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  1. #1
    alterforins Guest

    Default insurance deny lameness exam anyone?

    Ok, yes this is an alter.

    Has anyone ever had an insurance company deny their claim because the horse wasn't "lame enough"?

    I just had this happen...spent 675 on diagnostic work, called insurance company ahead of time to explain the problem.

    They reviewed my insurance and denied the claim because the horse wasn't lame on flexions. Yes, I told them that when I made the appointment. But I felt as a pro-active owner and rider, that something was wrong with the horse because:

    used to be able to jump (free jumped at 3 was great)
    used to be able to jump with rider (shown as a 4 year old over 2' fences)
    now, late in 4 year old year, can't clear 2'. Goes straight up in the air, while groaning, and lands ON THE JUMP. Can be solid or stadium type. Lands in cross canter. Loudly groans while shooting straight into the air. Doesn't pick up hind legs at all, they land on the jump.

    My thought was stifle or SI and vet found mild inflamation on ultrasound of the stifle ligament, both sides. Recommended 60 days small paddock rest, no forced exercise.

    So, was I supposed to jump the horse into the ground and make the horse lame to have it evaluated? Possibly compromising a career as a sport horse or long term soundness?

    Thoughts? I would think they would want to help find the problem before it becomes an expensive treatment issue and I am VERY disappointed. Insurance company has 5 insured horses of mine and is a huge sponsor for a lot of big shows.



  2. #2
    Join Date
    Feb. 3, 2000
    Location
    Nokesville, VA
    Posts
    35,069

    Default

    Just to clarify,

    It is the insurance UNDERWRITER (e.g., Great American) that makes the decision on whether or not to pay the claim.

    The insurance AGENT (e.g., EMO, THIS) doesn't make that decsion.

    Is it the underwriter or the agent that sponsors "a lot of big shows"?
    Janet

    chief feeder and mucker for Music, Spy, Belle and Tiara. Someone else is now feeding and mucking for Chief and Brain (both foxhunting now).



  3. #3
    alterforins Guest

    Default

    It is the AGENT. However, this time the underwriter is different from who it used to be, and I have insured horses for 5 years with no claims to date.

    The veterinarian is surprised as well.
    Last edited by alterforins; Jan. 28, 2011 at 11:52 AM. Reason: spelling



  4. #4
    Join Date
    Jun. 10, 2001
    Location
    nj
    Posts
    8,783

    Default appeal it.

    in writing.
    there is always an appeal process.
    explain the background that led you to have the horse examined.

    was the basis of their denial really just the fact that he wasn't lame on flexions? anything else they cited?
    http://www.eponashoe.com/
    TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique



  5. #5
    Join Date
    Sep. 13, 2002
    Location
    Pacific Northwest
    Posts
    4,944

    Default

    I have not encountered this and I've had my share of horses that would flex okay but were still having problems (geez, think of all the bone scans that insurance pays out on -- often those are required because the horse isn't lame enough to block or pinpoint an area). Did the vet fill out a report for the insurance? I'd be sure to get a copy and see if it is correct. And definitely inquire about an appeal.

    I'd be curious which insurance company (underwriter not agent) this is -- I'm shopping around as my renewal comes up in a couple of months so it would be helpful.



  6. #6
    alterforins Guest

    Default

    I am appealing (in writing). The underwriter is Lloyds of London.

    Because we did not take the next step (thermagraphy or such) is why they are not covering it. At least that is what their letter says.



  7. #7
    Join Date
    May. 24, 2005
    Location
    close to the Big Apple
    Posts
    3,110

    Default

    Then take the next step if they will pay for it. Maybe they want a diagnosis before they pay out on an unknown.. I have not had that issue, I had an insurance company drop the major medical becuase of too many calims, dollar wise compared to value. Okay after a year they reinstated it only to take it away a year later and there were no additional claims. Go figure that one out. I change companies...
    Good luck/ I would also appeal it..
    Mai Tai aka Tyler RIP March 1994-December 2011
    Grief is the price we pay for love- Gretchen Jackson
    "And here she comes. Is it a bird? Is it a plane? No, it's ZENYATTA!"



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