Long story short, my horse injured his suspensory last fall and his progress was going great until he fell over the weekend and damaged the suspensory at a different spot. Ironically, his policy was set to expire that night. So my question to the group is if this is a new injury to an area that they previously treated, would it be covered? I have reached out to my company (Markel) to see how they will handle it, if at all. I already claimed the full amount on the major medical on his first injury so I’m hoping this could be considered a new injury. I’m thinking not but thought it was worth an ask! Gotta love horses!
no actual experience with your situation, but dont be surprised if they dont cover because it is the same leg…
2 Likes
I have no insurance insider information but typically (from my understanding) an injury to a certain part excludes that certain part moving forward.
So I would think that this new injury to the same suspensory would be excluded.
2 Likes
This is my understanding as well. I want to say that it was detailed out in how my ASPCA insurance works but I have had that a while now and haven’t looked at the terms recently.
Part of the answer depends on what you mean by “I already claimed the full amount on the major medical.” If you mean that you had, say, $7,500 in medical coverage and all of that was reimbursed in your claim, then you have no more med coverage to use for anything for the rest of the policy period. However, if your policy has sub-limits for certain types of treatment and you maxed out those but not the overall med coverage limit, then you might have some coverage for this. Or you might not. It could depend on whether the insurer accepts this as a new injury rather than reinjury. Your vet’s opinion about this will be the most-heard voice by the insurer. If you have crossed into a new policy period and an exclusion now applies due to the first injury, it’s unlikely coverage would apply for the second injury.
4 Likes
Very probably that leg(s) will be excluded from your renewal. Unless you had a documented vet opinion that it was 100% healed.
So unfortunately it may not matter to which policy term it is assigned.
That is correct. I maxed out on the sublimits but not the overall coverage limit. The injury happened on the last day of the old policy but the new policy does exclude the leg. Super complicated to say the least! I guess it will all come down to the vet that day who treated him and whether or not the insurance will view it as a new injury on the old policy. Worth a try, at least! Thanks for the responses!
2 Likes
When I was in the market for major medical, I was told that any injury pertaining to a prior injury or medical condition wouldn’t be covered. My mare fractured her right radius near the knee at 18 months… so they said anything really pertaining to that entire leg would be difficult to get covered because I would have to definitively prove that her prior injury isn’t relevant.
1 Like
Do you have a copy of the policy wording you can post? It should outline whether or not that would be excluded. No need to post the personal details.
No harm in making a claim- since the new policy with the exclusion has not come into effect- Also I would have your vet word the exam carefully, indicating that this is a new injury
1 Like
