NFU policy wording

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Galaxy123

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My horse was recently out on loan and whilst out on loan pulled a muscle in her back - that's what we think so far anyway.

She's insured with NFU and according to the policy wording they only cover vets fees due to accident (defined as skin wound or fracture) or illness or disease.
A pulled muscle doesn't seem to fall under any of these. Does that mean I'm not covered?
I'm worried to death because my vet tells me it's causing her terrible pain and is so bad she can never be ridden unless they manage to cure it completely.
Also, NFU are sending a loss adjuster round to my house. Does anybody have any experience of loss adjusters, what they will want to know etc etc. I feel like I'm under a microscope.
 
If it's a pulled muscle then it is correctable with the right treatment. You need to find a very good deep tissue specialist such as an equine sports physio. Your horse would need deep tissue work not cracking of joints etc. a good therapist would be able to tell your horse did indeed have very sore muscles and if so exactly which ones.
Regarding NFU If you cannot find the exact cause then you cannot label it as muscular and you should therefore be covered for further investigation the same as if your horse went lame with a tendon or ligament issue but the exact casue was unknown without investigation.

I wouldn't write your horse off yet. Keep positive and good luck!
 
Galaxy your mare has a dis-ease. If you split the word down, you can see that it does not necessarily mean that she had to "catch" something. You are covered.

A Loss Adjuster is a person paid by the insurance company to get you to agree to the payout being as little as they can possibly get away with. You are insured for a certain fixed sum on the vets fees, so it sounds like they are negotiating loss of use. If this is not so and your mare is still in treatment, there is no point whatsoever in him meeting you and you should probably tell the NFU that and not allow him to call.

It sounds as though your vet has already told NFU that she is a write-off, or you have. If so, it's far too soon for that if it's a muscular issue and you need to stop the loss-of-use process. Of course the NFU would far rather payout, say £3000 loss of use than £5000 for a proper diagnosis and treatment, but they have no right to push this on you and this sounds very much to me like where it is heading unless you put them right about it.

Let me stress this, Loss Adjusters are not sent out for vets fee claims, (those are agreed between your vet and your insurance company) but for loss of use or death payouts. Someone has invoked this process too early and you need to stop it.
 
Galaxy if the NFU insist on the Loss Adjuster meeting then I strongly recommend that you have a VERY assertive friend with you, because there is no doubt in my mind that they are going to try and persuade you to take a loss of use payment instead of using up all the Vets Fee insurance and then still maybe taking a loss of use payment. If you live close to me I will gladly help if you PM me.
 
WOW. I'm overwhelmed by the responses. Thank you so so much. Sometimes I think I'm so blinking naive !
You are absolutely right though, we did put vets fees/ loss of use on the claim form, as we were not sure whether we might actually lose use... and didn't want them to say later that we couldn't claim for loss of use because we hadn't originally put it on the form.
I'm going to call NFU tomorrow and insist on some further information as to why the loss adjuster needs to come. I think I need to call a halt to the LOU, until the vets fees have been ascertained, and surely no loss adjuster can help them with that because they dont the problem.
Thank you so so much for your help everybody.
If they insist on coming I'll make sure my other half is out, then claim I can't agree to anything without his opinion !
 
Hang on....I used to work in claims management and did loss adjusting - were aren't all a bunch of money grubbing *rseholes you know! Lol

I dealt with an NFU loss adjuster after the terrible loss of my horse last year - we spoke on the phone to discuss her value. He was professional, respectful, knowledgable and very sympathetic - especially as I started bawling my eyes out when I had to go through her competition record.
There was no quibbling, no trying to beat me down and they agreed on my valuation and paid out in full.
 
[ QUOTE ]
Hang on....I used to work in claims management and did loss adjusting - were aren't all a bunch of money grubbing *rseholes you know! Lol

I dealt with an NFU loss adjuster after the terrible loss of my horse last year - we spoke on the phone to discuss her value. He was professional, respectful, knowledgable and very sympathetic - especially as I started bawling my eyes out when I had to go through her competition record.
There was no quibbling, no trying to beat me down and they agreed on my valuation and paid out in full.

[/ QUOTE ]

I had a very similar experience with a NFU loss adjuster when I lost a youngster. He was charming and just asked me to tell him about the horse. I only got as far as telling him her breeding when he stoppped me there and asked why she wasn't insured for more money! He then gave me some very useful information regarding value etc and NFU paid up her full insured value without a peep.
 
I agree, the NFU have been super with me, My mare has been treated for the past 6months for a broken pedal bone and the NFU have paid up, no problem at all. They are definitely easier to deal with than E&A who I was with a few years back.
 
A loss adjuster can be sent out for a vets fees claim not just a loss of use or loss of animal claim. Don't cancel the appointment, it will make them suspicious. Put it this way, there is no way they will pay out WITHOUT the loss adjuster report now.
 
Well it's been some time, but I'd just like to update you all on what happened...

Loss adjuster came round, lovely girl. Had a horse too and totally understood what I was going through. Luckily at the time we had our own place and horse was at home. After we'd been through all the why's and wherefore's of what had happened I offered to let her see my horse, and we hopped over to the field.

I explained everything in a bit more detail... how her behaviour had changed, the clear amount of pain she was in, the things that seemed to aggravate it etc. Her response..... "hmmm, have you considered kissing spines???"

We talked about kissing spines for a while and everything seemed so bang on. The only thing was the most sensitive area was the loins... bit strange for a spinal issue we thought. But every other classic symptom was there.

I mentioned this to vet and she suggested scans and xrays.

I chewed my nails rather a lot waiting for the results - and there it was !!! We had a diagnosis - she had kissing spines.

Found an amazing physio - will never use anybody else, ever ! and around five physio sessions later we decided we were taking three steps forward and two back so the best move would be surgery.

I'm pleased to say, surgery was a complete success and after about another five or so physio sessions I was recently discussing sending her away for complete rehab, re-breaking and bringing back into work (vet strongly recommended I didn't do this myself in case she still had in her head that was going to hurt).

Unfortunately, she then had an accident in the field, and is now on box rest (leg related this time) but hopefully next month will be able to start making plans for her rehabilitation.

NFU have been nothing less than excellent in respect of the KS claim.... which incidentally cost the full claim amount of £5k. Not a single query, quibble or even a hiccup. They have my business now for life !

The physio has become a great friend, and has been calling me for updates on the her progress with regard to the leg (not just the back).

I now have the vet@s mobile number on speed dial !

As for the loss adjuster, I'll never be scared again. I have even been emailing her progress reports on my mare and she too has kept in touch with a pic or two of her own pony.

My advice to anyone reading this and going through something similar in the future... be honest & open... and if you're with NFU, you're in good hands :) good luck !
 
That is good news - although sorry to hear about the latest injury.

I have always found the NFU to be good and they paid up without a problem for my horse's injury and rehab last year. In fact, when I phoned up the NFU office and said my horse had been so badly behaved at home I couldn't cope with him and I was sending him to a livery yard, the lady in the office said I could claim for time on the horsewalker if the vet recommended it, which they did, so I got some money back for that as well, which I wouldn't have thought about claiming for. They also paid out for all the sedatives he needed!
 
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