Your take on insurance exclusion wording...

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wench

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Just wondering what peoples opinions are. Horse has some exclusions on insurance, worded:

"resulting from or connected to" x part of the body

What happens if there is something wrong with x part of the body that is not connected to the actual exclusion.

Ie my horse has a cosmetic crack on one hoof, verified by x-ray. Unfortunatly this hoof showed an imbalance on the xray. Now, on the assumption that a vet was happy that the two conditions are not related (as the imbalance would not be connected to the crack), would the hoof be insured?

As I read it yes... but it seems open to interpretation
 
I'd call them to ask but in theory they could use it to get out of most things i'd imagine!

The hoof or the lower leg won't be insured i'd imagine.
 
IMHO the insurance companies would certainly try to use this as wiggle room to get out of paying for almost anything to do with that limb at all (other an obvious external injury) - an inbalance could (in theory) cause all sorts of strains and tension all the way up the limb.

I'd query it with them and get them to come up with much more specific wording that makes it clear what is and what is not covered.

Or have you claimed for the crack and now want to make a further claim for work to correct the inbalance?
 
A good claims assessor would contact the vet to say "we note there is the following exclusion on the policy...please can you clarify whether the current condition x is related to y".
 
I used to work for quite a well known equine insurer, and in my opinion, the less they know the better!

In your case, when was the exclusion applied to the policy and why? (i.e. if the crack first occured less than a year ago, but you have since had an insurance renewal, then the exclusion won't come into force yet anyway). Other than this, if the insurance wriggle, all you can do is get your vet to write a report to state that the two conditions are not connected (if this is the case), and don't give up without a very big fight.
 
wench said:
Horse came with crack in hoof. Weather or not the imbalance was there at the time or not is an unknown.
Click to expand...

Best bet is to get the vet to fight your corner then, but only if you are faced with a problem, claim for it as normal first, like you wouldn't think otherwise. If they reject the claim then go the next step.
 
Thanks for the advise. I have already advised the insurance company she's had some x-rays etc on unbalanced hoof. Vet is going to ring me back about another related matter so I will ask their advice then.
 
It's quite simple really - if you were to have another claim, your vet just has to confirm in writing that it is not connected to whatever the other condition is.
 
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