Pet Plan Equine Insurance Exclusions - Not Happy...

SirBrastias

SirBrastias

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All,

Slightly long story so pleas bear with me :(

Horse suffered a fractured elbow at the start of the year. Good news is that it looks like he will make, if not a full, a half-decent recovery. Cue my first ever equine insurance claim. Part of the claim form asked for a complete history of medical treatment, Pet Plan were very helpful and suggested that I could get the vet practice to print out a history to send them.

As you an probably imagine, for a thoroughbred and slightly neurotic owner, this covered a few visits over the last two years, including regular teeth rasping (vets have insisted twice a year), two abscess, a once over for a snotty nose/slight cough (which was put down to nothing more than possibly a slight hay allergy) and during our annual check up a once over on his back which showed he might be a little tight near his pelvis and that it wouldn't hurt to have a physio out but essentially nothing wrong.

Pet Plan have just sent me an updated insurance form with the following exclusions

Excluding claims resulting from or connected to The Back/Spine and associated soft tissue
Excluding claims resulting from or connected to Mouth and Oral Disorders
Excluding claims resulting from or connected to Respiratory System Disorders
Excluding claims resulting from or connect to Feet and Pedal Disorders both forelimbs and right hindlimb
(plus Fractured Elbow left forelimb - which I was expecting)

Even though he had no treatment for his back or cough/snotty nose they are both now excluded. I feel like a could cry! Truthfully unless I can get the above removed I don't see the point of insuring him after this year (ongoing treatment for the fractured leg, though considering x-rays aren't as expensive as I thought I could have covered this without the bloody insurance). I truly feel like I'm being punished for being over cautious.

Grrrrr I cant even understand what they have excluded his Mouth and Oral (?) just for having his teeth rasped?! Please someone reassure me that this is just a mistake and when I speak to them tomorrow they will apologise and remove all of the above? Do you really have a foot excluded every time you have an abscess??

I'm going to go and drown my sorrows in scones with clotted cream and jam, theoretical ones on offer to those who have taken the time to read this!

(Please excuse any spelling/grammatical errors - feeling very sad)

Thanks Emma
 
Phone them and check. Had my renewal through today from KBIS and had some exclusions on there I wasn't expecting.

Turns out it was a mistake and they had copied and pasted some exclusions from my other horse onto the policy. I was most relieved!
 
petplan gave us mouth and oral and reproductive system on our renewal..

only because mouth and oral has a similar code apparently (he'd had a carcinoma on his willy - no where near his mouth!)
 
Insurance companies are getting ridiculous. I insure with Scottish Equestrian who are now owned by Pet Plan. One of our horses was scoped for ulcers when investigating what turned out to be polydipsia (corrected by increasing his salt intake). When scoped nothing was founs and the vet even commented to the vet students observing that they would rarely see such a healthy looking stomach with no imflammation to be seen. On renewal of the insurance everything gastro intestinal was excluded. When I questioned it I was told that if he didn't have anything related to his stomach or gut in the next year I could ask them to review it. I thought that it would be sods law if he took colic within that year so fought the exclusion on the basis that the scope had shown how healthy his stomach was so should be reassuring for them. I asked if a horse had x rays for a vetting would they then exclude the legs because they had been x rayed even if they were clear? Eventually they agreed that they would remove the exclusion if I had a letter from my vet saying the horse had had no colic symptoms which he did.

In your position I would ask your vet for a letter stating that the dental treatment was routine and that there have been no recurrances of the other problems and ask for the exclusions to be removed. Good luck!
 
All looks a bit 'tick box' to me as far as those exclusions are concerned and screams to me of someone seeing something mentioned on a medical history and going down their 'list' of diseases/conditions and that's what they come up with to exclude!

I would suggest speaking to them or just moving to an insurance company that has underwriters who actually know and understand what they are reading on a veterinary medical history when it comes to horses. Looks like Petplan are going down a very script-lead underwriting style there which doesn't require any actual horse knowledge to issue policies!
 
I had similar happen-all arthritic conditions excluded when one hock has changes, nowhere else plus all external infestations are excluded cos one time he was stamping and I asked for a Dectomax injection. Mad, frankly. :(

I think you can have exclusions removed after a couple of years if you have no treatment on them.
 
I claimed through PetPlan this year for the first time, so it will be interesting to see why they decide to exclude.

Those exclusions do seem ridiculous. I would phone them up and back up your argument with a letter from your vets. I don't see it being a problem to have them taken off. And if it is, change insurance companies. I can't see another company wanting to exclude all those things!
 
Please let us know how you got on when you have rung them. My horse is insured with Pet Plan and was admitted to Leahurst last year for an annular ligament operation. They asked for her vet history and have excluded almost everything. One that really annoyed me was an exclusion for back/spine and soft tissues! Id had my vet out as she once reared when id broken her in at 3 year old (shes now 8) I got my vet out to be sure her back wasnt hurting and he put it down to excitement and being a youngster and Pet Plan excluded her back. I rang them and they wouldnt remove it!x
 
I've just had the same thing happen to me - ridiculous exclusions after a year with a claim. I spoke to my vet who agreed the exclusions were nonsense and he rang the insurance company for me, explained the situation with my horse and sorted it all out! Within hours of me ringing my vet, I had an e mail from the insurance co with updated exclusions in line with what I had expected.

So speak to your vet and see if they will help you.

X
 
I currently have full vet cover as part of mine, but will not be renewing it. Going to keep a vet fund instead. Makes more sense over all really.
 
Hmm it sounds to me like your vets have been overly thorough and sent them a complete history of EVERY treatment and not just the treatment you are claiming for, which is a bit bonkers.

I can't see why you would be excluded from future dental issues just because you have had routine 'preventative' dental care. The abscess thing is a bit strange as well. Abscesses are 'normally' easily treatable (unless you're my horse) and aren't usually an indication of anything more serious (again, unless it's my horse).

I would ring them and have a chat and see if you can get them to lift the exclusions.
 
My older horse (23 now) has always been insured with PP since I got him when he was 4. A few years back I decided it may be good to get vets fees added to his policy (think he was maybe about 18 at the time) as I worked for a horse insurance co. and saw the amount of vets fees claims we had.

I asked to add them and they insisted I had a 2 stage vetting done before they could extend the cover. Fair dos, I had it done when the horses had their next vacs. Now we all KNOW the limits of a 2 stage vetting but that is what THEY asked for. vet did it, very detailed etc but there were no issues. My horse has had no real problems in all the time I've owned him.

PP though decided after seeing the vet cert that THEY had requested, they then wanted his full vet history. He had seen the vet on 2 occasions I think for foot abscesses. So, of course that's ALL PP found and, as a result excluded nail bind! Really pretty hilarious but I was fuming as we'd paid for a 2 stage vetting when we could have saved the bloody money as they didn't accept that that could have possibly been done and for him to not have any lumps/bumps etc! Wish I'd made more of an issue of it really and put in an official complaint (I would do that now knowing even more about how insurance works!)
 
deb_l222 said:
Hmm it sounds to me like your vets have been overly thorough and sent them a complete history of EVERY treatment and not just the treatment you are claiming for, which is a bit bonkers.

I can't see why you would be excluded from future dental issues just because you have had routine 'preventative' dental care. The abscess thing is a bit strange as well. Abscesses are 'normally' easily treatable (unless you're my horse) and aren't usually an indication of anything more serious (again, unless it's my horse).

I would ring them and have a chat and see if you can get them to lift the exclusions.
Click to expand...

most insurance companies request a FULL history, OP speak to your vet, ones at work are often speaking to insurance companies about lifting exclusions and the vets seem to have far more success than the owners
 
Petplan are driving me round the bend with exclusions at the moment. Phone them up and ask if any of them are reviewable. You can probably get some of them removed with a report from your vet.
 
You don’t have to necessarily live with exclusions on you insurance policy!

I like many others I switched from NFU to KBIS because of the ridiculous increase of premiums. I filed in clinical details & also sent a copy of the vetting my horse had when he was bought 4 years ago. As a result I received a quote etc however there were 4 exclusions on the insurance.

1. Losses arising directly or indirectly from wound to right hind hock & capped hock
2. Ditto…… from wolf teeth
3. Ditto…… corneal oedema
4. Ditto……fibrous swelling of extensor tendon right hind cannon

I telephoned KBIS & followed up with a letter regarding the above telling them that (1) the wound was minor, the hock had slight fluid on it at time but was not capped & was now totally recovered. Regarding (2) he had had his wolf teeth removed 3 years ago so that exclusion was redundant. Regarding (4) I had no recall of him ever having this injury & I produced a full clinical printout from my vet where there was no mention of this on it. Regarding (3) I accepted that he had a minor eye injury from when he was young & this did not affect his sight but I understood they may wish to have this as an exclusion.

As a result I received a new policy of insurance & all exclusions except the eye had been removed.

If anyone has exclusions on their policy & the horse is now recovered, is fit & healthy & has no lasting effect then contact your insurance company & they will ask you to sign a health declaration & the exclusions will probably be removed. They will only remove exclusions if you take steps to have the removed.

As a result of this the one rear leg of my horse, which was basically excluded from cover, is now fully covered...... worth doing I think?

This is one of my old posts in 2012, I am still clear of the exclusions & horse is still fully covered, except for the one eye. :)
 
Bonkers but sure you'll be able to get most, if not all (not sure about the allergy/respiratory one) taken off. Just call them, although they might want to talk to your vet.

One of mine once got a nail stuck in his frog (which wouldn't even have been a vet fees claim except he had a reaction to the drugs the vet gave him and ended up very poorly - long story) and KBIS automatically excluded that hoof for everything the following year. All it took was a call to sort it out.
 
Thank you, thank you and more thank yous (and scones) to everyone who's replied! Feeling marginally more hopeful or rather feeling less like a lost cause. Will phone them in the morning and try to speak to my vets (big practice) directly on Sat. I'm flying out to Europe on Wednesday till the weekend for work so only got tomorrow to try and talk to them this week.

It just seems rubbish to have this thrown at me right when were in the middle of treatment and after I've already spent what feels like all day on the phone to them and the vets regarding payment on the first bill. Pet Plan reckon they paid on the 1st March but as the vets haven't yet had the money they then started telling me it can take 14days for a BACS payment to go through.

Just want to hide in my stable cuddling my poor horse who hasn't got the slightest clue the trouble he causes. It's a good job he's cute.
 
For those who wanted an update....

I phoned Petplan the following day (before my trip to the Netherlands) and essentially told them that I needed an explanation as to why these exclusions were included on his policy and that I was not happy with what they had put. The lady was very helpful (to a point) but couldn't really justify the exclusions in my eyes.

Anyway, apparently the 'mouth and oral disorders' were due to the fact that the vet mentioned he had 'large caudal hooks' in one of his reports - I pointed out that I have his teeth done twice a year on the vets instructions and that I felt I would be better off not having his teeth checked if they were going to exclude his mouth and she made some feeble comment about how if his teeth are sharp they might cause problems etc. She couldn't really disagree with the fact that it does appear I'm being punished for bothering to have his teeth attended too.

The feet and pedal bone exclusions are due to the fact after one abscess it was noted he had 'thin sole and close to sensitive structures'. I think (though my memory is a bit fuzzy) she then asked if his feet had been pinch tested since and I said yes, when they were investigating his front lameness (due to the break) and that he was fine. I was then told I needed to vet to confirm he no longer has sensitive feet (which as he is now barefoot behind and very sound isn't too difficult).

When I queried the back/spine and associated soft tissue I got told the vet had mentioned he had 'a long back' which I obviously audibly scoffed at because she got a bit cross and pointed out the vet had mentioned he had weak apaxial muscles++ (I did want to point out he was only a light hack but I didn't get round to it), she then asked me politely if he had built up back muscle since then at which point I pointed out that as he (essentially) has a broken leg and had been on box rest for 2 months, no, his back muscle has not built up.

I think by this point she was a bit embarrassed and promised to get the underwriters to send me information by email (though it came by post) with the information my vet needed to provide to have the exclusions taken off.

Spoke to the practice this morning and they said yes, of course they can look into this, so a letter from me, from the insurance and a photo copy of the exclusions on the policy was given to the vet this evening.

Fingers crossed the vet will reply and let me know whether she is happy to confirm that he has been clear for 12 months and there are no problems. Though as the back and cough where looked at in 2013 I'm not sure what she can do, but at least I might be able to have them taken off next years.

Still angry at Petplan for, in my eyes, being insensitive and ridiculous but have resigned myself to the fact that its going always be like this a bit with insurance companies!

Thanks everyone for your advice. If anyone is interested (and I remember) will follow up once I hear from vets/insurance.

To end on a good note, have been riding my boy (walk only) and he's doing really well despite the bone fragment sat round his elbow. It was touch and go at the start of the year but seems really positive at the moment.

Emma x
 
Good luck in getting the exclusions removed. My TB was diagnosed with hind limb PSLD, navicular and spavin two years ago. Petplan have now put ELEVEN exclusions on her policy. I can't remember them all, but one of them is brilliant - "excluding all lameness conditions on all legs". However they have also been great with other things. My little one had a minor bout of colic in August 2012, so in about November 2013 I got a vets letter and requested that the exclusion was removed. They removed it with no issues. I also used to have an exclusion on the TB's policy for "any issues relating to sinus or dental disorders" due to a major hospital stay in 2010 after a tooth abscess went very nasty and she had to have extensive sinus surgery. In 2012 I asked that the exclusion be removed and again, once a vet had examined her, they removed it without issue. So they're quick at putting exclusions on, but I think that providing you can get a vet to say that there have been no further issues after 12 months, they are also good at removing the exclusions too.
 
Warrior_princess said:
Please let us know how you got on when you have rung them. My horse is insured with Pet Plan and was admitted to Leahurst last year for an annular ligament operation. They asked for her vet history and have excluded almost everything. One that really annoyed me was an exclusion for back/spine and soft tissues! Id had my vet out as she once reared when id broken her in at 3 year old (shes now 8) I got my vet out to be sure her back wasnt hurting and he put it down to excitement and being a youngster and Pet Plan excluded her back. I rang them and they wouldnt remove it!x
Click to expand...


I HAVE REFERRED MY COMPLAINT TO THE INSURANCE SERVICES OMBUDSMAN
SEIS told me in writing that they had excluded anything related to lameness and any condition showing the clinical signs of lameness, after the horse had been found in the field lame in September.
However The exclusion had been applied the previous month in August so this reason they had given me was deliberately false and misleading.
It is also so wide in its interpretation as to make any diagnosed condition which has as a side effect the horse being lame . for example if she were kicked in the field, if she was to suffer a puncture or deep trauma wound, if she were to have a nail impaled in her hoof, or should she be injured say having been hit by a car , as all these conditions would display the clinical signs of lameness and as such be covered under the exclusion .
By reference to a Legal firm they explained that any exclusion , so broad in its interpretation as to render the policy impractical would have to be removed.

Limitations on Exclusion Clauses

Exclusion clauses may be void if, in interpreting their ordinary and natural meaning, their literal construction creates an absurd result or defeats the whole purpose of the contract. (Craddock Murray Neumann Oct 2014)

There were other issues also and it will be interesting to to see what the end result is.
 
We had my daughter's pony insured for Death and vet fees. He developed what seems to be ulcer symptoms (low grade colicy stuff: not eating well, lying down a lot) which didn't respond to medication. Had him examined and blood tested at the vets, nothing conclusinve, try a different ulcer medication... He appeared to respond, but died unexpectedly 6 days later. PM showed nothing conclusive (histology could not be done as he dies when we were away for the day and it was 42 degrees here so post mortem changes had set in).
PetPlan rejected our claim as the policy excludes "anything arising from colic"...
We now self insure.
 
I tried to get insurance through petplan for my horse but because of his vetting saying that he had a few marks on him that may have been sarcoids (but arent) they eliminated basically his entire body as they said they won't cover sarcoids or any skin issues. Real helpful. They wouldn't insure hooves either because of a surface crack on one of them which the vet even put down would go away. Plus they also got the results back on what they could cover had the info for months and didn't bother to tell me so they lost out after I got fed up waiting. He isn't insured but like others I am just trying to save up for emergencies.
 
There staff are clearly idiots

I have two on going claims. One hock issue on his back left. and one coffin joint on his front right

My recent payment from them was for my horse having his hocks fused. They've put the treatment down for his coffin joint claim.

I've contacted them with a sarcastic email. I'm not sure how many horses have hocks in their coffin joints, but my horse has them on his back legs

I wouldn't have bothered had my coffin joint claim been over but this would take it very close to my 5k limit and I have another vet invoice for 1k
 
I has an exclusion for my old horse with pet plan that was - Excluding claims resulting from or connected to Pyrexia (high temp) of unknown origin.

I phoned them and asked if he had a pyrexia of known origin would he be covered, lady at end of phone laughed and said "No, we're not that nice"
 
I'm with Petplan and will be leaving when my insurance renewal is up in April next year - I've had exactly the same problems as you, and we are now on the 5th letter from my vets to the underwriters at Petplan and still the exclusions are there.

In a nutshell it is the underwriters who decided the exclusions, not the staff at the end of the phone - and because we the customers cannot speak to the underwriters you will spend your life talking to someone who doesnt really know what the underwriters are thinking and how best to remove the exclusions. The more health checks, vettings etc you do with your horse the worse Petplan respond - the more you look after your horse the more exclusions they will apply.

I have simply given up trying to get mine removed now, it is hopeless as they will argue every word your vet writes and ask you to word it slightly differently every time - and still you dont get anywhere. I will be finding another insurance company next year, and will be having a long chat with them before I send any vetting or medical history as I'm not going through this again!

My youngster had a stage 2 vetting when I bought him, there were a few notes from the vet but he passed the vetting and was deemed fit for purpose as a future dressage horse. So what do Petplan do? Exclude anything related to an outward deviation of the front forelims (despite the vet having noted it was a very slight deviation that will change with age as his chest broadens and his feet are regularly trimmed). The worst one is his stifle - the vet during the vetting process felt something he was unsure of, so to be safe we came back a week later and x-rayed the stifle before I agreed to purchase him (he was 1 at the time). X-rays came back clear and he noted all of this on the final vetting report.

So of course petplan exclude anything related to the stifles - I asked them how on earth can you exclude something that has been proven with x-rays (which they have copies of) to not be there? But apparently because I had to go to the precaution of taking x-rays it means there 'could' be something wrong so they need to exclude it. So the process with the vet who did the vetting started - 2 letters from him with detailed explanations of his notes and the stifle x-rays, and still they wont remove it. 1 year later, got my vet to re-examine him and write to Petplan to confirm there is no issue and has not had any treatment in the last 12 months for anything related to the stifle. That still isnt good enough, the wording my vet used was wrong - another 2 letters from my vet with slightly different variants on the wording and still no joy.

I honestly give up with them, the more cautious you are with your horse the more they punish you - in order to have no exclusions with petplan you cant have even had your vet out for your annual vaccinations (yes they did exclude anything to do with equine flu because I had him vaccinated!!!) and god forbid you get the vet out to check something out......

They are good value, but there is a reason why they are cheap - because they'll never pay out if anything happens to your horse because it will all be excluded! I've come to the conclusion I'd rather pay more for better service than waste my time with Petplan. I like the idea of paying into an account each month for vets bills, but after my youngster had a field accident (which Petplan did pay out for.....thankfully he injured such a random part of the body even Petplan couldnt find an exclusion for it) the bill came to £3k and it would take years of saving £30-£50 per month based on a typical insurance monthly fee is, to get to that kind of money, so if there is an injury before you have saved up enough you are a bit stuck and will end up relying on credit. If I could afford to be throwing £200-£300 a month into an account for vets bills to get you to a good fund quickly, then I would....but for now £30 a month is a more feasible way of ensuring he will be covered in the event something happens.

I hope you have more luck with them OP - get the customer service person to speak to the underwriters, and get them to tell you word for word how the vet needs to explain each of the issues and hopefully you might have more luck than I did. If they are being awkward ask to speak to a manager and kick off until you get them to talk to the underwriters - I had to speak to a manager before they bothered to get up and talk to the underwriting team; that still didnt work for me but you never know, you might be luckier than I was!
 
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