kissing spine / SI, PTS and mortality claim

[This_riveriswild]

Help, I have exhausted all proportionate and reasonable options for investigation and treatment of horse with kissing spine and sacroiliac disfunction (including operation, multiple steroid injections in different parts of his body, nerve blocks, bone scans, xrays, physio, accupuncture, rehab, bute trials). Horse is no better now than when we started and has shocking and visceral reaction to palpation of his back and is struggling in field.

Vet has advised that should 100% consider PTS and they have completed relevant forms for insurer to that effect. What are peoples experience of being successful in a mortality claim with a horse with similar issues? Insurer says that doesn’t meet the BEVA guidelines right now but has suggested a specific waiting period for re-assessment, or earlier if there is deterioration. However, I don’t want to get to the end of the period and be no more likely to receive any money and have put my horse through a further period of pain. For full context if a claim were not to be agreed this would represent a substantial monetary loss for me (as well of course as a substantial emotional loss).

This is all very recent and by the time I have slept on it I may well come to my own conclusions (that welfare should trump money and go ahead and PTS despite what the insurer says) but I hate being put in this position of uncertainty.

 

[Melody Grey]

I have unfortunately too been in this position so you have my sympathies- I didn’t claim mortality as the horse was an OTTB insured only for a low value anyway so it wasn’t a factor.
I’d have thought your vet approving PTS should be enough to claim on your insurance if all veterinary possibilities have been exhausted. Why is your insurer stipulating a waiting period? Are they hoping for a miraculous recovery or for you to forget about it?!

 

[chaps89]

Unfortunately it is highly unlikely the insurance will pay out for a mortality claim in this scenario.
As you've mentioned, the BEVA guidelines need to be met in order for them to consider mortality claims - that's usually for instances where PTS is non-negotiable, e.g. broken leg.
This sort of scenario is what loss of use insurance is really for, and why it is so much more expensive to have, as you are more likely to claim successfully for LOU than mortality.
I'm sorry you've gone through this though OP.
If it helps, my mum went through similar- spent alot of money on a horse for him to go lame not long into ownership, he had psd and associated op, stifle and sacroilliac problems. He spent time turned away, time in strict rehab programmes, time at specialist rehab yards but hasn't been able to successfully return to work - and he has a tendency to go up if pushed. Fortunately for her she did have LOU, and he is now a retired field ornament at the grand old age of 10(ish), kept sound on a strict weight management routine (he also has ems) and gabapentin.
It wouldn't be my choice personally but whilst no pressure is put on him he seems comfortable enough and she has her own land so she can.

 

[gunnergundog]

If you have it, loss of use would probably be the 'easier' claim.

How long have the insurers suggested as their waiting period? Does your vet think this is reasonable/realistic? Also, who is your vet? If, without being rude, he/she is just 'Joe Bloggs MRCVS' local dog & cat vet, then consider getting a second opinion from a 'name' at a referral hospital or practice. It shouldn't make a difference, but....

PS Just to add, it is a horrible position to be in. I have had to PTS a 6 year old on what I and my vet deemed were welfare/quality of life/ call it what you will grounds with no chance of a pay out but unfortunately shit happens and sometimes you have to do what you have to do in order to be able to live with yourself. It's the price we pay for having horses in our life. You have my commiserations and best of luck for a 'positive' outcome for all concerned.

 

[ihatework]

I’m really sorry to hear about your horse, but I’m afraid I can’t imagine you would get a mortality claim in these circumstances. You would have needed LOU cover with the added premium that comes with.

Im afraid in your shoes I’d PTS and swallow the financial loss. Horses are heartbreakers sometimes x x

 

[Trouper]

Well I did - twice I am sad to say. I was insured with NFU.
On the first occasion - which sounds very similar to your situation - I submitted a claim and was quoted the BEVA guidelines as a reason for not meeting the claim. I challenged this emphasising the welfare aspects of keeping a horse in pain when there were no veterinary procedures which could guarantee a life free from pain. This was backed up by a supporting letter from my vet. To NFU's great credit they 'phoned me to apologise for the way the claim had been handled, agreed to pay in full and added an extra payment of £100 for the trouble and upset I had been put to in having to challenge in the first place.
The second time - only some 18 months later - the claim was paid without demur.
I think much hinges on the support you get from your vet and you don't say with whom you are insured??

 

[Melody Grey]

Definitely worth getting your vet to challenge the insurer’s response.

 

[Red-1]

I as in a similar position with my ginger horse. I decided to go ahead and PTS. I thought forgoing the money was a fair exchange for him being out of pain.

 

[foxy]

I am in a similar position and waiting to hear. When I spoke to NFU they said I had 24 months from the start of the claim to make a LOU claim. I am still at the stage of my vet providing all the info. NFU said if they accepted the claim then I had the choice to have him branded LOU or PTS. I am not sure I will be successful but as I have been paying for LOU it seemed silly not to try and claim

 

[Auslander]

I'm afraid that I don't think you will get a payout for mortality. I've only ever heard of a payout for that where the horse has to destroyed because of catastrophic injury or illness that calls for immediate euthanasia.
It's absolutely rotten that your lovely horse can't be fixed, or even made field sound, but what you describe doesn't sound like it would be considered for a mortality claim. I think LOU would be more likely to result in a satisfactory outcome for you

 

[fredflop]

Had three horses in similar scenarios. They don’t meet Beva guidelines and you won’t get any insurance money from it

 

[McFluff]

Sorry you’re in this position OP.
I had similar with my TB mare, was insured with horse-insurance.Com - they initially said no, but my vet (experienced equine vet) argued that she did meet the guidelines as she couldn’t live pain free (like yours she was sore). The insurers wanted us to try surgery, but vet argued she wasn’t good candidate for this. Insurance accepted. It took a week to agree, and we were able to keep her in a paddock on her own and buted up. I would’ve PTS if it hadn’t been agreed and taken the loss.
Hope you can find a good outcome. Hugs. It’s a stress you don’t need when you are facing the loss of your horse.

 

[spotty_pony]

Who are you insured with? What a horrible position to be in. I claimed for my last boy AFTER He had been pts and he had navicular. Insurance (nfu) paid in full with no questions asked.

 

[splashgirl45]

sounds awful to me, cant your vet stress that the horse is in pain and wont improve..worth a try..

 

[Flyermc]

from the 2 horses that i have owned, we have had pay out for both. One was liver failure and the other was a (originally) seemed like a minor field injury, but after 5 months of treatment, got to the point he was unable to walk properly even on bute and was going downhill fast.

There was nothing more that any vet could have done for my horses and they were PTS. Petplan paid out on both, however there were low insurance values and wouldnt have mattered if they hadnt.

 

[Illusion100]

Help, I have exhausted all proportionate and reasonable options for investigation and treatment of horse with kissing spine and sacroiliac disfunction (including operation, multiple steroid injections in different parts of his body, nerve blocks, bone scans, xrays, physio, accupuncture, rehab, bute trials). Horse is no better now than when we started and has shocking and visceral reaction to palpation of his back and is struggling in field.

Vet has advised that should 100% consider PTS and they have completed relevant forms for insurer to that effect. What are peoples experience of being successful in a mortality claim with a horse with similar issues? Insurer says that doesn’t meet the BEVA guidelines right now but has suggested a specific waiting period for re-assessment, or earlier if there is deterioration. However, I don’t want to get to the end of the period and be no more likely to receive any money and have put my horse through a further period of pain. For full context if a claim were not to be agreed this would represent a substantial monetary loss for me (as well of course as a substantial emotional loss).

This is all very recent and by the time I have slept on it I may well come to my own conclusions (that welfare should trump money and go ahead and PTS despite what the insurer says) but I hate being put in this position of uncertainty.

Which insurance company are you with?

 

[Illusion100]

Insurance companies sometimes send particular claims files to their consultant vets for opinions. It is not unheard of for a consultant opinion to be incorrect.

Such claims as yours have met BEVA guidelines before.

I've attached a pic of the guidelines for your information. Ask your vet if they believe euthanasia meets the criteria stated.

 

[Frumpoon]

So, so sorry you are in the position and hugs to your poor horse

They bloody break your heart

Thoughts are with you

 

[Red-1]

I am in a similar position and waiting to hear. When I spoke to NFU they said I had 24 months from the start of the claim to make a LOU claim. I am still at the stage of my vet providing all the info. NFU said if they accepted the claim then I had the choice to have him branded LOU or PTS. I am not sure I will be successful but as I have been paying for LOU it seemed silly not to try and claim

But LOU is different to trying to claim for mortality. Still difficult to get, but a much lower threshold than BEVA guidelines for PTS. You were essentially being paid for the LOU portion rather than because you PTS.

 

[EllieBeast]

A good friend of mine had a lovely horse who had ks so severe that the pain of just standing in the field kept his ulcers reoccurring after treatment.

He was pts, and the insurance company paid out for mortality- under Beva guidelines. It’s definitely worth fighting for!

 

[FireCracker238]

Is no.4 on the guidelines as gruesome as it sounds? ?

 

[chaps89]

Is no.4 on the guidelines as gruesome as it sounds? ?

I worked in equine insurance for a couple of years and never did we have to inspect a carcass etc.
I suppose maybe if horse has a broken leg in the field and a knackerman is the first one out to pts, then maybe you'd hold off disposal to get a vet to verify reason for death in order to assist with a mortality claim?
You might also need to keep the body for a PM if there's no known cause of the illness/death (though obviously the BEVA guidelines aren't applicable for horses who pass away naturally, then it would just be down to the insurers t&c's)

 

[Illusion100]

Is no.4 on the guidelines as gruesome as it sounds? ?

It tends to regard horses that have been found dead by the owner/yard/member of public, it means the insurance company wants a death certificate completed by vet after their examination into cause of death before the carcass is disposed of.

If the cause of death is not obvious, a post mortem is required.

Otherwise, if foul play is suspected, injured body parts are removed and sent for imaging/further investigation.

 

[This_riveriswild]

Thanks everyone for your lovely and supportive responses. I went through this with NFU previously and they were amazing and accepted the claim in full (severe wobblers put to sleep at vet hospital while under GA) but I am with a different insurer for this horse. The original timeframe given was 3 months. Unfortunately today a new, horrible issue arose which meant we had to urgently go back to my insurer and with the help of my specialist equine vet we have persuaded the insurer to accept the claim, not for full market value but enough to be getting on with. tomorrow we will say farewell.

 

[blitznbobs]

This is pretty much why I don’t insure my horses... so sorry op... hope it goes without incident. Be kind to yourself.

 

[Melody Grey]

Thanks everyone for your lovely and supportive responses. I went through this with NFU previously and they were amazing and accepted the claim in full (severe wobblers put to sleep at vet hospital while under GA) but I am with a different insurer for this horse. The original timeframe given was 3 months. Unfortunately today a new, horrible issue arose which meant we had to urgently go back to my insurer and with the help of my specialist equine vet we have persuaded the insurer to accept the claim, not for full market value but enough to be getting on with. tomorrow we will say farewell.

Sorry to hear things have taken a turn for the worse- my sympathies. I hope everything goes ok for you tomorrow.

 

[Illusion100]

Thanks everyone for your lovely and supportive responses. I went through this with NFU previously and they were amazing and accepted the claim in full (severe wobblers put to sleep at vet hospital while under GA) but I am with a different insurer for this horse. The original timeframe given was 3 months. Unfortunately today a new, horrible issue arose which meant we had to urgently go back to my insurer and with the help of my specialist equine vet we have persuaded the insurer to accept the claim, not for full market value but enough to be getting on with. tomorrow we will say farewell.

It's fairly common for full market value when initially insured to be reduced after the insurance company speaks to their valuer regarding the details of certain claims. Usually approx £500 is taken from market value, again depending on the classification of initial insurance and the specific/historic claim details.

Each claim is treated individually.

I'm really sorry today was a tough day, sadly this will have ensured BEVA guidelines were met, but very sad for you.

You seem to have been put through hoops by this insurer. NFU is more fair and reliable.

 

[Sossigpoker]

There are descriptions of the expected outcome is for various conditions under BEVA guidelines. I'm afraid your vet recommending PTS does not mean that BEVA guidelines are met. If your vet also says that currently those guidelines are not met, it would be extremely unlikely you would get a pay out.
If your vet recommends PTS then to delay in the hope of a pay out is cruel. I had one PTS due to severe lameness knowing that the insurer wouldn't settle until he was found in the field on the floor and unable to get up. I couldn't put my horse through that.