Insurance won't pay up because...

[Elbie]

I know that the initials are similar, but this is SEIS, not SEIB.

ETA This is for the benefit of some posters who are getting muddled between the two, not the OP.

I was just going to point this out!

OP - had you only recently taken out insurance with them when the injury occured? That's the only reason I could think they would decline on the basis of no vet history as they may suspect the injury pre-dates the policy.

However, that being said, I work in equine insurance and they can't decline without evidence the injury did pre-date the policy. They would have to have something firm like if the vet said it had x month's duration which identified it as pre-existing the policy

 

[Illusion100]

He is still however not budging on the clinical history or lack of it.

Ask him why you are being refused an accident/injury claim on the basis of having a previously healthy animal that has not required Vet attention for the last x years, the fact that the nature of the injury make clin hx irrelevant and their policy (as far as I know) does not state that any insured horse must be given any unneeded vet check up in order to provide a clin hx in case of a future claim.

He should find it hard to wriggle out of that. Good luck.

 

[smellsofhorse]

You have to check the smallpromt and be sure of why's you are covered for.

I do think that is it common for insurance companies to insist a horse is vaccinated.

 

[dianchi]

Was this Scottish Eq insurance services?

FYI they are underwritten by Allianz and are sister company to Petplan

 

[cobgoblin]

Turn it around and ask them (SEIS) to provide the aetiology of shoulder dysplasia due to lack of vaccination.

 

[wills_91]

I was just going to point this out!

OP - had you only recently taken out insurance with them when the injury occured? That's the only reason I could think they would decline on the basis of no vet history as they may suspect the injury pre-dates the policy.

However, that being said, I work in equine insurance and they can't decline without evidence the injury did pre-date the policy. They would have to have something firm like if the vet said it had x month's duration which identified it as pre-existing the policy

No he has been insured with them for 3 and a half years it renewed in April I really cannot see any way out of it for them.

 

[wills_91]

Turn it around and ask them (SEIS) to provide the aetiology of shoulder dysplasia due to lack of vaccination.

I did ask him this morning how flu/Tet was in anyway related to shoulder lameness, there was a lengthy silence before he asked if he could ring me back

 

[wills_91]

Ask him why you are being refused an accident/injury claim on the basis of having a previously healthy animal that has not required Vet attention for the last x years, the fact that the nature of the injury make clin hx irrelevant and their policy (as far as I know) does not state that any insured horse must be given any unneeded vet check up in order to provide a clin hx in case of a future claim.

He should find it hard to wriggle out of that. Good luck.

I will do. Have just picked up a copy of the letter from my vets, have scanned it to the equine centre in Glasgow for them to sign as well so hopefully that will get them shifting.

 

[ester]

It clearly has nothing to do with his current issue and I wish you good luck pursuing it. However, am I the only person who has always understood vaccinations to be part of the conditions of insurance?
It always was when I used to insure horses (I have a separate savings account now).

I always thought it was a condition/pre requisite regardless of whether it affected any particular issue. It has always been one of the first things in the info booklets with various insurers, though it also then mentions you should only use a registered farrier even though they would pay/part pay for a rockley trip. Not been an issue for me as not been insured since his barefoot rehab but if I had continued it would be in the knowledge that if they questioned it I would have to fight it but also that they don't ask for a farrier record so would be unlikely to find out he wasn't seeing one!

As an aside how unhealthy do they think a shetland is that it would need to see the vet within a 3 year period!

I completely understand why many would not have flu vaccinations done but I am pretty shocked to find that anyone doesn't do tetanus.

 

[criso]

I always thought it was a condition/pre requisite regardless of whether it affected any particular issue.

I completely understand why many would not have flu vaccinations done but I am pretty shocked to find that anyone doesn't do tetanus.

I guess is comes down to the wording and the OP quoted their specific policy as saying

"You must keep your horse vaccinated against flu and tetanus and wormed as recommended by your vet. If you do not keep your horse vaccinated and wormed we will not pay any claims that result from injury or illness that would not have occurred if your horse had been vaccinated or wormed."

So in this case the injury did not occur because they were not vaccinated.

With Tetanus according to the vets I spoke to at my nearest horsepital, after a certain amount of regular vaccinations, horses acquire longer term protection as in humans so they recommend dropping to 2 or 3 year intervals.

 

[Nudibranch]

Ah well in that case it looks pretty cut and dried amd hopefully OP will have success.

 

[Tiddlypom]

Ah well in that case it looks pretty cut and dried amd hopefully OP will have success.

Not cut and dried, IMHO. Whilst I have much sympathy with the OP, the fact that a vet has not 'officially' seen the pony in 3 years could easily ring some alarm bells. Letting the tetanus vacs drop is much more serious than allowing the flu jabs to lapse.

It's well worth a fight, but if you're going to insure, do just read the terms and conditions, peeps.

 

[Nudibranch]

As I mentioned, I have always presumed vaccs to be part and parcel of the conditions but if you look at the quote from Criso it clearly states they wont pay out for issues related to non vaccination - which this isn't. I happen to agree about the tetanus cover, but again that's not related to the shoulder lameness. While not ideal, it appears to be irrelevant by their own wording. Unless of course there are further clauses we don't know about.

 

[ycbm]

Not cut and dried, IMHO. Whilst I have much sympathy with the OP, the fact that a vet has not 'officially' seen the pony in 3 years could easily ring some alarm bells. Letting the tetanus vacs drop is much more serious than allowing the flu jabs to lapse.

It's well worth a fight, but if you're going to insure, do just read the terms and conditions, peeps.

The terms and conditions are perfectly clear. This horse is covered except for illnesses which would have been prevented by vaccination. They are liable. The horse has been healthy for three years and she can produce witnesses to that. She will win if this is taken to the ombudsman.

 

[Tiddlypom]

I agree that that the OP may well prevail with the support of her vets. The lack of vaccination will not have caused the shoulder injury. It has muddied the waters, though, as it means that the pony has not been seen by a vet in the interim.

For general information, here are the BEVA guidelines re vaccination.

TETANUS

Primary Vaccination
* Foals from 3 months of age from vaccinated mares
2 injections 4–6 weeks apart
Booster at intervals of 18–30 months
* Foals’ vaccination start times depend on their ability to respond to vaccination as well as their dam’s vaccination history
FLU & TETANUS

Vaccinate foals at 4 months of age
4–6 week interval for flu and tetanus
5–7 month interval for flu
Not more than a 365 day interval between vaccinations
Thereafter annual boosters giving flu or flu and tetanus in alternate years

 

[wills_91]

Just to clarify the whole vaccine thing. He is tet jabbed every 3 years, last done in January 2012. I missed it this year as other things got in the way and hadn't got round to getting it done again. He is booked in next week to start the course again, cannot believe it has caused all this hassle .

 

[smellsofhorse]

Just to clarify the whole vaccine thing. He is tet jabbed every 3 years, last done in January 2012. I missed it this year as other things got in the way and hadn't got round to getting it done again. He is booked in next week to start the course again, cannot believe it has caused all this hassle .

I thought flu was yearly and tetanus every other year?
I understand there is research saying we over vaccinate but as the guidelines are as I said above I thought that it was how it is still given.

 

[wills_91]

Yes I believe it is. Tbh as he is so teeny I do worry about what I am putting into him and not just vaccines, my vet is happy to leave for the 3 years.

 

[ester]

Ah that does make sense OP, and yes with an older pony I wouldn't see 3 years being an issue.
It does also seem that your specific policy wording should mean that they should be paying out. I hope you are successful and they pay out in the end!

 

[Illusion100]

I will do. Have just picked up a copy of the letter from my vets, have scanned it to the equine centre in Glasgow for them to sign as well so hopefully that will get them shifting.

You do not 'need' Vet back up on this! By all means do it if you want to but they have NO grounds to refuse your claim.

 

[Exploding Chestnuts]

There are two tet vaccines, one is 2 year and one is 3 [according to local, though not good vet], I looked on the manuf website about the vaccne for some reason, I think it was recommending the normal timescale, but said that protection lasted longer, so you may have to delve deeper.
If the vaccination and the problem are not related, going by the wording, they should pay up.

 

[popsdosh]

Tetanus is every 3 yrs normally . Does not have to be done by the Vet. Most policies as far as I am aware carry the same wording in that they can only refuse to pay out if it is a problem directly related to the missed vaccination. As for the vet not having seen the horse for several years thats just trying it on ,how is that any sign of an issue with the horses. Soon they will be asking for monthly check ups lol and I guess the vets may support them. The whole insurance market is a racket the punter needs to realise they dont subsidise it out of a sense of charity they are in it to make money.
Never have felt the need to line their pockets!

 

[EQUIDAE]

The tet 'rules' wind me up - even in the 'old days' it was every 10 years in people. Now they say after your childhood vaccs you only need one adult booster to give lifelong immunity. I know horses are more susceptible to getting it in the first place, but their immune systems respond the same way to the vaccinations.

 

[ycbm]

http://www.ncbi.nlm.nih.gov/pubmed/26284567


I wondered about this. I've been told that I've had five tetanus vaccinations in total so I'll never need any more. Is there any reason why a horse would need more, does anyone know? I plan to give my mini two boosters (five in total) and then stop, unless any horse medics can tell me otherwise?

I found this report above too, we are all being duped into vaccinating every two years, it seems. The conclusion is quite strong - 'the tetanus guidelines should be changed to every three years.'

I can't find anything that suggests any trials have been done over more than three years. Since vaccinations aren't risk free, this seems to me to be extraordinary. We have vets putting needles in our horses without knowing that they actually need them .

 

[Nudibranch]

I do think a lot of vaccination policy is money making. Last year the youngster's combined tet and flu was 2 days late. Not an issue for health, but for competing he will have to start the flu all over again.
Our tetanus is every 2 years and always has been. Pretty sure it depends on the manufacturer. I do think it is odd that we can get away with boosters every 10 years...but in fairness you cannot necessarily compare species so for now I have to go with what the vet says.

 

[criso]

I think because no research has been done no one is prepared to say after a certain number of boosters you have lifelong protection or that it will definitely last x years.

Getting back to the original question, it looks like the insurers have moved on from querying vaccinations and are now focusing on the fact the horse hasn't seen a vet for 3 years. I wondered if there was a clause in the small print that says something about seeing a vet regularly. I know one policy I had said something about seeing a farrier regularly - with no definition of what they considered appropriate intervals.

 

[SO1]

Vaccinations would not have prevents or foreseen the injury.

If there is nothing in the insurance that claims you horse has to be checked by a vet every year and when the vet last checked your horse is was in good condition and apart from the lameness is still in good condition then there is no reason as far as I can see that you have breached the policy, unless they think the pony has had the injury for a while and you did not notice or call the vet when he first went lame.

I would go back and ask where on the policy does it say that they won't pay out if the horse has not been checked by a vet in x amount of time. In fact some insurances will remove exclusions if a horse has not had to be treated for that problem for a certain amount of years.

 

[wills_91]

Just thought I would update. After months (literally) of battling SEIS have finally caved and settled with vet school
Huge weight of my mind.

 

[ycbm]

You have done a lot of horse owners a favour. Well done!

 

[wills_91]

I put in a complaint as well that's being investigated. They have been a nightmare to deal with.