insurance wont pay up....advice

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serena2005

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very long sorry


my friends horse has been recovering from endles cuts on the same leg, followed by extreamly bad mud fever and infections.

i looked after the horse a few weeks ago and the cuts, which are really deep and wide, seemed to be slowly healing, there was no puss or lameness.

i spoke to her last night about him and she said she was trying this new stuff which she had to syringe on to the leg. the horse suddenly picked up his leg (a usual thing fir this horse) and sliced open the wound again.
by the weekend she was away and the loaner was taking care of him, and was advised by other people in the yard to turn him out. she turned him out with stable bandges on and by the time him came in after going crazy in the field his leg was gushing with blood and puss.

vet is concerend the infection has gone to the bone and he will need an op to cut away the wound. hes going in for xrays tomorrow. vet advisored her to talk to her insurance company, and they said as it will be an on going treatment they wont pay out for it!

she spoke to the vet about this whos going to go ahead with the xray, and she said she asked if he had to have the op if she could pay for installments but he said no.

i dont know what to say or how to help her anymore. i just know she cant affprd to pay out £1000's in one go, is there anything she can do!?
 
Is the insurance company a member of a professional group? Maybe go to their ombusdman?

What a horrible situation to be in. The only other advice is interest free credit cards....
 
I think it is difficult to comment re the insurance without knowing the details of her cover, the medical history of the horse etc etc.

From what you have said it sounds as though there might be exclusions on the leg? An illness/injury requiring several courses of treatment isn't usually a reason to refuse cover?

Very sad situation.
 
I can see where they are coming from but I think its very mean of them not to cover the surgery.

By rights they should have been informed as soon as treatment for the cuts started but in all honesty how many of us would bother their insurers for something like a cut?
 
shes never claimed anything before on the leg or on the horse. shes been with the compeny only 3 weeks which is another one of their reasons for not paying up.

i know she has the very basic cover for him because shes never had any problems.

just wish i could help her.

i said if worst came to worse what about trying to sell a story and try and get sponsorship, donation type of thing, or am i just being silly!!
 
Ah, did the original wound occur before she took out the insurance? I believe ....this is worth checking.....that you must have 14 days between taking out a policy and an incident occuring before you can claim for certain sections on the policy plus pre existing conditions wont be covered.
 
he has had cuts and mudfever on the leg before the insurace was taken out.
but it was healing, due to the wound being reopened the vet was called. there was no envolment from the vet before the weekend.
 
It may be that the problem is a pre-existing problem - prior to taking out the insurance. I believe most Insurances will not pay out for anything that occurs within the first 14 days of cover.
Poor horse and owner, I hope she resolve the problem
 
[ QUOTE ]
he has had cuts and mudfever on the leg before the insurace was taken out.
but it was healing, due to the wound being reopened the vet was called. there was no envolment from the vet before the weekend.

[/ QUOTE ]

Oh dear, sadly I dont think she has much of a chance with the insurers although its worth a letter.
 
so just because there was a wound already there its possible they will just link the 2 injuries and refuse to pay? what would the letter say if she did write one?
 
well if thier is puss! that is a good sign that the wound is healing, but not so good if the wound keeps re-opening, the wound needs to form a scab, keep him in a stable for a wee while.
I'm with that insurance company
crazy.gif
, hope you get it sorted may be talk with the underwriters of the company.
 
[ QUOTE ]
he has had cuts and mudfever on the leg before the insurace was taken out.

[/ QUOTE ]

Well that would be why then, and you can hardly blame them.

Otherwise none of us would take out insurance until we saw an injury we needed to claim for.
 
I'm a bit confused, surely you would not expect an inurance company to cover a pre-existing condition even if it has become worse since insuring the horse it is still a pre-existing condition or at the very least a problem made far worse from a pre-condition.
confused.gif
 
The insurance company probably consider that they would be paying to treat in illness/injury that had occurred prior to your friend taking out the insurance. This is very unfortunate but I cannot see them changing their mind. It would be like you crashing your car, then insuring it & expecting the insurance company to pay for the damage you caused before you took out the policy.
Your friend will have to somehow find the money for the treatment because I can't see Petplan changing their mind
frown.gif
 
i understand that completely but the cuts before and the mudfever didnt require the vet, and were healing when the insurance was taken out 3 weeks before the injury that the vet was called for the new injury.

and saying to her on the phone that hey werent going to pay out because its going to be an on going problem, and the easiest thing she can do is clain loss of use but he will have to be stamped. they said thats the only way she will get any money.
 
so did she take the insurance out because the horses leg had got injured?

This is a horrible situation for her but I dont think she has much chance of them paying out. Did she declare that the horse had mud fever/ cuts on the leg when she took out the policy?
 
But why would she claim for loss of use? She will be able to use the horse again once it heals?

I think she needs to write down all the facts and send a letter to the insurance company or speak to someone else again, the information she is getting is a bit vague.

I imagine when she insured the horse if the cuts/ mud fever did not require vet treatment she wouldnt of told the insurance about it therefore is the reason they wont pay because the vet is classing it as an on-going injury i.e the injury before wasnt properly treated and has escalated?
 
she wont claim loss of use, she was so insulted when they said that!
the vet is classing it as an on-going case due to he's going to need an op and following treatment.

someone had a vet up there a few weeks ago, to look at another horse and was asked to look at his legs just for their opinion. and they said that what she was doing to encourage them to heal was correct and to continue doing it.

the problem before was being treatment an was healing, i wouldnt say it has escalated. this new injury was not a result due to the preivious one.
 
You have stated that there were cuts on the horse's leg and THEN he developed mud fever, it was healing but then went bad again - therefore the condition certainly WAS pre-existing and the insurers should have been made aware. I am on the side of the insurers I am afraid, and I think the fact that the vet hasn't attended the horse prior to now is a factor in why the infection has gotten so deep
frown.gif
 
no i said she trying something new on his leg to help with the healing, she was using a syringe and he jumped lifted his leg sharply and the syringe went into the wound reopening it.

as iv been saying the exsisting wound was healing
 
If they are offering Loss of Use take it, she'll get a lot more money for the horse than the vet bills will ever be. So what if it's got a LOU freezemark if she is happy with the horse
 
It is still the same wound, no matter how it reopened. I think your friend has just better buckle down and see what she can do to pay herself, as you haven't got a chance to get the insurance to pay.
frown.gif
 
Yes I understand that, but I cannot help but think there was a lot going on under the skin that meant these injuries were not healing as well as they should and as fast as they could. A syringe (presume there was no needle attached!) head should not "open a wound" unless the dermis was unstable (this obviously is just my humble opinion!). I do feel wretched for her, but I don't think the insurers had a choice in the matter. Legally she has only had cover for 7 days and it would be one hell of an aggresive injury for it to come to this in 7 days.
 
he was for sale before this all happened and her plan is still to sell him, he wont be worth anything near what shes asking for him if she does claim loss of use.

miss huggy bear i can see what your saying, but it is bloody bad luck. thanks for all your input.
 
i see what your saying weezy, no there was no needle! i see what u mean by more going on under the skin, and maybe she should have called the vet before. but as he wernt lame and there was no puss she didnt see the need.

if it is the case hopefully she will learn from it and realise a £50 call out is nothing compared to what its going to cost her now
 
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