There is a lot of confusion over the different types of equine insurance policies currently available, and the small print is rarely read until problems occur.
Your horse can be insured in different ways for different eventualities, including:
- all risks of mortality (ARM) or destruction on humane grounds (death cover)
- permanent incapacity for the purposes for which the horse is insured (loss of use – not short-term “loss of use” while convalescing!)
- vet fees for varying amounts, ranging from cover where you pay a small excess to so-called catastrophe cover, where insurers assist with major vet bills only, for instance surgical or medical fees greater than £500
Essentially you get what you pay for, and loss of use insurance is becoming less readily available. It is also the most expensive, particularly for relatively high-risk sports such as eventing.
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There are very strict criteria to fulfil an insurance claim for destruction on humane grounds. Importantly they are not necessarily the same criteria by which you may decide that in the best welfare interests of the horse it should be put down.
The British Equine Veterinary Association, in conjunction with the insurance industry, has defined the criteria for destruction on humane grounds as follows: “That the insured horse sustains an injury, or manifests an illness or disease, that is so severe as to warrant immediate destruction to relieve incurable and excessive pain, and that no other treatment options are available to that horse at that time.”
For example, a horse with a complex fracture of the upper forelimb, with the bone ends penetrating the skin, unquestionably has an incurable fracture and excessive pain, and merits immediate humane destruction.
However, the owner of the horse would have to ensure that the insurance company was also informed as soon as is practical and the vet would be required to submit a written report with all the relevant details, including confirmation of the horse’s identity.
In some instances a post-mortem examination may be requested by insurers, so it is essential to contact them immediately if you are ever faced with such an unfortunate situation.
Cover for veterinary fees
Insurance for vet fees provides for repayment of fees for any legitimate part of veterinary investigation and treatment, provided that the insurance company is notified of the problem from the outset. However, some aspects of investigation and treatment are specifically excluded. These include fees for hospitalisation or for cosmetic surgery (eg removal of an unsightly splint in a show horse).
Failure to disclose a minor health problem may jeopardise a major claim in the future. For example, presume that your horse had low-grade colic that resolved rapidly following examination and treatment, but the insurance company was not informed. If in the future Lucy required colic surgery the insurance company could legitimately refuse payment. The vet would be obliged to disclose all previous records, which would document that Lucy had previously had colic.
While it could be argued that many horses have an occasional bout of colic, it must be recognised that some horses may have a predisposition to the problem. Insurance companies operate as a business based on risk factors and it is therefore a precondition of insurance that they are informed of previous problems. It is the owner’s responsibility to keep the insurance company informed and there is no doubt that honesty is the best policy. Do not expect your vet to distort the truth.
Excess and loss of use
It is usual that the owner is obliged to pay a small sum of the total bill for any particular problem, the so-called excess. There is a temptation, if the total bill is small, for the owner to pay it and fail to inform the insurance company of the problem. This represents failure of disclosure and may jeopardise a future claim, either for vet fees or loss of use.
This happened with Molly, a nine-year-old advanced eventer, who had a low-grade foot lameness attributed to foot imbalance. The insurance company was not informed. Despite corrective trimming and shoeing, the lameness persisted and six months later more thorough clinical assessment revealed chronic damage of the deep digital flexor tendon. At this stage Molly’s owner was becoming frustrated and after nine months she filed a claim for loss of use. The insurers legitimately refused to consider the claim because they were not informed of the problem until six months after its onset.
It is important to note that excess values relate to individual problems. That means that if a vet was asked to examine a mare for forelimb lameness, but also noted that she had back pain, the insurance company may legitimately charge separate excess for the fees related to each problem. The vet would be required to provide two separate itemised accounts.
The vet may recommend that the back be treated with physiotherapy and that the feet required corrective trimming and shoeing. These would be classified as “alternative therapies” unless performed by the vet, so it is important to check that alternative therapy and corrective farriery are included in the basic veterinary fees cover.
Most equine insurance policies run for one year and are then renewed. Usually this is straightforward, but if the horse has experienced a problem in the previous 12 months the insurance company has a right to place exclusions on a similar or related problem. Similarly, at the start of the policy an insurance company has a right to place exclusions relating to pre-existing conditions.
For instance, Jack underwent a pre-purchase examination and the vet noted that the front feet were asymmetrical in size and shape. The vet’s X-rays of the feet appeared normal and therefore they recommended that Jack was a fair risk for purchase. Nonetheless, the insurance company placed an exclusion on foot-related problems.
It is well known that in association with lameness, especially foot-related, the foot of the lame limb may become contracted and more upright. Thus, asymmetry of the front feet implies that the horse may be at increased risk of future lameness. So while the vet may recommend purchase based on his clinical evaluation, the horse may still represent an increased risk to an insurance company, which may refuse cover or place legitimate exclusions.
It is important that exclusions on a policy are not too generalised. A tendon injury of the right forelimb will correctly be excluded from future cover after injury. Sometimes the entire limb is excluded, or all tendon and ligament injuries. This is unfair, because there is no evidence to suggest that a tendon injury may predispose to other injuries in that limb. It is reasonable to exclude strain-related injuries of other tendons, but not a laceration due to external trauma for example.
Similarly, if recurrent obstructive airway disease (RAO) was recognised at a pre-purchase examination or disclosed by the vendor, it would be reasonable to exclude future claims relating to this and related conditions, but exclusion of any claim related to respiratory disease would be unjustified. If the horse then developed strangles this should be a legitimate and unrelated claim.
It is crucial that these sorts of issues are discussed with your vet and the insurance company. This is particularly important if you are buying a horse you wish to insure. It is important to recognise that exclusions may be reviewed following a period of full work and re-examination at a later date. An exclusion is not necessarily for life.
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- This feature was first published in Horse & Hound (28 October, 04)