PTS: Insurance Claim Advice *please*

[HayleyUK]

I'm posting on behalf of a friend who is incredibly upset at the prospect of putting her horse to sleep and the possibility of fighting her insurers. I'd really appreciate any advice you could give.

Basically horse had a hock op last year to remove floating bone chips etc. Horse has a history of ulcers - which were treated on insurance 18months-2 years ago.
He had a number of months box rest following the hock op - and didnt do too well with it, he gets really wound up about others going out - rears, spins, canter piri etc in his stable which obviously flares the ulcers up again.

He'd been back in work, doing small amounts of walk a day and was slowly introducing trot work when he pulled up lame. Investigations show he's done the tendon in his hock on the op leg.

Vet and owner both feel PTS is best option - horse would be looking at 12months more box rest which he isnt coping with, pain meds flare his ulcers up etc and the prognosis is for light hacking/field ornament at best.

Her insurers are refusing to pay out it seems - based on the fact that box rest is an alternative and should be tried. Horse is reluctant to even get down in stable as simply knows he cant not get up without pain. Insurers do not see ulcers/pain etc as a reasonable reason to PTS.

Regardless, owner knows this is the right thing, but I was wondering if anyone had experienced anything similar, fought a company for a payout when they've refused and could offer any advice at all?

Thanks in advance.

 

[MissSBird]

When my mare was diagnosed with pedal ostitus, we had the same thing. Box rest was an option, but the prognosis from the vet was that even if she did become sound, she'd never be able to be turned out again. I felt that was no quality of life for her, so made the decision to PTS.

The guidelines on when an insurance company will pay out are quite complicated, but it is basically only in the case of serious injury when there is no other option, such as the broken leg in the field scenarios.

My advice to your friend would be to save herself the stress and not fight. This is absolutly standard and I personally have never heard of anyone winning of these fights. It's in the terms and conditions of the policy to begin with.

I'm afraid it seems to be a loss we just have to accept at an awful time.

Thoughts with your friend

 

[HayleyUK]

Thanks for your reply.

Its such a horrible situation, and I really believe they should pay out because in reality, its compromising welfare of the horse to be stuck in, stressed and in pain.. ?

 

[MissSBird]

Thanks for your reply.

Its such a horrible situation, and I really believe they should pay out because in reality, its compromising welfare of the horse to be stuck in, stressed and in pain.. ?

I believed the exact same thing. They wanted me to try and keep my mare (who's pedal bone was disintegrating) in a stable for 12 months, which may have made her sound. Then she'd never be turned out in a field again, never be able to work off of a surface. That's not a quality of life.

Unfortunatly they don't seem to be interested in quality of life or the horse's mental health, just whether the horse is physically healthy or may physically be fixed.

ETA: I'm only speaking from my personal experience. I just wonder if trying to fight with the insurance company over something that seems to be pretty solid might make this situation worse for your friend

 

[BeckyD]

I'm afraid my experience is that they won't pay out either. My horse had PSD, was operated on but it was unsuccessful and at a scan 18 months later when he'd gone lame again, the vet found the hind suspensories in tatters and just thin threads holding the relevant bits together. Obviously horse was lame, there was no way of fixing it, and the only thing to do was either PTS now, or wait for the winter mud and his natural exuberance to do the trick of snapping those thin threads and having to PTS when he'd broken down completely. I went for the former option, but the insurers (NFU) made it quite clear they would only pay out if I went for the latter option and waited for him to break down. I'm afraid I stuck to my guns and the insurers wouldn't pay out.

I'm very sorry for your friend as it's a horrible position to be in.

I have full LOU on my new horse so that I don't end up in that position again (even though it costs me £120/month!).

 

[ihatework]

I really can't see your friend getting a payout - the payout on death is quite limited on insurance policies. To cover horse value she would need LOU in this instance.
Sorry about the horse.
How bad is the injury - might it be possible to treat with pain relief and paddock rest instead of box rest?

 

[miller]

My experience also that they won't pay - OHs old mare did her tendon for 4th time and went down with lami

 

[miller]

Stupid phone! They wouldn't pay out as 1 year box rest on bute was deemed humane

 

[Gamebird]

It's not really insurance companies being inhumane or otherwise - it's people not always understanding the details of what they have their horses insured against.

Insuring a horse for death really only insures it against a) dropping dead or b) having a problem which necessitates immediate emergency euthanasia on humane grounds eg. an irreparable long bone fracture.

Otherwise the only way of getting the value of the horse back is to insure it for loss of use - this is why premiums that include LOU are so much higher.

If you have a horse only insured for death rather than LOU it isn't a case of the insurance company wriggling out of paying - they're not obliged to pay because you aren't insured against what you're claiming for.

Unfortunately it seems to be a misconception that when a horse is put down you should get your money back.

 

[dixie]

What does your vet say?

I know someone who had their horse operated on his hocks and he was still very bad afterwards. He was put down and the insurance company paid out but I have to say the vet was brilliant and it was mainly down to him that the claim was upheld. I believe the vets who operated (he was a reffral casae, so different vets) thought she didn't have a chance.

It might be worth having a chat with them to see what their thoughts are on the matter.

 

[annunziata]

Hard one this my insurance company supported my decision and paid out full value when I had my old horse put to sleep. It really depends on the insurance company and the value of the horse.

 

[Kat]

And this is why some less than scrupulous types might find that their horse "accidentally" gets into the feed room and "just happens" to gorge on unsoaked sugar beet causing a serious colic for which the horse can be euthanised and the insurance will pay out for......

 

[Leg_end]

As others have said already you will only get a payout (and help with disposal costs) if your horse drops dead or if it conforms to the BEVA guidelines of humane destruction.

My personal experience wasnt positive, even though my vet fought my case for me. However I have heard of success stories of vets who agree to destroy and will say it falls under the BEVA requirement.

 

[soulfull]

It's not really insurance companies being inhumane or otherwise - it's people not always understanding the details of what they have their horses insured against.

Insuring a horse for death really only insures it against a) dropping dead or b) having a problem which necessitates immediate emergency euthanasia on humane grounds eg. an irreparable long bone fracture.

Otherwise the only way of getting the value of the horse back is to insure it for loss of use - this is why premiums that include LOU are so much higher.

If you have a horse only insured for death rather than LOU it isn't a case of the insurance company wriggling out of paying - they're not obliged to pay because you aren't insured against what you're claiming for.

Unfortunately it seems to be a misconception that when a horse is put down you should get your money back.

echo this

 

[sam-b]

I had this with my insurance company. I decided it wasn't about the money it was about what was right for my mare. I put her to sleep as my vet said that was the best thing to do for her

 

[ElaineLightning]

Great advice from everyone. Great post gamebird and sam-b I completely agree. If your vet is of the opinion that nothing more can be done for the horse then fair enough but if they are recommending that with box rest there is a good chance she will come good again then there is no reason for the insurance company to pay a LOA claim. As has been said this is what LOU is for. Not a nice situation for your friend but if she feels the best thing for the horse is to be PTS then that's her choice and it's not up to the insurance company to pay for that.

 

[MrsMozart]

When my four year old mare was diagnosed with chronic damage to both rear suspensories, I thought she would be a field ornament. Sadly she continued to deteriorate and I knew she would not last the then coming winter.

My vet was on my side. I fought the insurance company. She was going to be pts no matter what they said.

After a strongly worded letter from my vet and yet another conversation with the insurance company, they paid out for loss of animal and pts costs.

 

[angelish]

hi
sorry to here about the poor mare

i thought i'd mention as a lot of answers are no they won't pay although i don't know the full details as it was my horse and was a long time ago

horse in question suffered a kick to the shoulder which turned out to be a fracture ,he was box rested for months (4-5) when he went lame behind with an arthritis problem (think it was hock but can't remember) that the box rest was making worse

the horse was unlikely to come sound enough for even light hacking but insurance co wanted to carry on treatment as after another few months box rest he could "possibly" be a field companion supported by bute
owner decided to PTS and insurance refused to pay out ,but we have a very good vet that argued and argued the case and she did eventually get a payout although it did take months


my friend also recently lost her mare (my past posts about fetlock injections) she had bony changes in her fetlocks ,injections didn't work etc and it wasn't looking great but we hoped she would get the summer and have a serious think in the autum
she just wasn't coping at all and got worse ,she was lame on 4 bute a day by the end and was found with an absess in a front foot one particularly horrible night and the decision was made there and then to pts as keeping her imobile/the absess stopping her moving around would make her fetlocks worse and it wasn't felt worth putting her through that just too loose her anyway in a few months time

it was a one of those brave "a month too soon rather than a day too late" decisions and the insurance co were not even consulted we got the vet straight out without permision to pts then rang insurance the next day

they have just agreed to pay out ,not without a fight from me ,my friend and our vet but they are paying just if your friend has a good vet that will fight her corner it is possible that they will pay out ,good luck

 

[zoon]

I won a case with my insurance company. In the end the horse wasn't actually PTS so the claim didn't complete- but that is a long story. Had he been PTS they agreed they would pay out despite it being against BEVA guidelines.

One day my horse was fine, the next day refused to be touched from the neck down though to the saddle area. He would react very violently to any contact in these areas. X-rays, nerve blocks, bone scans, MRI and ultrasound all revealed nothing, the horse was totally sound and muscle was fine, blood tests all normal, very high dose bute (6 sachets daily) and gabapentin (for nerve pain) did nothing. The Animal Health Trust held a video conference with vets around the world to try to work out what was wrong. In the end it was decided he would be PTS as it was dangerous to handle him. Insurance company obviously refused a pay out, but when confronted with the idea of a very large claim from a 3rd party who may be injured by him, they quickly changed their minds. He wasn't PTS in the end and recovered from his mystery illness after some "alternative" treatment so no claim was made, but my case proves they can be swayed

 

[ElaineLightning]

hi
sorry to here about the poor mare

i thought i'd mention as a lot of answers are no they won't pay although i don't know the full details as it was my horse and was a long time ago

horse in question suffered a kick to the shoulder which turned out to be a fracture ,he was box rested for months (4-5) when he went lame behind with an arthritis problem (think it was hock but can't remember) that the box rest was making worse

the horse was unlikely to come sound enough for even light hacking but insurance co wanted to carry on treatment as after another few months box rest he could "possibly" be a field companion supported by bute
owner decided to PTS and insurance refused to pay out ,but we have a very good vet that argued and argued the case and she did eventually get a payout although it did take months


my friend also recently lost her mare (my past posts about fetlock injections) she had bony changes in her fetlocks ,injections didn't work etc and it wasn't looking great but we hoped she would get the summer and have a serious think in the autum
she just wasn't coping at all and got worse ,she was lame on 4 bute a day by the end and was found with an absess in a front foot one particularly horrible night and the decision was made there and then to pts as keeping her imobile/the absess stopping her moving around would make her fetlocks worse and it wasn't felt worth putting her through that just too loose her anyway in a few months time

it was a one of those brave "a month too soon rather than a day too late" decisions and the insurance co were not even consulted we got the vet straight out without permision to pts then rang insurance the next day

they have just agreed to pay out ,not without a fight from me ,my friend and our vet but they are paying just if your friend has a good vet that will fight her corner it is possible that they will pay out ,good luck

Yip. Like I said the insurance company will use the vets educated and qualified opinion as to the route to take but the OP said the vet has said box rest and thats the reason the insurance company wont consider a LOA claim which is quite right IMO? Unless I have it wrong OP?

ETA Yes I did get it wrong sorry OP, but if your vet things PTS is the only option then that should be reiterated to the insurance company, perhaps even a second opinion sought or ask the insurance company if they want to get their own vet to investigate?

 

[Waltzing Matilda]

I used to work in animal health and argued with my insurance company when they wouldn't pay for my horse to be pts. He was lame, had low grade lami, had lost loads of weight and his back legs kept giving way. He had had sum tests done but all came back clear. They wouldn't pay as wasn't an emergency and said other tests could have Been done, even tho the first lot had been very traumatic for him. I argued that if I was investing the case from an animal health persective a would consider the animal to have unnecessay suffering and could Persue prosecution of the owner. Also we had him post mortemed and the only treatment would have been to give him steroids which we couldn't do cos of the lami! Unfortunately my vet conviniently forgot that bit as the post mortem was a favour and unoffcial!

 

[HayleyUK]

Wow - thanks for all the replies.

I've read all of them, and passed them on to my friend but will try to reply to as many points here.

Gamebird- thanks for your advice, much appreciated. Would the lack of payout still apply if it was the vet stating that the horse should be PTS I wonder?

For those who weren't sure, the vet is advising PTS as this is best for this horse in this situation - the vet has reported this back to the insurers who are still refusing to pay.

Thank you for sharing your experiences, they have all been really useful. Regardless, the owner will do whats right for her horse even if it doesn't result in payout.

Thansk again