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What if you don't contact Insurance Company as soon as a horse is unsound???

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  • What if you don't contact Insurance Company as soon as a horse is unsound???

    How strict are Insurance Companies about reporting a lameness. A friend of mine is having a nervous breakdown because she has had her vet out 4 or 5 times for what she thought was a bad abscess and it turns out there may be something serious. She never reported it. If the horse now has a surgical problem, will there be a problem? She has followed the vet's instructions all along.

  • #2
    It depends.

    I had no trouble opening a claim with GAIG back in 2010 when my mare was hurt, even though she'd been unsound for a few weeks. I didn't open it until I was sure I'd be over my $750 deductible; the vet filled them in on what he'd done to date (lameness evaluation, Lyme titer, treatment for Lyme, second lameness evaluation, ultrasound after the Lyme treatment took care of 3 of her 4 legs.) The ultrasound, which happened about 7 weeks after the initial lameness exam, was what pushed it over, and I opened the claim and he called them the day after he did it. I then had 6 months coverage, back-dated to the first lameness exam. They ended up paying out about $6000 for surgery, drugs, further evaluations and ultrasounds. This was not the total balance less deductible, as she needed treatment beyond 6 months, but it was very helpful to have those checks...

    HOWEVER -- please note that most insurance companies are dropping major medical coverage for horses valued under $15K, on the day the current policy expires, so if the policy is coming up for renewal soon she should open a claim now.
    You have to have experiences to gain experience.

    1998 Morgan mare Mythic Feronia "More Valley Girl Than Girl Scout!"

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    • #3
      Originally posted by quietann View Post
      HOWEVER -- please note that most insurance companies are dropping major medical coverage for horses valued under $15K, on the day the current policy expires, so if the policy is coming up for renewal soon she should open a claim now.
      Yes, this is true.

      I have always opened a claim ASAP so I can't speak to your friend but I suggest calling right away. My insurance company is very understanding if nothing develops from a claim. Happens all the time.

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      • #4
        I had a similar issue this summer. Horse had some swelling in her leg, and a minor case of scratches, which we assumed were related, had vet out to drop off SMZs and some panalog, and debride scratches, barely more than the cost of farm call, didn't bother calling Insurance, because no biggie.

        A week later, the SMZs hadn't done anything, and there was a weird LUMP in the middle of the leg. Ended up having to xray, ultrasound, drain, culture, etc. I didn't call the Insurance (Great American) until the LUMP showed up, and explained that it initially didn't look like a big deal and how things had progressed, and didn't have any problems getting compensated. I've actually always had really good experiences with getting compensated from them, it's a shame that the coverage policy is changing, though from a financial standpoint, I understand where they're coming from.

        But I'd call ASAP now that you realize it is a problem.
        A Year In the Saddle

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        • #5
          A "good faith misunderstanding" of a reporting requirement won't generally have any effect on coverage unless the failure materially alters the company's risk. That's a question of fact in each case.

          But if there has been a delay caused by misunderstanding then notice should be given ASAP. Nothing comes from failure to give notice and bad things can happen if the delay becomes unreasonable.

          Tell you friend to pick up the phone and comply with the policy terms and conditions.

          G.
          Mangalarga Marchador: Uma Raça, Uma Paixão

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          • #6
            A friend of mine had a similar issue - initially the injury didn't look serious, but after several weeks of treatment with no improvement, friend took the horse to the clinic for a 2nd opinion. Horse ended up needing surgery but the insurance company paid.

            I called my insurance company when my mare had WNV, a tendon tear, and a very mild case of colic, but never had to file a claim as all she needed was TLC for full recovery. For minor stuff, if the vet came out to treat, I do let them know at renewal time - ie, an abcess, an injury that needed stitches (but not in a critical area), etc.

            Your friend should make sure she has copies of all the vet reports to date for this injury ready to send to the insurance company as they may want that when she tells them waht is going on

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            • #7
              With the company I use for my horses, invoices from treatment more than 90 days prior are not covered and all claims need to be reported prior to the policy expiration date. Definitely tell her to call and get it on record. If it really turns into nothing, it won't hurt anything and if the horse really does require more treatment, it's best to get the claim set up ASAP.
              It's not about the color of the ribbon but the quality of the ride. Having said that, I'd like the blue one please!

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