Making a claim
When you’re worried about your horse, sorting out an insurance claim can feel like one job too many. But it’s simpler than you think
A straightforward process.
ALTHOUGH WE ALL hope we’ll never have to, where horses are involved it’s likely you’ll need to make an insurance claim at some point. When this happens, the first thing to remind yourself is not to worry — your insurance company and veterinary surgeon are on hand to give you support and advice. Here are some of the things to consider.
The claims process
“As soon as you know you’ll need to claim on your insurance, it’s important that you contact your insurer straight away. You can do this by phone or email,” explains KBIS. “You and your vet will then need to fill in a claim form providing all the necessary information and documents so that your claim can be assessed correctly.”
This claim form can either be sent to you or downloaded from your insurance provider’s website. Submit the form as soon as you can in order to get peace of mind that your horse is covered for this particular claim. Usually, you get the nod quite quickly.
Many providers, including Petplan Equine and KBIS, will deal directly with your vet, but check with your vet first. In most instances, once the insurer has agreed to the claim, your vet can invoice them directly for settling, and you’ll be sent a copy for your records. However, it is your responsibility as the policyholder to make sure your insurer has all the information required.
The excess fee explained
“When you bought your insurance, you’ll have agreed what your excess amount will be. This is the contribution you need to pay towards the cost of diagnosis/ treatment when making a claim for veterinary fees,” says Petplan Equine.
Of course, if the vet’s bill comes to less than this amount, you won’t be claiming at all — you’ll just pay the bill yourself. If it’s more than the excess, then you’ll get an invoice from your insurer for the amount due. This tends to arrive early in the claim procedure.
If you are not making a claim, just paying the bill yourself, you still need to let your insurance provider know that your horse has needed veterinary treatment.
If the situation is an emergency, call your vet, get it dealt with and then inform your insurance company as soon as you can. Never stall urgent veterinary treatment.
How much?
The level of cover for vets’ fees varies hugely between insurance companies, so be aware of what cover your policy offers. Generally, it ranges from £2,500 to £6,000 (KBIS offers an extension of up to £7,500 for colic surgery) and may be per incident or for the full term of the policy. The latter is cheaper, but could leave you vulnerable if you make a big claim. For more on vet fees cover, see page 8.
Exclusions
Exclusions — the things that aren’t covered — is one of the most misunderstood and confusing parts of insurance for owners.
“An exclusion means, in practice, that if your horse has a previous injury or illness, you may not be covered for it now,” explains Petplan Equine. “At Petplan Equine, exclusions can be reviewed and are often removed following a period of the horse not showing symptoms for a length of time.”
This is why your provider will require a full history when you take out insurance. It also means that when you make a claim for something in the future, you may not be able to claim for that again. It could be a particular illness, or an area such as the left hindleg.
It’s worth noting that the part of the body/incident will still be covered for a period of time from the onset date of the incident until your policy is due for renewal — check the terms with your insurer.
“What is excluded from your policy is a company decision and not one that a vet can influence at the time,” says veterinary surgeon Colin Mitchell MRCVS from Scott Mitchell Associates. “Sometimes I’m asked to write a letter for the owner when the renewal is due, stating that their horse hasn’t suffered with the same issue in the previous 12 months. It’s then up to the insurer to decide if the exclusion can be lifted. I find they’re generally very reasonable and pay close attention to my assessment. They want to lift exclusions as much as the owner does but, of course, this can’t be done if the risk could be too costly for them.”
Lameness diagnosis explained
Lameness is one of the most common conditions claimed for and, at times, it can seem as if the number of tests done and the process followed to diagnose are all a bit excessive. Like many owners, you may have wondered why an MRI scan isn’t done at the start to get the whole thing sorted quickly, with fewer costs involved. However, it’s not quite as simple as this, as Colin explains.
“There are two stages to lameness investigation,” he says. “The first is to localise the lameness — which leg or legs, and which part is affected. The second is imaging, used to give a better indication of the problem.” It’s important that both stages are worked through to make sure nothing is missed and the best treatment is sought.
“The first stage,” continues Colin, “is all about the clinical examination — a thorough assessment, plus palpation of the legs and feet for anything obvious. This is often enough to highlight which leg is affected. Once we know this, we need to find out which part of the leg is involved, and if we can’t tell during assessment, nerve blocks will be carried out, working from the bottom of the leg upwards. If your horse is too lame for nerve blocks, or the lameness is intermittent, a bone scan may be undertaken. The insurer will need to agree to fund this.” Stage two (imaging) can only be done once it’s known where the problem lies, hence the need to go through stage one first.
“It may be a straightforward case, where it’s clear quite quickly what the issue is and treatment can be started immediately. If not, we move into stage two,” says Colin. This is where most of the investment is as the diagnostic scans used are costly. If the horse is insured, it’s not usually a problem. If not, the owner has decisions to make about how far to take the assessment. Many owners opt for the ‘wait and see’ approach.
“It’s important to remember that an MRI scan, ultrasound or X-ray can show changes in pathology, but there is no way of actually imaging pain,” cautions Petplan Equine. “That’s why the initial stages of diagnosis are so important, as it means use of expensive imaging can be limited to a more discrete area, thus minimising expense to the owner and inconvenience to the horse.”
Death of your horse
The decision to destroy a horse on humane grounds is ultimately the owner’s decision, but should be taken in consultation with a vet. The horse’s welfare is the primary concern.
“In the case of a mortality claim, check what documents your insurance provider requires,” says KBIS.
“For instance, we may need to see a post-mortem report and a supporting veterinary report.” For more on mortality cover, see page 10.