When to submit insurance claim, when to wait

[scrbear11]

Even though I’ve been in horses for years, I’ve never had an insured horse. I just paid all expenses out of pocket and hoped for the best.

I insured the little mare a year after her flexor tendon injury. She’s accident prone, my first true forever performance horse, and valuable (to me, at least).

So here’s my question, when do you submit an insurance claim and when do you just fork over the cash to the vet in order to not get an exclusion slapped on the policy upon renewal? For example, say she comes up lame behind. Vet does lameness exam and x-rays of multiple areas to attempt to pinpoint or find an injury or area that could benefit from a joint injection. Vet finds nothing conclusive and determines simple time off is best. Bill exceeds deductible. Do you file a claim on that and hope no exclusion is slapped on the renewal? Or do you just pay for it out of pocket?

I guess my question is this: I’m not sure when to use the insurance and when to just pay the bill.

[raisethebar]

I would talk to your vet about this and see what they say.

I had back xrays done on my guy to rule out kissing spines. He doesn’t have KS and they still tried to exclude his back! So many things could happen with our horse’s backs that isn’t related to KS so I tried to fight the exclusion and ended up going to a different insurance company and sent them all the information and loss runs and it was not excluded.

I’ve been told normal “routine” care to not submit - hock injections, etc.

[findeight]

Don’t think they pay out on " normal care" injections anyway. If a lot of other things anymore. Only if the treatment is in response to specific symptoms…like lame. Not to keep them comfortable and not lame. That actually makes sense, they’d be paying out more then the average horse’s insured value if they covered all that “maintainance” stuff.

Your application for insurance and annual renewal will ask you to include any vet work that was performed for injury or illness even if no claim was submitted, they can ask the vet on record if they performed any other work on the horse when a claim is submitted… hiding things from them is not a good idea.

[jherold]

Read your policy. With mine, you are supposed to report it whenever your vet comes out for anything that’s not routine. My then 2 year old wacked her knee which blew up. I had the vet out and I knew, that with my luck, if I didn’t report it, it would end up being some thing serious that needed surgery. If I had waited to report it, they could then refuse to reimburse me on the grounds that I didn’t report it. And Findight is right. On my renewal, it asks if I’ve had the vet out for anything not routine. If I have and I say “no,” it’s insurance fraud. Better to be truthfull. It’s not like car insurance where you can decide not to file a claim.

But when your policy is renewed, make sure you look closely at the exclusions. I had to to back and forth with mine last year. I expected an exclusion for the knee. They tried to exclude the front legs. I said, “no, just the left knee.” They came back with the left leg. I just keep sending it back until they got it right. 2 years later she still has an exclusion for her left knee, but only the left knee!

[Kyrabee]

Yes…it doesn’t matter if you report it or not. As jherold said, if you had something treated and say no, it is insurance fraud not to mention if your vet has the records that may be forwarded.

I used to insure then started ‘self’ insuring with a fat savings account. The last year I insured my current horse, I dutifully reported all her relatively minor dings ( she was a silly 2 y.o.) and a couple minor choke episodes. I never filed a claim, even for the scope to assess her for the choke. The next year they excluded every body part that was involved in said dings and didn’t even give me a chance to get a vet exam to assure them all those things had resolved. OK…take your insurance and shove it. She is now 15 y.o. Never been sick and has had one hoof abscess in all that time. They could have made a lot of money off me but now it is in my bank account instead of theirs. Of course, she is a horse…it could all be gone tomorrow. I know that;).

Susan

[Bluey]

Practically every horse insurance we ever had and have today requires notifying the insurance company within so many hours any time a vet works on your horse, or the policy is not valid.

If your vet comes out for a light colic, gives a couple shots and the horse gets better, that also counts.

Read your contract and follow it very carefully, or you may as well not have insurance, because they won’t pay if you don’t.

Insurance policies also have time limits per incident.
If your horse gets hurt, they will pay for what you have to do for so many months only, generally four, which we know that is not enough, some horses have ongoing problems for months.

We had a horse kicked by another, didn’t look like it hurt it.
A few days later he was off and swollen, vet was called, insurance notified.
They questioned why we didn’t let them know when it happened, but relented and paid their share of the four months vet bills.
The horse didn’t get better, eventually we had to go to surgery, etc. and by then they didn’t have to pay any more, past the time they covered that injury.

Do read the policy you are signing very careful and be sure you understand what you and the insurance are agreeing to.

[Nestor]

All of the above! Insurance is really not helpful in the end.

You are supposed to report any vet treatment, even if you don’t pursue having the insurance pay for it. So whether you use the insurance or not, these things get excluded. Sometimes only for a year, sometimes for the life of the horse.

And insurance companies are getting sneakier, and excluding standard things within the fine print of all policies. Owners don’t find out until the colic or lameness happens, and they discover their insurance won’t cover any of the five-figure vet bill. This varies by company, of course, so be sure to read your policy carefully.

The only thing I’ve seen be a good reason to have insurance is for the mortality coverage. For example, for friends whose horses had colic surgery but did not survive in the end, the mortality payout helped cover the vet bills that major medical did not cover (or exceeded the policy limit). These were $30,000 or so mortality policies, and not much was left after the vet bills were covered, if that gives you a sense of how little major medical covers (I think most policies have a $10,000 colic coverage limit, and if your horse needs and has surgery, it’s usually twice that).

Yup, and now I’ve officially reminded myself why I’ll never pay an insurance company for coverage for my horse again. I like Kyrabee’s savings account instead.

[Palm_Beach]

@scrbear11

Even though I’ve been in horses for years, I’ve never had an insured horse. I just paid all expenses out of pocket and hoped for the best.

I insured the little mare a year after her flexor tendon injury. She’s accident prone, my first true forever performance horse, and valuable (to me, at least).

So here’s my question, when do you submit an insurance claim and when do you just fork over the cash to the vet in order to not get an exclusion slapped on the policy upon renewal? For example, say she comes up lame behind. Vet does lameness exam and x-rays of multiple areas to attempt to pinpoint or find an injury or area that could benefit from a joint injection. Vet finds nothing conclusive and determines simple time off is best. Bill exceeds deductible. Do you file a claim on that and hope no exclusion is slapped on the renewal? Or do you just pay for it out of pocket?

I guess my question is this: I’m not sure when to use the insurance and when to just pay the bill.

READ YOUR POLICY. It will have claims reporting procedures clearly outlined. If you don’t follow them (ie, seek treatment before reporting the injury/illness) you might not be able to file a claim. Most insurance policies have a condition that states you must report claims immediately. If you fail to meet this condition, the insurance company is deprived of the ability to investigate and the result may be your claim does not get paid. An insurance policy is a CONTRACT between two parties (yourself and the insurance company) and there are terms and conditions that both parties must keep.

[TakeAChanceinVA]

You must always alert the insurance company that something is going wrong with your horse. It might start as no big deal but then turns into something major - if you havnt notified them within a certain amount of time from onset (depending on individual policy) you may be jeopardizing any chance to have that claim covered. And at renewal you MUST disclose treatment the horse has had - as mentioned above, if you dont, this is considered insurance fraud.

I have my horses insured with major med. I dont expect it to pay out on a ton of diagnostics and treatments but I do have it in place for those accidents and emergencies. My horses $7500 joint involved laceration would have been difficult had it not been for his insurance. I dont mind paying my maintenance joint injections and lameness exams when I know I have coverage for anything unexpected.
Having said that, I don’t pay a fortune on my premium but I have a policy that I know isn’t that broad in its major med coverage. But thats the trade-off I make.

But end of story - yes you are required to inform claims any time the horse is seen for anything that is not considered routine care.

[Pico_Banana]

My policy also requires reporting for anything other than routine vet checks. And even if you don’t report at or around the time of occurrence, you have to disclose upon renewal. I’m in my first year so I’ve yet to see how that impacts my policy next year (I’m prepared for the worst).

I know a lot of people who ignore this and are willing to not disclose everything even when required to do as a condition of coverage, but I’m not willing to be dishonest. My option is to take my business elsewhere. Which may end up meaning that I self-insure, but if that’s the case, so be it.

Full disclosure – I’m on a bit of a campaign (albeit maybe a campaign of one) to try to overhaul how equine insurance works. I have had my dogs insured for years and my insurance company has never tried to exclude anything that arose during the term of my coverage (including cancer!). My understanding is that other dog/cat insurance companies work the same way and it has to be that they needed to provide that coverage to keep up with the market. We need somehow to figure out how to make this happen with equine insurance.

[eclipse]

Read your policy! I’ve had two major medical claims on my horse each for the max $10,000 and both were called into the insurance on the way to the clinic! The first was because he’d severed his extensor tendon and we knew it was going to be a claim the second was a second colic and ulcer scope and I called them because I knew if he had to have colic surgery they needed to know AND because ulcers are covered under my plan! Knowing your policy inside out will help you in emergencies and for other instances (for instance I’m allowed to claim a bone scan and subsequent treatment for up to 3 months etc].

plus if my horse had died at the clinic and I hadn’t reported he was getting treatment they’d probably deny mortality… I too am in the full disclosure camp! My insurance has saved my thousands and helped pay for expensive medicines

[ZELLA]

@Nestor

And insurance companies are getting sneakier, and excluding standard things within the fine print of all policies. Owners don’t find out until the colic or lameness happens, and they discover their insurance won’t cover any of the five-figure vet bill. This varies by company, of course, so be sure to read your policy carefully.

Not true. I’ll add to the chorus: Read your policy. By law, all the text in an insurance policy must be the same size, in a readable font, so there is no “fine print.” Every word is an important part of a contract that binds you to certain action if you want to receive a benefit. Nothing sneaky about that. Any health conditions that are excluded beyond the standard policy coverage wording must be listed as well. If you overlook it, it’s not the insurance company’s fault. Terms can change as years go by; nearly every carrier in the market has revised aspects of its coverage in the past five years, so it’s important not to make assumptions about your renewal coverage based upon understanding of the expiring policy.

[Nestor]

@ZELLA

Not true. I’ll add to the chorus: Read your policy. By law, all the text in an insurance policy must be the same size, in a readable font, so there is no “fine print.” Every word is an important part of a contract that binds you to certain action if you want to receive a benefit. Nothing sneaky about that. Any health conditions that are excluded beyond the standard policy coverage wording must be listed as well. If you overlook it, it’s not the insurance company’s fault. Terms can change as years go by; nearly every carrier in the market has revised aspects of its coverage in the past five years, so it’s important not to make assumptions about your renewal coverage based upon understanding of the expiring policy.

Of course you should read your policy. I apologize, I used fine print as a figure of speech. But to be fair, the font on those policies is TINY.

Anyone ever gotten ahold of one BEFORE they have to pay the premium? Again, I gave up on insurance when it got ridiculous (yes, I read the policies, the TINY bit it covered was useless, and with a BIG premium and BIG deductible), so it’s been a few years. I’ve seen COLIC excluded, including on my own horse, on a renewal. THAT was when I stopped renewing.

And I have had no issue getting insurance to cover my expenses. I was literally following the trailer to the vet hospital after my horse broke his jaw, and talking to my insurance company. We were in contact for the next 5 months, and they were great about covering just about everything (no stabling at the vet hospital, that was all they didn’t cover). Too bad that was the company that then excluded colic (never even had one, let alone put in a claim) a year later, doubled my deductible, and also doubled my premium.

Your best bet for insurance, as I said, is a fat savings account. Seriously. Put your premium in there every year.

[tbchick84]

Insurance is great for bubble wrap horses who almost continuously need stitches. Major medical, they pretty much don’t cover squat. Just self insure if it’s going to be for injection related issues.

[Palm_Beach]

You are allowed to read a copy of the policy before you buy it. Just ask for it.

[IndysMom]

@Palm Beach

You are allowed to read a copy of the policy before you buy it. Just ask for it.

Wellll, maybe… I tried several times last year and never did get a copy until AFTER I paid the premium

[eclipse]

@tbchick84

Insurance is great for bubble wrap horses who almost continuously need stitches. Major medical, they pretty much don’t cover squat. Just self insure if it’s going to be for injection related issues.

Id say it depends on the company! My major medical included the vet stay (as long as needed), trailering, all medications, treatment , all supplies (for the severed tendon and subsequent wrapping), all follow up vet visits until the vet stated he was healed until I hit my $10,000! For the ulcers they covered everything including gastrogard and all scopes!

[HJdaydream]

I’m firmly in the insurance (mortality and major medical) camp. I was able to get a full copy of the policy before paying a dime and have been very happy with my coverage.

I’m on my 2nd year with the company (Praetorian) and so far I have been paid out more then my policy price both years, so I am very happy to have it, it has literally saved me thousands.

I will probably never again have a performance horse that does NOT have a policy. I had a heck of a first year with my guy (many claims) and I felt the exclusions the next year to be extremely reasonable.