Successfully challenging insurance exclusions

HayleyUK

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Has anyone ever done this and been successful?

Long story short- I'm in the midst of a month long battle with my insurers to get an exclusion removed and feel like all I'm getting is contradictory advice. Wondering if its worth perusing further with them or just letting it go.

Little mare went to Leahurst on 29th April 2013 as usual vets unable to confirm cause of unusual lameness in LF. Pony trotted up 2/10 lame LF as expected, but threw a curve ball in that she trotted up lame on the straight line on the RH. She was kept in for a week and had various procedures carried out - all claimed for on insurance.

No further RH lameness whilst she was there, and it was the first time we'd seen it so vets decided not to investigate - final diagnosis was DDFT injury in LF, Kissing spines and the RH lamness was chalked up to a compensatory lameness.

Renewal has come through and exclusions are as expected - but with the RH excluded.

I'm disputing this however, underwriters won't accept compensatory as a diagnosis. Lots of back and forth between vets, myself and insurers (1hr upwards on the phone every single day for 2 weeks) and a shed load of contradictions and confusing responses later I'm no further on.

Initially I was told that if the vets would say the lamness was a 'direct cause' of the DDFT injury or KS that the exclusion would be removed. Vets have done this. Exclusion not removed. I'm literally jumping through hoops and then the goalposts are being changed each and every time I deliver what they ask for.

My other option is to wait a a month, and have it reviewed under the 12months clear guidelines however, no one can be clear as to what the vets need to advise she has been clear off. One adviser says DDFT LF injury - others say RH lameness. I've pointed out that to accept LF lameness under the 12m clear rule as a diagnosis is a contradiction of what they've said about accepting it under the review criteria to which they've agreed but still none the bloody wiser as to what they want in order to have the exclusion removed.

Wondering if its actually worth pushing or if its just best left alone and chalked up to experience.
 

georgiegirl

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We have done so sucessfully in the past. My horse stood on a 4 inch screw that went right the way up into his hoof around the frog cleft area. Thankfully no catastropic damage was really done but it did require an emergency call out, antibiotics, xray and lots of dressings. The insurance company at the time tried to exclude his foot from any further claims again - obviously an incorrect decision from an accidental injury - we just got the vets to correspond with the insurance company and in the end they revoked their decision.

Could your vets not get in touch again and try and provide any evidence ie xrays/scans etc to support their claims? If not perhaps try getting in touch with the ombudsman (or at least threaten to?)

Good luck - Its all you blooming need when going through a stressful time. I have to say though when it came to renewal with this company we did move elsewhere (NFU now) who have been fantastic. We have just gone through a big 5k insurance claim with them and they have been fantastic and so supportive the whole way through. God knows what my premium/renewal will be next time but tis worth it as they have been so brilliant.
 
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Laafet

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I have too, NFU excluded everything on mine apart from colic after a diagnosis of PSD to both hinds and mild arthritis in the hocks. They refused to budge, moved to KBIS, they reviewed the vet reports and reinstated everything apart from his hind legs from the hock down.
 

Ema03

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I have too, horse came in with random tendon sheath swelling. Wasn't lame but wasn't going down, vet advised a weeks box rest with cold hosing and if it still hadn't gone down would need it scanning. Had it scanned and nothing was found, swelling randomly disappeared and the insurance then excluded that leg. Managed to get them to change their mind after the vets wrote to them and explained nothing was found. This was with the dreaded E&L as well!!
 

chestnut cob

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Yes, with two different insurance companies relating to two different horses. Though neither issue was as complicated as yours. First one was diagnosed with soft palate displacement, which was treated successfully. Renewal came through and they'd excluded "entire respiratory system" so my vet wrote a letter saying there was nothing wrong with the rest of his respiratory system. They changed it to just directly/indirectly attributable to soft palate displacement. Other was after horse developed a sarcoid, they tried to exclude "all skin conditions". Vet wrote a letter saying horse has no other cuts, marks, abrasions or skin issues besides the single sarcoid, now successfully treated. They lifted that exclusion and changed it to just sarcoids.
 

popsdosh

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You can challenge it but remember at the end of the day the insurance company are not obliged to continue cover !
 

star

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I have twice on two different horses. One was an exclusion for anything related to mediolateral foot imbalance which was pointed out on his vetting. Got farrier to write a letter after a year and say feet all balanced so they lifted it. Second was current horse who tweaked his DDFT in a field accident due to direct trauma to the tendon. The leg he damaged was already excluded so couldn't even claim for the injury yet they still excluded both back legs for any tendon or ligament damage. After a year he was back in full work so I asked them to review it. They checked his vet history and competition history and lifted the left hindleg exclusion completely.
 

Twiglet

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Not with SEIB by any chance are you OP?!

I would say your vets are your best friends in this - they're going to be in the best position to argue on your behalf. Some are better at it than others.
Make sure you have correspondance in writing and keep a note of everything that's been discussed....it's likely that the underwriters themselves will be the ones pushing back on it.
 

Elbie

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Just checking I have dates right. Mare showed slight RH lameness during a work up in April 2013 and your renewal has just come through?

Assuming your mare has not shown any signs of RH lameness since I would get vet to submit full history showing she has never been seen for this and provide a letter stating that it was just a 'one-off' that had never been seen before the work-up or since.
 

LeannePip

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Yes, quite recently with Petplan acctually! whilst trying to claim for something else they came back and said something along the lines of 'after investingating your horses vet notes we have found that she has had veterinary treatment that you have not disclosed to us, so we have added these exclusions to your policy:
Bi-lateral UFP (What i was trying to claim for and why they were looking at her notes :S)
Lameness resulting from UFP
Mudfever and other skin conditions (i had been given a pot of mudfever cream from the vets and didnt even think about it - never mind claim or inform them)
and lameness of the left fore limb'

I was confused about the lameness of the left forelimb as she has never been lame and so called them up an apparently because that is the leg which she had the mudfever on this has weakened the structure of the leg hence the exclusion! Excluding a whole leg because of mudfever is a new low!

this as we all no is utter tripe! so i kicked up a bit of a fuss and eventually they removed it but have kept the mudfever exclusion.

I am still in big battles with them regarding the UFP and next step is ombudsman.

Good Luck, OP!
 

Jill White

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I have too, NFU excluded everything on mine apart from colic after a diagnosis of PSD to both hinds and mild arthritis in the hocks. They refused to budge, moved to KBIS, they reviewed the vet reports and reinstated everything apart from his hind legs from the hock down.

I have only ever used KBIS - it is run by horsey people who understand horses - not insurance clerks!!
 

HayleyUK

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Thanks for all the success stories - this one isnt one I'm sad to report.

After much battlnig and call listening by the team leaders at the insurers - they've backtracked, and refused to remove the exclusion unless we go down the 12m clear of symptoms route.

Its only a month to wait - so will just get it removed then :)
 

AshTay

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Glad you've found a solution!

Initially I was told that if the vets would say the lamness was a 'direct cause' of the DDFT injury or KS that the exclusion would be removed.

Was that the right way round?? Surely it would only make sense to remove the exclusion if the DDFT injury or KS were a direct cause of the RH lameness?


I had a letter similar to one described above with a msssive long list of exclusions which were to be applied. I nearly died! Then noticed that there was a different horse and owner name at the top and it had been sent to me in error. I felt very sorry for the true horse and owner!

I've had an exclusion applied for viral infections because my gelding had a blood test to check his behaviour wasn't due to a virus and he had a slightly raised white blood cell count. The issue was ultimately found to be to do with his back so I either need the vet to tell the insurers this in a very direct way or test again in 12 months.

Petplan can be confusing as they add all future exclusions onto a new policy document at the time of renewal without mentioning that this won't kick in until after 12 months for conditions which have just been diagnosed and are currently being treated for and claimed for. LeannePip - that's why the fist exclusion was added in your letter.
 
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