Sympathy needed! Insurance won't pay!

PucciNPoni

PucciNPoni

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For my mare's scintigraphy that she had earlier this month! Basically they told me that becasue they didn't have something in writing before the diagnostic, they won't pay on principal as they didn't get the option to approve or deny, so they just denied...regardless of two different vets' reports etc. They are using their fine print against me, and yep it's my own fault for not saying to the vet on the day "could you please get permission from my insurer first"!

Beans on toast for life I think til I pay off my vet bill.
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Oh aren't they bar stewards! They play on the fact that the first thing on your mind is helping your horse in pain. Honestly, sometimes THEY should be prosecuted under welfare laws. When Henry had a call-out for lami, I didn't contact the Insurance company until all the treatment had been given, including a repeat prescription of bute and x-rays. They paid up no trouble, but it hadn't occurred to me that I should write to them BEFORE treatment - I told the vet to bring the x-ray machine with her on the first call-out!

Do you have the option to appeal, or have you already done that?
 
NFU tried this on us when we had to have our old mare put to sleep, she was 24 years old and broke a bone in her front leg and they said we should have contacted them before we made the decision to put her to sleep so mum said the last thing on our mind was calling them as we were so upset and because of her age it was unfair to put her through an operation, so we said we would cancel all our insurance with them which is 6 horses and the full farm, all the houses, stables and cars and they paid up then.
 
I would appeal against it - talk to a solicitor if need be. When my horse had the vet out for lameness and needed x-raying, I called my insurer for a claim form straight away. I asked them for permission to x-ray, nerve block if needed and then treat but they said they wouldn't give permission or deny it, just to do whatever I felt was neccessary and they would decide afterwards whether to pay. They also told me that most people don't bother calling them until treatment is finished.

When mine tried to find a way out of paying (years ago now), they used the "pre-existing condition" excuse (which it wasn't). I remember writing to them and demanding a refund for the last X years of insurance because there had "clearly been little point in having the horse insured if you are going to renage on our agreement". They paid up 2 days later!

Fight it, they usually back down.
 
I got a severe letter from my insurers when i put on my renewal some minor treatment that i had not claimed for as it was only £200. And warned they would not pay up for future claims if i did not tell them of every visit from the vet whether or not it resulted in a claim!
 
They did say to me on the phone when I rang to inform them of her impending horspital visit that for bone scan they had to be informed prior and give consent. So I told them that it was very likely there would be bonescan as part of the diagnostic. Then on the day that I took my mare to the vets, there was of course so much going on, non the least was my mare a) trying to remove bits of my friend's trailer with her teeth and rearing which is completely out of character b) the vet needing to sedate her when she came off the trailer just so he could do an examination c) then hanging around while he did all the necessary flexion tests etc. Oh yes, and this is like 3 days before my friends (who hauled us there) wedding, so she was patient but in the background I know she was anxious to get away and do stuff for the wedding. So I never even THOUGHT to say to the vet that they want it in writing til the next day, AFTER it'd been done.

Thanks for the sympathy - and the info - I will be appealing it. ON the phone earlier today I pushed back with "If I had to haul her home, and then wait for you to give us an authorisation, I'd have to either keep working the horse so that she was suitably lame for scintigraphy and perhaps do irreperable damage, or stop working her and have the scintigraphy be worthless, and a waste of money. grrrr

I don't know if this the way all insurers do it but SEIB seem to want it all in writing first....so just keep that in mind if you do insure with them.
 
Dont mean to sound harsh but they did tell you specifically they wanted it in writing and you didnt do it. A letter could have been faxed from your vets surely?

Whilst I think they are being mean, they do have every right to stick by the terms of the contract between youselves. I work for an insurance company and it does annoy me that people blame them for not paying when it is clear in the wording what is and isnt covered. Why should they pay for something that they are not required to? Its not a charity.

Do by all means request a review though. Hopefully they will be sympathetic and pay for the diagnostics.
 
I have always found seeib very good. They have paid me very quickly for my ongoing claim for my boys hobday and tieback operation however i did obey to the letter everything they requested which included them having to give permission for the op and pre and post op reports from my vet. If you did not do as requested i amnot surprised you are having problems they have procedures that must be adhered toto
 
I hear what you're saying - and I'm not slating the insurance company ....just saying that I frigged up and now I'm paying the bill - though I do find that the rule in this case is being rather harshly adhered to.

In almost every insurance claim I have ever had to do (whether for work, car, or what have you) I rarely have a problem. This time I'm screwed because of a momentary (well, more like 24 hours) mind block while at the vets - lots of stuff going on and just plain old forgot...not deliberate or trying to scam or anything like that - just human nature FORGOT.

In my line of work I get people who sometimes don't show up for appointments. I have a policy in which I charge for no-shows if a future appointment is to be made. However, on the signage that states teh policy, it says "Management Discretion Applies". If someone just said to me "Gee, I'm really sorry, I completely forgot" chances are I'll let it slide, even though I'm not a charity and I have to pay staff etc regardless. It happens and I treat each case as an indvidual, not just cos it's policy.
 
My insurer won't pay and it's not my fault! I did everything they asked me to do and more, but the equine clinic have made an error on the report and stated that the horse was lame for a month before I sought veterinary advice, which is completely incorrect and I am now trying my best to prove that this is the case. I am having to getting my farrier to write a letter and trying to get my vet to do the same, and I am having to write a detailed letter including dates and times!

So I do sympathise. I am around £2500 out of pocket, have a horse that is likely to be PTS soon (and they probably won't pay out on death either), and am simply gutted.
 
LankyDoodle, I'm so sorry to hear this...hopefully the financial bit will get sorted, but meanwhile the rest is just heartbreaking. It just adds insult to injury.
 
I understand where everyone is coming from but surely people realise that a contract is a contract and you have to check what you are signing and then abide by your responsibilities? There was financial legislation some time back that stated insurers mustn't hide important stuff in the (literally) small print. I'd urge everyone to go and read their policies so they know what their rights and responsibilities are. It's very very clear in my policy that any health issues must be notified to them, even if I'm not making a claim. I guess it's as clear in other policies too, but only if you read it in the first place!
 
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