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  1. #1
    Join Date
    Mar. 11, 2004
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    Pennsylvania
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    Default Equine Medical Insurance

    We have mortality and medical coverage for our horse. About a month ago, he was not happy and the vet thought he might have ulcers. So, I called the insurer and told them he might have ulcers and asked what to do to file a claim. They told me.

    Turns out, Dobbin did not have ulcers, but his blood values were too high so the vet thought he might have something else. I call the insurer to tell them the new diagnosis and they send me the papers to file a claim. Dobbin gets meds, recovers fully (to outward appearances as well as work), and competed in a CDE beautifully.

    Time for medical insurance renewal rolls around and we get a notice that they are excluding him for mortality/medical for colic and gastrointestinal disturbances. I call and they tell me that it's because the ulcer/infection issue has not been resolved. They said they need a clean bill of health from the vet and will reconsider the exclusion. (Note, I have not even filed a claim yet at this point. Just called to inform them and ask questions). Vet and I discuss what needs to be done and we're doing it.

    Med bill will now add up to from $500 to over $1000, depending on what Dobbin's blood test of yesterday says.

    My inclination is to file a claim. MrDZ advises not to because it'll just give the insurer an excuse to continue the exclusion. From how I understood things, they imposed the exclusion because, as far as they were concerned, there was an unresolved medical issue that, I guess, increases colic etc. risk. Once that issue is resolved, that can (but not guaranteed to) change their view on the exclusion.

    So, we're doing what needs to be done for Dobbin to get a clean bill of health from the vet and to request that they drop the exclusion. But then the question is: should we file a claim or not?

    Anyone had similar experience? I'm not going to name the insurer on a public BB but if anyone needs to know to answer my question, I'll respond in a PM.

    Thanks in advance for any input.
    Last edited by dizzywriter; Sep. 25, 2009 at 10:07 PM.



  2. #2
    Join Date
    Oct. 2, 1999
    Location
    Mendocino County, CA: Turkey Vulture HQ
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    Default

    It is my understanding that they will put an exclusion on there whether you make a claim or not - just as you experienced with the ulcer that had no claim.
    If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket



  3. #3
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    Mar. 11, 2004
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    Default

    bumping



  4. #4
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    Aug. 17, 2004
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    Rixeyville, VA
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    Default

    File the claim. I have had carriers remove exclusions without too much issue. It sounds like your horse is recovering and will get a clean bill of health -- the carrier will have a form for the vet to complete. I strongly recommend working with your carrier.

    Personally, I think you are doing everything correctly. You are supposed to notify the carrier in a timely manner of a potential claim. It is irrelevant if it materializes into a claim, the policy requires that the insured provide notification of non-routine veterinary intervention. I dutifully call in my "potential" claims and then follow up with their resolution, even though I may never submit an actual claim to the carrier.

    I am always amazed when people say, "don't file a claim" because it might lead to an exclusion. I am sorry, but what are you buying the insurance for? If you have a loss between $500 - $1K, I certainly think that merits a claim. And since the carrier can write an exclusion based on the potential claim, there is no point in NOT filing for an actual loss. I'd recommend having your vet stick to his area of expertise and leave the insurance advice to the professionals.
    Where Norwegian Fjords Rule
    http://www.ironwood-farm.com



  5. #5
    Join Date
    Apr. 2, 2004
    Location
    Louisville, KY
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    Default

    Not to mention that technically, not filing a claim and trying to "hide" the medical issue from your carrier would be viewed as insurance fraud should your horse later die of that condition. Not something to get involved in.

    I would think this is an easy exclusion to get out of. He didn't colic, after all. And if this particular company refuses to remove the exclusion, there are plenty of other carriers that would be happy to have your business.

    If they left an exclusion for ulcers, fine...but colic? He didn't colic...

    Work with them, and if they are not cooperative, drop them.
    Strong promoter of READING the entire post before responding.



  6. #6
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    Mar. 11, 2004
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    Pennsylvania
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    Default

    Thanks for that. My inclination is to file the claim. After all, the condition is being resolved and is not something permanent that, I guess, could make the insurer stick to the exclusion. I view it more as filing a human insurance claim for getting treated for an infection (i.e. treatable and then it's gone) versus a claim for some chronic condition that requires endless, expensive procedures that never lead to a cure (for which our wonderful insurance companies will try to find an excuse not to cover).

    But Mr. DZ (not the vet) is pretty adamant that the insurer will just use it as an excuse.



  7. #7
    Join Date
    Oct. 2, 1999
    Location
    Mendocino County, CA: Turkey Vulture HQ
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    Default

    Quote Originally Posted by dizzywriter View Post
    Thanks for that. My inclination is to file the claim. After all, the condition is being resolved and is not something permanent that, I guess, could make the insurer stick to the exclusion. I view it more as filing a human insurance claim for getting treated for an infection (i.e. treatable and then it's gone) versus a claim for some chronic condition that requires endless, expensive procedures that never lead to a cure (for which our wonderful insurance companies will try to find an excuse not to cover).

    But Mr. DZ (not the vet) is pretty adamant that the insurer will just use it as an excuse.
    You might want to retitle this "Equine Medical Insurance" to get more views.

    Human medical insurance is regulated quite differently from equine insurance. Basically, your equine insurer can renew your policy (or not) under any terms they like pretty much at their discretion.

    I would make the claim. It's why you bought the insurance - which is a contract to cover medical for one year only - and I'd feel silly if I didn't make the claim and they still added the exclusion.

    I don't know how old your horse is, but sometime in his mid to late teens they will decline to renew at all, based on his age.
    If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket



  8. #8
    Join Date
    Oct. 2, 1999
    Location
    Mendocino County, CA: Turkey Vulture HQ
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    Default

    Fun, irrelevant fact: the official insurance company "Line of Business" for equine insurance is Inland Marine.

    "Marine" apparently was a line created to insure goods in transit. Inland Marine was for travel between ports on land.
    If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket



  9. #9
    Join Date
    Mar. 11, 2004
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    Pennsylvania
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    Default

    Thanks Poltroon, I will retitle.



  10. #10
    Join Date
    Dec. 29, 2005
    Location
    Reddick FL
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    341

    Default

    Myfriends horse coliced before she could get insurance, and altho it was never a surgical issue, they would've excluded colic on the horse (she was told by agent) until a certain amount of time had passed. The horse went to the clinic for treatment/ observation and they scoped for ulcers WHICH CAN CAUSE COLIC so most likely the reason your company wants to exclude colic as well. The agent told my friend if her horse had no more colic issues after 6-12 months they would probably remove the exclusion since there was no surgery. She got the insurance- with the exclusion, has had no more colic issues and now it is renewal time, so we will see if the exclusion can be removed. her agent told her to give them as much info as possible as to how her horse is CURRENTLY & that the horse is okay now- and back to showing and if she can get a vet statement, even better - then they don't have a reason anymore for the exclusion

    Work with your agent too.



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