NFU insurance exclusions

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SophieOtis1990

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Hi so my boy came in lame just over two weeks ago. Originally vet suspected issue in the foot and almost treated like abscess. We’ve jumped to X-rays of the foot and nothing found. Now talk of MRI etc. HE is insured BUT he had a claim in 2020 for proximal supensory desmitis. Now, I called them and they told me its condition linked so if not same condition the would cover…. But looking into this more it seems it might be any ligaments on same leg wouldn’t be covered?!!! What’s the point in insurance if that’s the case! So fustrating as vet hasn’t even nerve blocked before jumping into x rays so we can’t be 100% sure if leg or foot. If foot I believe would be covered. Anyone got any experience with similar with NFU…
 
SophieOtis1990 said:
Hi so my boy came in lame just over two weeks ago. Originally vet suspected issue in the foot and almost treated like abscess. We’ve jumped to X-rays of the foot and nothing found. Now talk of MRI etc. HE is insured BUT he had a claim in 2020 for proximal supensory desmitis. Now, I called them and they told me its condition linked so if not same condition the would cover…. But looking into this more it seems it might be any ligaments on same leg wouldn’t be covered?!!! What’s the point in insurance if that’s the case! So fustrating as vet hasn’t even nerve blocked before jumping into x rays so we can’t be 100% sure if leg or foot. If foot I believe would be covered. Anyone got any experience with similar with NFU…
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The exclusion would have been in your documentation and you can always ask for review at renewal time- often a vet letter will get exclusions revised or removed. Insurance companies need to make money from you, they aren’t a charity. For them, the risk of a horse that has already had a ligament injury makes the horse more liable to need pay out, so of course they will want to mitigate against that.
 
TheMule said:
The exclusion would have been in your documentation and you can always ask for review
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When I was with NFU, they didn't list specific conditions per horse but had general catch alls excluding any condition relating to a previous one

On the plus side I had 3 different claims on the same leg with the vet saying they weren't related.

In fact similar but the other way round so a claim for foot soft tissue issues which were resolved then some years later a suspensory ligament issue.
 
This will probably be one you need to argue and the success might depend on what the eventual new diagnosis is.

Assuming 2020 was hind PSD -

If this is a front limb lameness and it’s not a ligament desmitis then I’d be confident you could get it covered.

If it’s hind limb and ligament related then unlikely to get covered. If orthopedic/bone then it would be worth a try saying unrelated
 
It was a front and same leg. But vet is thinking it’s more foot related hence the x rays of the foot although I now think on reflection an nerve block to isolate would have been a more logical approach so have kind of queried that. I totally understand them excluding proximal suspensory as they have already paid out for that. But an unrelated ligament issue in the same leg won’t be linked to the previous condition. I pay a small fortune for insurance because I have claimed so whilst I appreciate they have to make money it also works both ways doesn’t it. I have flagged with bet before they did x rays so hoping they will support me in their wording so to speak. My renewal docs don’t list exclusion but says about not covering previous conditions. But then found a policy document online that says about ligaments in same leg or bilateral…. Bit of a minefield!
 
In my experience if your vet can word things in an optimal fashion the NFU are totally understanding and helpful. Last year my mare had totally inconclusive lameness investigation by my usual vet and spent up my claim money. I self referred to another practice whose report enabled another claim to be opened and the situation had a good outcome.
 
Midlifecrisis said:
In my experience if your vet can word things in an optimal fashion the NFU are totally understanding and helpful. Last year my mare had totally inconclusive lameness investigation by my usual vet and spent up my claim money. I self referred to another practice whose report enabled another claim to be opened and the situation had a good outcome.
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Hey, that’s good to hear. Overall NFU have always been fantastic. But I’m just a little concerned about racking up lots of fees without knowing where I stand. I’m a little frustrated that vets x rayed before nerve blocked as cheaper and helps identify where coming from …. Horse only had op 18 months ago and not ridden much with pregnancy so real shitty luck with lameness again. I was praying it was an abscess but doesn’t seem it was the case…. :( some self pity here lol
 
SophieOtis1990 said:
It was a front and same leg. But vet is thinking it’s more foot related hence the x rays of the foot although I now think on reflection an nerve block to isolate would have been a more logical approach so have kind of queried that. I totally understand them excluding proximal suspensory as they have already paid out for that. But an unrelated ligament issue in the same leg won’t be linked to the previous condition. I pay a small fortune for insurance because I have claimed so whilst I appreciate they have to make money it also works both ways doesn’t it. I have flagged with bet before they did x rays so hoping they will support me in their wording so to speak. My renewal docs don’t list exclusion but says about not covering previous conditions. But then found a policy document online that says about ligaments in same leg or bilateral…. Bit of a minefield!
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You will be on stickier ground with another ligament on same limb I’m afraid
 
I’ve had NFU cover a few things that I wasn’t sure they were going to due to possible links with previous issues (even when those issues weren’t claimed for) / where they’ve accepted splitting claims in ways that they’d have been reasonable to want to combine them.

They once put a generalised arthritis exclusion on a policy I had and then paid out for a claim where part of the diagnosis involved arthritic changes (tbf I think I could have fought them on it anyway as the reasoning for the exclusion didn’t really stack up / what would have made more sense for that particular horse would have been excluding the feet)

Also had them accept a lameness claim including fetlock / coffin joints on a horse with known sidebone (which I never claimed for as no treatment prescribed, just found on foot balance checking X-rays ironically I think the fact Leahurst had trotted him up sound about 6 months previous to the front limb lameness claim may have helped) and a kissing spines claim on a horse who’d seen Tom Beech for muscular pain in his back (which had improved and then gotten worse again and started showing new behaviours hence the investigation… also somehow convinced them to accept a separate claim for an abnormality found at the base of same horse’s neck… think it was possibly before renewal so no exclusions had kicked in yet?)

Definitely worth trying to put the claim in and seeing what they say? (Although if you can’t afford certain things without them covering it then if possible may be wise to delay anything expensive until you know their decision which seems to take a couple of weeks usually)

Please note they did eventually refuse to renew the policy on the Highland due to the impressive amount of bills he racked up in the last year of being insured with them… had he not been PTS I may have had some interesting conversations with them re the in progress claims that still had time and money left on them and what view the ombudsman might have about that…

Now with Agria so no such worries about exclusions etc (minor worries about being responsible for 25% of every claim though!)
 
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Oh and think definitely worth getting them to nerve block before chucking thousands at MRI as even if you ARE covered they may dispute paying for that unless horse has blocked to the foot / vet has some kind of proof/ reasoning the foot is where the issue is! Would also be frustrating with them xraying without blocking to figure out WHERE they need to X-ray if supposed to be conducting a lameness exam!
 
Boulty said:
Oh and think definitely worth getting them to nerve block before chucking thousands at MRI as even if you ARE covered they may dispute paying for that unless horse has blocked to the foot / vet has some kind of proof/ reasoning the foot is where the issue is! Would also be frustrating with them xraying without blocking to figure out WHERE they need to X-ray if supposed to be conducting a lameness exam!
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This is all really good to know.
I am frustrated with x rating without blocking first and I’ve tried to raise this passively so as to not get their backs up as need them on side. But if they block on Tuesday and it’s not the foot I’ll be slightly more proactive in challenging I think as that’s potentially just cost me especially with the uncertainty of the injury. There is certainly heat in the pastern/top of coronet band and hoof wall in comparison the other leg/foot. As I clipped his legs today there is also a slight bit of swelling in the back of the leg but not puffy still quite firm which then makes me worry about a potential suspensory issue which is what he had before but before it was proximal so higher up. I think I’ll have more of a fight on my hands if suspensory and I’ll need the vet on side to help with wording. I’ve told them I suggest if not foot we strictly ultrasound rather than jump to mri but that conversations deffo need to be had with insurance to get some confirmation on cover. I reckon we are up to £400 now with those x rays which would be what I would pay in excess so if they won’t cover the now anything going forward will be out of my pocket so to speak. It’s so stressful especially my boy having had this operation on his hind only 18 months ago I’ve not had much luck at all : (
 
I think you just have to be clear with the vet that with an MRI being so expensive and there being a question mark over the insurance, you want to nerve block and take it from there.. Also check if NFU want to pre approve MRIs, they did when I had one but it was a long time ago.

There is another question with foot issues. With a clear X ray, it may be soft tissue. You can ask if having an MRI it will make a difference to the treatment.
 
criso said:
I think you just have to be clear with the vet that with an MRI being so expensive and there being a question mark over the insurance, you want to nerve block and take it from there.. Also check if NFU want to pre approve MRIs, they did when I had one but it was a long time ago.

There is another question with foot issues. With a clear X ray, it may be soft tissue. You can ask if having an MRI it will make a difference to the treatment.
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Yes agreed I’ve told the vets this. So I guess nerve block and let’s see.

That’s a good question thank you! I guess their response might be depends on which soft tissue in the foot…. ?
 
So update. It’s an SDFT injury and he’s done quite the job of it :( Here comes the long recovery…*sigh*, I know it’s going to take time and I’m going to be patient and I know it’s what is best….just sucks!

Anyways, Ive put in a claim and I’ll just have to wait and see….. it’s in the same leg but it’s a different structure and 6/7 years after the suspensory with a big gap where he returned to normal work. Guess time will tell!
 
SophieOtis1990 said:
So update. It’s an SDFT injury and he’s done quite the job of it :( Here comes the long recovery…*sigh*, I know it’s going to take time and I’m going to be patient and I know it’s what is best….just sucks!

Anyways, Ive put in a claim and I’ll just have to wait and see….. it’s in the same leg but it’s a different structure and 6/7 years after the suspensory with a big gap where he returned to normal work. Guess time will tell!
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Sorry to hear about the injury :( Out of curiosity, did you MRI in the end?

Good luck with the claim, fingers crossed for you! Just a thought, if your horse has been seen in the last 6/7 years for vaccinations etc, the vets may have written down on his clinical notes that the horse was well&sound etc. So IF the insurance company does decline based on previous injury/claim, you may be able to get your vets to write a letter saying the horse was sound previous to this current injury.

I hope all that makes sense!x
 
SophieOtis1990 said:
So update. It’s an SDFT injury and he’s done quite the job of it :( Here comes the long recovery…*sigh*, I know it’s going to take time and I’m going to be patient and I know it’s what is best….just sucks!

Anyways, Ive put in a claim and I’ll just have to wait and see….. it’s in the same leg but it’s a different structure and 6/7 years after the suspensory with a big gap where he returned to normal work. Guess time will tell!
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If it is SDFT then that is a tendon not a ligament, so if the wording states ligaments in the same limb then you should be fine 🤞
 
DPDOT said:
Sorry to hear about the injury :( Out of curiosity, did you MRI in the end?

Good luck with the claim, fingers crossed for you! Just a thought, if your horse has been seen in the last 6/7 years for vaccinations etc, the vets may have written down on his clinical notes that the horse was well&sound etc. So IF the insurance company does decline based on previous injury/claim, you may be able to get your vets to write a letter saying the horse was sound previous to this current injury.

I hope all that makes sense!x
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Hey, we didn’t do MRI, ultrasound confirmed. Poor boy! And so unfortunate after only having had an op on hind 18 months ago! Guess this is horses though!

I’m sure my vet would happily support this. Does make sense :)
 
SophieOtis1990 said:
Hey, we didn’t do MRI, ultrasound confirmed. Poor boy! And so unfortunate after only having had an op on hind 18 months ago! Guess this is horses though!

I’m sure my vet would happily support this. Does make sense :)
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From my own experience, vets are generally quite happy to provide supporting letters and try to help where they can when it comes to insurance! They may just add on an admin fee, I think mine is around £20/£25 but that covers completing all of the insurance forms and liasing with the insurance company.

Wishing you all the best with recovery and rehabbing the injury :)
 
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