WWYD--Insurance report and/or claim question

[horsegurl]

Probably not so brilliant of me, but I inquired with my equine insurer (Great American) who says–
“The terms of the policy are that if there is an accident, injury or illness the carrier should be notified. Even if you don’t file a claim for reimbursement they can be notified of an “incident”. Especially if whatever is being diagnosed now is later associated with a claim that does require extensive Vet treatment. You are not required to submit any invoices associated with the claim/incident”

So, what would you do, what is your experience? If I have the vet out to check on possible soft tissue injury, and don’t file a claim or give any info to insurer on diagnostic appointment, will any resulting long term treatment/care be covered, if I then do file a claim for the injury and treatment?

And my main fear–If I do notify the carrier, but don’t file an actual claim, will they dis-clude this particular soft tissue and/or joint area???

Thanks for any opinion and info.

[ladipus]

I would say don’t report any incidents unless you are filing a claim…and yes …they will exclude whatever you’re claiming come next renewal time

[Gardenhorse]

I believe that most policies require you to report any non-routine vet treatment whether you claim it or not.

https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/9929935-when-to-submit-insurance-claim-when-to-wait

[wsmoak]

Even if you don’t tell them now, you’ll have to tell them at renewal time. And more than likely, they will exclude that body part for at least the next policy period. So if you think it may turn into a claim, you might as well tell them now.

[AndNirina]

It’s definitely in your best interest to disclose the injury or lameness workup to your insurance. The condition may be excluded upon renewal but you can work with the carrier or your agent to make the exclusion as area-specific as possible (as in “left front fetlock” instead of “left leg”)

[SnicklefritzG]

I’ve heard enough unpleasant stories about insurance claims that I can understand now why some people put money into an investment account instead

[TullyMars]

I have a horse that has a very very mild inconsistent off that nobody can fin, and I bet I am going to get a full leg exclusion even after MRI and NBS show nothing… Bummer since I still have no diagnosis. I feel for you!

[ZELLA]

At renewal, the underwriter will consider any and all treatment your horse had previously, whether or not you claimed it.

[equest]

@SnicklefritzG

I’ve heard enough unpleasant stories about insurance claims that I can understand now why some people put money into an investment account instead

My experience has been otherwise.
My horse broke his mandible two weeks ago, as of now about $3500 in surgical and treatment costs have already been paid by my carrier minus a $300 deductible. I’ll probably incur several hundred more dollars worth of costs for that injury.

My premium for my horse was $340 this year.
It would take one heck of an investment return to cover that spread.

[bt1]

@equest just wait til next year…

[gottagrey]

When I had a similar situation, I called the insurance company to let them know of a possible situation and that vet was coming. When it turned out to be nothing, I called them back and advised that horse was fine, no injury and that I would not be pursuing filing a claim.
You can wait until the vet comes out and see what he determines the issue is and what, if anything else needs to be done. and then contact the insurance company based on what vet’s recommendations are. It might be that there is nothing to file a claim about i.e. meds, poultice, stall rest vs diagnostics.

Note - if you do call insurance and injury turns out to be nothing serious but you reported it, generally your vet can write a letter to insurance company so that you won’t have any exclusions based on your claim.

[SnicklefritzG]

Then you are one of the lucky ones!

@equest

My experience has been otherwise.
My horse broke his mandible two weeks ago, as of now about $3500 in surgical and treatment costs have already been paid by my carrier minus a $300 deductible. I’ll probably incur several hundred more dollars worth of costs for that injury.

My premium for my horse was $340 this year.
It would take one heck of an investment return to cover that spread.

[mvp]

@equest

My experience has been otherwise.
My horse broke his mandible two weeks ago, as of now about $3500 in surgical and treatment costs have already been paid by my carrier minus a $300 deductible. I’ll probably incur several hundred more dollars worth of costs for that injury.

My premium for my horse was $340 this year.
It would take one heck of an investment return to cover that spread.

Me, too.

I just finished submitting a claim with The Hartford for an expensive cut on an inexpensive horse. And this is the second claim I have filed with them for this one horse (oy vey!). They could not have been nicer to deal with! So far, they are in the hole with me.

Don’t diss horse major medical insurance. It’s the kinder, gentler version of human health insurance. Help them stay in business because they usually do lose money insuring inexpensive horses.

[scrbear11]

I’m working on maxing out my MM :eek: On a ~$350 premium.

I paid $300 deductible out of pocket.

Little Mare’s entire front end will basically be excluded when her renewal is underwritten (any day now). But by the time my 90 day window is over they will have reimbursed ever penny of $7500.

Non-routine visits are reported at renewal. My carrier required a vet certificate of health for renewals, so any out of the ordinary visits my vet would report if I don’t. A visit with no diagnosis does not mean an exclusion. Only excluded if actually injured. (Someone correct me here).

[equest]

@mvp

Me, too.

I just finished submitting a claim with The Hartford for an expensive cut on an inexpensive horse. And this is the second claim I have filed with them for this one horse (oy vey!). They could not have been nicer to deal with! So far, they are in the hole with me.

Don’t diss horse major medical insurance. It’s the kinder, gentler version of human health insurance. Help them stay in business because they usually do lose money insuring inexpensive horses.

I have the Hartford and agree that they have been excellent to work with.

[Madison]

I have had the unfortunate luck of being a veteran of multiple major medical claims. I have not reported til I had a definitive diagnosis, and I have never been hassled about it, and they even paid the farm vet bills that predated the diagnosis at the university. As someone mentioned above, reporting on your renewal application is where the issue arises even if you don’t report the incidents in real time. However, if you get an exclusion that is overbroad, and your vet will support you with documentation, do not be afraid to push back!! My carrier tried to exclude an entire leg on a muscle strain that didn’t even result in a claim or any treatment. I pushed back and submitted a vet certificate describing the injury very specifically and stating that the horse was sound. I told them not to cash my renewal check unless the exclusion was removed. They backed down, and it totally saved me because 6 months later the horse injured himself in a completely different area of the leg, they tried to deny the entire claim, and I referred them to their underwriting file and they came back and reversed their decision and covered the whole claim (as well they should have). So, if you have the vet documentation to back you up, negotiate on that exclusion, don’t just accept what they initially try to stick you with.

[kiwichick]

I had a huge claim too, was about 8k. They paid out great and it was a great investment for that extremely stressful period.

BUT

When it appeared that things were going pear shaped and I first made the decision to euthanase, my insurance company let me know that his death benefit wouldnt be covered because he had further surgical options (these werent covered by insurance as I hit my yearly cap) and were not ethical options. However euth is based on Veterinary association regulations, and my condition wasnt covered.

My policy was up for renewal about 3 months later, they told me a number of exclusions and that my death cover needed to be adjusted as my horse wasnt ‘worth as much’ after all his medical issues. In theory I had 12 months to reopen the initial claim, even though my policy exclusions started 3mo later. However I already hit my cap also. I cancelled his policy.

My horse was euthanased nearly exactly 12mo after the final surgery, uninsured and at my own expense.

So whilst I agree that an insurance policy is a good safety net, you need to be completely aware of what you are covered for. People have the impression that if they decide to Euth rather than operate (say colic surgery, which can be 10k with 50% chance of survival) you cannot elect Euth and get paid out, if there is a surgical option it must be taken, even if this is your own expense, unless the vet declares the prognosis is death anyway.

My new horse is insured, same policy. Im just far more pragmatic about it now.

[mvp]

@kiwichick

So whilst I agree that an insurance policy is a good safety net, you need to be completely aware of what you are covered for. People have the impression that if they decide to Euth rather than operate (say colic surgery, which can be 10k with 50% chance of survival) you cannot elect Euth and get paid out, if there is a surgical option it must be taken, even if this is your own expense, unless the vet declares the prognosis is death anyway.

I did know that. In fact, when my mare got surgically hurt, I was prepared to euthanize her rather than operate on their nickel if the prognosis wasn’t awesome. It would have saved them some money. No dice.

I suppose I see why they can’t open up the can of worms of allowing a policy-holder to ask for euthanasia based on economic reasons or anything but the most rigorous of medical reasons. Most people who buy insurance want the company to go to the wall to pay up for their share of the treatment, up to the limit of the policy, so I don’t think there’s a lot of public pressure for giving insureds the option of choosing euthanasia. I agree that you shouldn’t be able to choose that and also collect of the mortality policy. Part of me thinks the insurance policy should cover euthanasia costs if the owner is doing that for financial reasons and realizes that both parties would loose their shirt if the surgery or treatment were done. But I think the public at large would lose its collective mind if they knew that insurance companies allowed this. And imagine the case where the insured feels pressured to euthanize and save money, just because it can be done. That’s certainly untenable since most people bought insurance as a hedge against a vet bill so large they’d euthanize for financial reason.

[kiwichick]

where the issue is here, is most people think that the insurance company pays the bill. However, you pay the bill and the insurance company reimburses you once the claim is accepted (if its accepted)
The financial side of things becomes an issue if the owner cant cover the initial bill. you need to supply the paid bill for the claim.
I was lucky that my horses surgeries came in waves, so I kept paying the same few thousand to the vet to have it given back, to pay it to another vet and so on.

And I agree that you shouldnt be able to elect Euth just on financial reasons, but again a lot of people dont realise this.

I never took out loss of use, as I couldnt see how that wasnt a wrought, ironically it was the only policy that would have been useful for me!

[buschkn]

I have never reported unless I was filing a claim. Way too many ‘Dobbin NQR’ times with a little eval and nothing noteworthy. I don’t want them to have any excuse to balk at stuff. I’ve had pretty good experiences with insurance but have only used it a couple times. I have too many now for it to be practical to insure but in general I feel like insurance companies across the board- Equine, Human, automotive, Home, etc. like to find any reason not to pay if they can.