongside not instead of as I was away and always intended to ask my own vet to investigate when I got home.

I also know that when I had a bone scan and MRI done, NFU my insurers at the time wanted to approve this before they were done and an operation as a result of the bone scan also needed pre approval from them.
 

teddypops

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Sorry if you've already said, but when were the insurance company informed? Before or after the investigations/surgery?

I'm pretty sure my insurance has a clause that they must be notified before treatment, unless in cases of emergency which the vet would be able to argue for you if that was the case.
I insure with Petplan and have made loads of claims and I haven’t ever notified them before treatment and it hasn’t been a problem
 

criso

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I insure with Petplan and have made loads of claims and I haven’t ever notified them before treatment and it hasn’t been a problem

Did these claims involve a non emergency operation?

My experience albeit with different insurers is most treatments don't need pre approval but a few do and operations and some more expensive diagnostics e.g. bone scans did. When I needed pre approval for an MRI it was 10 years ago at least and they were not very common so they may not need pre approval now.
 

teddypops

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Did these claims involve a non emergency operation?

My experience albeit with different insurers is most treatments don't need pre approval but a few do and operations and some more expensive diagnostics e.g. bone scans did. When I needed pre approval for an MRI it was 10 years ago at least and they were not very common so they may not need pre approval now.
Yes. My sec D had to have a wind op. Also sarcoids treatments, lameness work ups etc. I also had a pony pts and they paid out for death and disposal.
 

milliepops

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KBIS didn't require preapproval for MRI last year, i did ask and they said there was nothing needed in advance. i think i'd still always ask the question though.
 
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