Dealing with Horse Insurance

[Equestrianette]

My horse was recently diagnosed with bilateral proximal suspensory Desmitis of the hind limbs as a 5 year old. I’ve had him insured this entire time. He is not a candidate for the surgery to fix it as his is secondary to conformation.

We only received the diagnosis last month and I’ve been doing the prescribed therapies while also having to reconcile with the huge potential spectrum of him returning to full work and continuing my plans to move forward in eventing or him not recovering at all.

I have him insured for mid 5 figures because at this point in order to replace him that’s how much it would cost, and he’s essentially worthless now. But he wasn’t! He was supposed to be great. Just the thought of having to start over from 2 horses ago is incredibly disheartening. I have to consider my goals with his welfare and I’ll just say it outright, I don’t trust anyone. I don’t feel like I can sell him because if he doesn’t recover from this then his value is $0 and he won’t make a trail horse. Once he leaves me I no longer have any control over what happens to him when I send him to someone that by then would have convinced me he’d be safe only to find out a year later he wasn’t. I am worried about someone just seeing dollar signs at his expense. I’ve yet to send a horse somewhere to someone that didn’t turn out to be a total counterfeit lying POS.

That being said… “loss of use” has anyone went this way with horse insurance? What exactly is it and how does it work?
Then there is euthanasia, he’s only 5 years old. He has a long life ahead of him to already be crippled.

I’m reviewing my insurance policy but of course it’s clear as mud. They’re already upset with me because when I submitted this claim for the PSD in the veterinary report it said “lame for 2 years” with previous exams I never submitted. Because that “lame for 2 years” was always dismissed as strength, behavior, training, attitude, etc. The lameness vet I took him to in February yielded me zero results and they said he wasn’t lame. So to me, I’m being gaslighted for 2 years by everybody because they say he’s not lame and there’s nothing wrong with him, and now his insurance is looking at me sideways.

If I do move forward with this either loss of use or euthanasia, do they pay me for what I have him insured for? Or would it be at a reduced value because he wouldn’t be worth that much with his condition?

This is only something I’m considering if in this next year of rehabbing him he doesn’t become sound.
I can’t sustain pasture ornaments and I don’t trust people to send him to while also taking a huge loss and setting me back 6 years. It feels selfish no matter which way I look at it. This is life and he has value, I don’t see him as disposable. It’s a hard choice. It’s not like I’m of the means to just start over from scratch. I had him insured because if something happened to him he would need to be replaced and I wouldn’t suffer such a loss. I feel like I’ve been throwing good money after bad all in the hopes that maybe in a year we will be right back to where we were 2 years ago.

[dmveventer]

@Equestrianette

If I do move forward with this either loss of use or euthanasia, do they pay me for what I have him insured for? Or would it be at a reduced value because he wouldn’t be worth that much with his condition?

Do you actually have loss of use coverage with your insurance policy? It’s not standard, you would have had to add it on to your medical and mortality policy, and if you have it there will be language in your policy detailing the terms and conditions. Coverage can vary so your options really depend on what you’re paying for specifically.

When I looked into it I decided not to add loss of use coverage, from what I read it doesn’t seem to benefit the average horse owner very much. Some companies will take the horse or require it to be euthanized, some will refuse to pay out if they can argue the horse still has any potential uses even if it wasn’t what you bought it for, etc. If you’re looking at potential euthanasia anyway you may have options under loss of use or under your mortality policy, that would be worth a call to your agent if you get to that point, but if you’re looking at a lengthy rehab period you should be aware of when your current policy expires since this diagnosis will affect your ability to renew.

I’m sorry you’re going through this, but your horse is lucky to have someone like you in his corner.

[Bonnie2]

Big can of worms here. First, so sorry you and your horse are going through this. Second, the insurance is going to be more headache and heartache. If “lame for 2 years” is on the vet report and you did not tell the insurance company he had been seen by a vet for lameness when you renewed, there is a low likelihood the insurance will pay. They will argue it is a pre-existing condition that you did not disclose. If you are going to make a claim you need to do it before your current policy expires. You can’t wait until after a year of rehab. If you currently have loss of use coverage (which is separate from mortality and medical) and the insurance company agrees to pay it, you will receive the amount defined in the policy and the insurance company owns the horse. Sometimes you can accept a decreased amount and keep the horse. If the insurance company agrees to euthanasia, you will receive the amount stated on the policy. Hugs!

[Pico_Banana]

You are in a difficult spot here with your insurance. Have you spoken with your broker? Some are useless and some are great. If you have a good one they may be able to help you out. They should at least be able to help you understand the extent of your coverage.

On loss of use, that is typically a separate endorsement on your policy that you have to pay extra for. As an endorsement, it would be one of the extra pages at the end of the package.

As for the lameness, you have an uphill battle. You are going to need to argue your case to get anywhere with the history of lameness, even if it was written off as something like strength, behavior, etc. From the ins co perspective, they will argue that they would have excluded it under your policy.

And then on euthanasia, again, typically they will only pay out on mortality if they agree that euthanasia is the right choice.

Equine insurance is just awful to deal with, in my opinion. We’ve gotten so used to how health insurance works for us (especially since Obamacare) that we expect similar treatment for our animals. Some small animal pet insurance is very good, others not so much. I feel like equine insurance is stuck in the dark ages still.

[Libby2563]

Yes to contacting your agent with questions! Mine helped me work through a protracted diagnosis process earlier this year and I did in the end get reimbursed. She is awesome. Don’t send questions in writing because they are constrained in how they can answer, but if you can talk on the phone you might get some good insight.

@Equestrianette

The lameness vet I took him to in February yielded me zero results and they said he wasn’t lame.

Do you have or could you get a written report from that vet saying they did not find lameness in Feb? What about an amendment from the vet who wrote “lame for 2 years” to something like “performance issues for 2 years with no lameness discovered in prior exams and behavioral issue assumed”? If you can’t get that walked back, I think you are unfortunately out of luck on the current medical claim and any future euthanasia arising from it.

Honestly, I hate to say it but I think you should probably plan as though you will never see a cent of the $25k mortality settlement. Fight for it, but don’t count on it.

As others said, loss of use is a separate endorsement that you would have had to purchase with the policy. I’m guessing you don’t have it since it’s pretty uncommon and (from my understanding) rarely beneficial.

I’m sorry you’re in this position. BTDT, started over, and it sucks for a lot of reasons.

[beowulf]

I know I commented on your other thread, but just reiterating how sorry I feel for you to be in this situation - and your horse. You are in a very tough position.

Others gave great advice and I initially wasn’t going to comment just to echo them, but in your shoes I would file the claim now. Do not wait - the insurance company is not going to give you the benefit of the doubt. Your policy likely expires before then, and once and if it renews they will do everything they can not to pay it.

For the loss of use settlement, this really depends on your insurance company and the language. Like Bonnie pointed out, you may not be entitled to the money if you keep the horse or don’t euthanize. Some insurance companies possess the horse in exchange for LOU payout.

Follow up with the vet that wrote “lame for 2 years” and have them do everything in their power to correct that statement, if it is not true. The insurance company will see that and think that’s their out as a pre-existing condition they weren’t made aware of.

Something completely unrelated to your question at hand: what has the vet said for prognosis for this disease? What is your management like currently? This is not to make light of your situation – just wondering if there are small things you can do now and during rehab to give you the best chance of getting your partner back. Once he is cleared for it, the best thing I’ve seen for horses with his condition is 24/7 turnout. Any amount of stalling seems to make their symptoms worse. PSD is not always a career ending prognosis, even in a younger horse - the variables depend on the extent of injury, the management, turnout, and farrier work. Don’t overlook these components in your journey - especially not the feet or the turnout.

If nothing else, you may consider after rehab if he is servicably sound finding him a low stress job locally. This is how many lovely ponies end up in Pony Club, with typically top notch young riders and five star homes. Many of them are leased out for a year or two as kids get their ratings, and it can be win/win for someone who wants to retain control of their horse that needs a less strenuous job, but needs them off their payroll.

[Feathered_Feet]

I agree with the others’ replies on insurance, and don’t have much more to add there. - except that, if you DO have loss of use, some companies will compromise on a percentage payout if you want to keep the horse (eg. if they take the horse, you get the full payout, if you want to keep the horse, they pay out 50%, or whatever). Something to look into if you have LOU and go that route (and want to keep the horse).

I know this isn’t what you asked, but having just gone through this with my performance horse, I want to throw out a few things to consider if you feel you’re at a dead end:

I think there is a lot of misconception about the neurectomy and fasciotomy surgery. Because PSD is essentially a repetitive strain injury (RSI) with sometimes tremendous inflammation, you essentially end up with compartment syndrome (where the inflamed structures compress the nerves, which can be very painful). The neurectomy therefore cuts the nerve, immediately relieving the sensation of pain, while the fasciotomy mechanically relieves the compression by giving the inflamed structures physically more space. Just because your horse’s PSD is due to conformation does not logically follow why he wouldn’t benefit from the N&F surgery. Mechanically, if his suspensories are inflamed, he will feel better after the surgery. If I had to guess, I would say that the vet(s) are recommending against surgery because, unless you change the cause (his straight hocks), it’s likely to come back. Which makes sense (and I agree with).

However, PSD is often due to a couple of synergistic factors that result in a lack of ergonomic mechanics. It sounds like, for your horse, he has straight hocks that the vet(s) think are the cause of the strain, and this is likely at least partially true. In my horse, the cause was definitely due to poor farriery. If I were you, I would get a consult from a very, very reputable farrier - maybe the podiatry dept at Rood & Riddle (when I did it it was ~ $300), but probably better from someone like Yogi Sharp or Daisy Bicking (these are both farriers with EXCELLENT understanding of biomechanics). They will want to see external photos and radiographs, but make sure you take good ones (bad ones can be misleading). Bad farriery can cause secondary strains such as PSD, stifle pain, SI pain, back pain, etc., all while the horse is technically sound.

Contemporary veterinary knowledge on equine podiatry is not extensive, and I would NOT trust your own vet(s) to give you a knowledgeable answer as to how much the feet are a contributing source. While vets can pretty reliably recognize and generally address major hoof pathologies like founder and navicular syndrome, they will not recognize a lot of gross distortions that aren’t outright obvious pathologies - many vets unfortunately see a lot of truly awful feet as somewhere on the spectrum of normal. And this is not a slam against vets - they have A LOT of stuff to know and keep on top of and it is a very, very challenging profession that I deeply respect. Unfortunately the old “no hoof, no horse” adage is true whether you recognize hoof distortions and poor farriery or not. So, while you say that the issue is his conformation, I invite you to think again about whether the feet are a potential contributing factor, where perhaps improvements can be made.

I absolutely sympathize with you as I’m in a similar boat. My horse came “sound” after the surgery and a slow rehab, but the feet are still not fixed and I know the strain will return if I continue her training without fixing the feet. I can’t afford a second horse until this one is off my payroll, insurance won’t payout mortality since she can technically mosey around a retirement pasture (I don’t have loss of use), and I really like the damn creature, anyway. It’s been really, really challenging finding a competent farrier, to the point where I’ve started to educate myself more by attending hoof care clinics and workshops as I literally don’t know who to trust at this point. I encourage you to get a hoof consult and I hope have access to better farriers in your area than I do. I guess I’m sharing all this just to say - if you can’t get the insurance stuff sorted, and you are at a dead end, and are willing to embrace this as your journey now, I would look to the hooves and whole horse to see where the PSD is really coming from, as it’s probably more than just the straight hocks.

I share all this just as an alternative path to consider. You’ll get no judgement from me if you decide to just “move on,” however that ends up looking in your world.

[Laurierace]

I too want to add my sympathy. I would be surprised if you have loss of use insurance because those policies are very expensive and to collect on them you have to do some things you likely don’t want to do so people just don’t buy/sell them much anymore. You can be forced to give ownership of the horse to the insurance company to do what they want with or accept a much smaller payout in order to keep the horse.
Mortality is likely going to be a can of worms as well since he has had this mystery lameness for two years without needing to be humanely euthanized, they will argue that nothing has changed in regards to that just because you now know why.
I echo those who say reach out to your agent. My guess is your best bet is going to be maximize getting as much of your out of pocket expenses to date paid for once they tie those things together as being one diagnosis. Maybe your agent will have insight into how to document everything to make the best use of your coverage.

[Absolut_Equestrian]

@Equestrianette

If I do move forward with this either loss of use or euthanasia, do they pay me for what I have him insured for?

First of all, hugs to you. This is a tough situation all around.

Your agent will be the best resource for details here, but sharing my experience with a euthanasia claim in case it’s helpful. Without going into details about what our specific issue was, it was not something that immediately required euthanasia nor was euthanasia something that the vet could definitively advise after extensive diagnostics.

The insurance company made it clear that it was my decision to euthanize the horse, and that I would be required to notify them of this decision and have the option to file a claim after the fact. This claim required a full necropsy report, followed by an independent veterinary review. In my case, the veterinary review determined that euthanasia was in the best interest of the horse after all.

While in the end it was a relief that the insurance company paid the mortality claim, the hard part was the gut-wrenching euthanasia decision that I had to make in the first place. I knew I’d have to live with the choice regardless of what the insurance company decided. I also had to be mentally prepared for them to deny the claim, and it took several months to get the final answer. In the end I knew the horse, felt that euthanasia was the right thing, and was at peace with that regardless of what the insurance company decided.

[Arlomine]

Years ago, my insurance agent flat told me that if I loved my horse, I would not get loss of use insurance. Who wants their horse to be ultimately owned by a corporation? Not me!

I have only made one claim on my insurance, and it was a big one. I bought a foal in utero, insured the pregnancy, and the mare was sent to a professional foal raising station to give birth. Within 24 hours of birth the foal was transported to the hospital and Treated for symptoms of C-Diff. 10 days later, all of them being in the ICU, after multiple rallies and regressions, I made the decision to euthanize him. The blood work came back positive for C-diff after I make the decision to euthanize him. It was an excruciating experience.

I spent over 10k trying to save him.

My insurance company paid the mortality immediately, with no question: it more than covered what I spent on trying to save him… and the breeder essentially gave me another baby from that year for what I had left from the insurance policy.

So, unless you specifically requested loss of use, you don’t have it. If you can get your Vet, to modify the paperwork, if I remember correctly, they’ve already sent it in, it’s worth a try.
Plus you have a lameness vet document saying that he WAS NOT lame. That counts.

[clanter]

well at one time back in the 90s/00s my corporation own all of our horses, they were used in advertising of the corporation

as for equine insurance we have had one claim, that was when Socrates broke his left front cannon bone, insurance carrier was easy to deal with

[Laurierace]

That corporation was not an insurance company however so obviously not comparable. Insurance companies either sell the horses or euthanize once they assume ownership after a loss of use payout.

[NaturallyHappy]

When my late DH DVM was living, we used to rehab loss of use horses and sell them for insurance companies. Under no circumstances could they be resold to the owner.