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Created June 2012. Includes live question results.

Top reasons for horse insurance claims to be rejected

The most common reasons for insurers to refuse claims and how you can avoid your claim being refused.

The 5 most common reasons given by insurers for refusing a claim according to the Financial Ombudsman Service (FOS) are listed below.

1) Pre-existing conditions

Your horse suffered from, or had clinical signs of, a condition prior to or on the date that the horse insurance cover began.

When you sign up for your policy you will be asked to disclose any of your horse's previous or current illnesses or injuries. For example, if you had seen signs of lameness the week prior to taking an insurance policy out you must disclose this to the insurer. If you fail to do so, you will not be covered for vet fees and your insurance claims will be refused.

Here is an example case where a claim was refused but the policy holder complained through the FOS and won.
Example Complaint - for 'Pre-Existing Condition' *

2) Initial 'no cover' period

Your horse showed signs of a condition shortly after you took out the policy, and the policy did not cover conditions arising so soon. Many insurers don't cover for conditions starting in the first 14 days of the policy, which is the cooling off period when you can cancel your policy.

3) Time limit on cover

Insurers usually cover a condition for 12 months from either:
the date the injury happened / illness was first noticedthe first date of treatmentthe date a claim is made

The Financial Ombudsman considers whether long-term treatment was reasonably foreseeable. 'If the vet advises the policyholder that treatment is likely to be ongoing for several months, they may say that the insurer should pay the claim for the full 12 months, even if the policy was not renewed.'
For example, your policy starts in January and your horse is diagnosed with unknown lameness in December. Your vet advises that it will take at least 3 months to diagnose and treat. Your Insurer should cover the vet fees through January, February and March even if your policy is not renewed. However, insurers are within their right to refuse a claim when the policy has expired if:
the policy documentation made it clear that cover stopped at the end of the annual policythe condition is one which the vet does not expect to recur.

4) Bi-Lateral Conditions
The horse has a condition which begins on one side of its body but then spreads to the other side. You may claim for treatment to one side but then the condition spreads to the other side more than 12 months later when the condition is no longer covered.

5) Reasonable Care
To refuse a claim based on 'reasonable care' the insurer has to prove that the horse owner was aware of something that could damage the horse''s health or cause injury and did not take steps to avoid it. This can be based on various conditions such as horse trailer maintenance, regular dental checks and treatment etc.

Example Complaint - for 'Reasonable Care' **

Other exclusions and limitations

The exclusions and limitations are a set of rules around a policy which, if they are not followed, can render your policy invalid and you will be unable to claim on your insurance. These will vary from insurer to insurer and can be found listed in your policy terms and conditions. Here are some common restrictions and exclusions for horse insurance:
Your horse must have an annual dental examination and any recommended treatmentYour horse must be kept up to date on vaccinations against tetanus and fluYour horse must be kept up to date with wormingYou must have proof of a 2 or 5 stage vet examination when you purchased your horse. This requirement will depend on the value you insure your horse for and whether you insure for loss of use.

Do insurers check up on claims?

Yes, loss adjusters can be assigned to investigate a policy holder's claim. They will check that the claim is genuine and that all of the facts given are accurate and there is no missing information. The insurers then receives the loss adjuster's report which can affect whether the claim is paid out or declined.

Top tips to avoid claim refusals

1) When you sign up with an insurer make sure you tell them everything, including existing and previous illnesses and injuries that your horse has had.

2) Tell your insurer as soon as possible when anything happens to your horse which could lead to a claim, for example, your horse has a fall or is involved in an accident.

3) Check on your policy certificate for the activities you are insured for and tell your insurer as soon as you plan to start any additional activities outside of these limitations. For example, if you are insured for hacking up to 25 miles and then start pleasure or endurance rides over this distance.

4) Be aware of the initial period where your horse isn't covered by your new insurance policy. This varies from insurer to insurer (usually around 14 days) but they should make it clear to you when you commit to buying the policy.

5) Make a claim as soon as possible. Most insurers only accept claims within 12 months of first clinical signs or injury.

6) If you are buying a horse, have a 5 stage vet examination so that you can prove the value of the horse.

Sources

*Financial Ombudsman News – 85/01 'equine insurance – insurer refuses to pay claim because policy holder did not disclose earlier illness suffered by her horse'.

**Financial Ombudsman News – 65/02 'pet insurer refuses claim on grounds that policyholder - failed to take reasonable care'.

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The FOS says...

'Most policies contain similar exclusions and limitations. But if we find that any are significant and unusual, we will look at whether the policyholder was made aware of them – and their scope – when the policy was taken out. We also look at whether an insurer’s interpretation of key words in the policy conditions was reasonable'.

Reasons horse insurance claims are rejected

Vote for reasons given to you by your insurer,
or post a new comment if your claim was rejected for something else.

Pre-existing conditions

Your horse suffered from, or had clinical signs of, a condition prior to the horse insurance cover starting.

StephanieChard from Bridgend

09/07/12 08:55

Pre-existing condition, even though it was 2 days after I had brought the horse, not having known its past!!

Bi-lateral conditions, i.e. previously occurred on other side of horse

You claim for a treatment on one side of the horse, but then the condition spreads to the other side more than 12 months later when the condition is no longer covered.

bev from bolton

03/07/12 23:16

horse was only a yearling pet plan wouldnt insure for loss of use at the time

and wouldnt pay out on humane grounds despite only being able to walk on the toe on the affected leg after a serious fetlock injury

LisaAyres from Glos

24/06/12 19:39

Insurance for veteran horse didn't cover tendon injury sustained in field

This injury wasn't covered as not external visible injury, however was told by ins co would have to submit claim even though wouldn't cover it, they even wanted to know if injury had healed about 3 months later.

Claim was outside the time limit for an existing condition

A specific condition incurred further costs after the time limit (e.g. 12 months) expired.

bingo from spalding

06/07/12 10:10

canker

he was treated for thrush but it turned to canker he had a very long opp removed all tisue down to peadle bone, insurance said it was pre existing so wouldnt pay. i have owned him since he was born so i would of nown if it was.

Rosie from Shudy Camps

24/06/12 19:15

Refused as horse on working livery counted as business

CathrynStabb from Ivybridge

20/06/12 21:53

Insurance didn`t cover internal injuries.

Problem occurred in the initial 'no cover' period

Your horse showed signs of a condition shortly after you took out the policy, and the policy did not cover conditions arising so soon.

judith pashley from leicester

13/07/12 18:09

tendon injury nota visible injury

E&L said as i had 19 year old horse they could only pay out ona visible injury so i argued isnta swollen leg visible they said npo

lette from birmingham

12/07/12 20:29

not included

Marie from St.Helens

10/07/12 16:39

Insurer said condition was pre existing

My horse rubbed her skin raw in May one year, never had any previous problems, was treated with antibiotics, anti inflammatories. No diagnosis was made, just treated symptomatically. The following year in April it started again, treated with antihistamines, went for allergy tests in the June. Insurer argues that condition was present the year before and as not within the same 12 months wouldnt cover it. Ended up with around a £700 bill.

ElaineStevenson from Stoke on Trent

09/07/12 21:46

Elaine

Insurer decided that the horse could have gone to liverpool just as he was being pts

The horse did not have periodic treatments (dental, vaccinations, worming)

Reasonable care

The insurer proves that the horse owner was aware of something that could damage the horse''s health or cause injury and did not take steps to avoid it.

This website does not provide financial advice or recommend a particular supplier. Although we strive to keep the information up to date, we can not guarantee that all information is accurate. Always confirm accurracy by looking on the suppliers website.

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