Please read this leaflet prior to making a claim for the cost of veterinary fees from your Insurer. The information applies to all companies currently providing equine insurance and does not relate to any specific Insurer. Please read it carefully as soon as possible after deciding to make a claim and do not hesitate to ask your vet or Emma Cooper on 01508 558228 if you have any queries.
This information relates to insurance cover for the cost of veterinary fees and does not include information on "loss of use" or "mortality cover" claims.
How to Start a Claim
Simply call your Insurer and inform them that your horse/pony has sustained an injury or has become ill and that you would like to make a claim. It is quite possible that you will not know the exact nature of the problem at this point, so do not worry about being too specific. Further information will be provided to the Insurer on the completed claim form.
The Insurer should then send you a claim form. When you receive it, complete the owner section promptly, ensuring that the policyholder signs/dates the completed form, and then email or post it to us (or drop it off in person). We must receive your completed claim form within 3 working days of us first seeing your horse for the condition.
Indirect and Direct Insurance Claims
Indirect insurance claims are where the policyholder pays for all treatment themselves, and then claims back the amount from their insurance company. This type of claim will be processed and sent off to your insurance company by us within 5 working days of us receiving it (providing everything is correct and complete, for example all policyholder sections of the form are filled in correctly). We will process indirect claims for any amount, and you will not be charged our £22 insurance form completion fee for this type of claim.
Direct insurance claims are where the policyholder pays their excess, £22 insurance form completion fee, and any non-insured treatment in advance of the claim being submitted by us to the insurance company. The claim is then paid directly to us by the insurance company. There is a minimum lower limit of £300 for this type of claim.
Your Policy Excess
Unfortunately, most policyholders never read the finer details of their policy until they need to make a claim. As a result of this they often don't know what is, and what is not covered. Check your policy to determine your limit and any time scale allowed to make a claim - most policies provide cover for up to 12 months after the onset of clinical signs or identification of an illness/injury, normally the date that the veterinary surgeon first attended the occurrence. However, it is important to remember that if an illness/injury is identified, that subsequently appears to have been present for a prolonged period prior to the veterinary surgeon first attending the patient, the Insurer may not honour a claim or may start it from when the owner first believed there to be a problem. This may compromise the care you are then able to provide and limit the finances available. Make a note of any exclusions in place on the policy - these are usually written in a separate section and might relate to previous injuries, pre-existing problems or illnesses. Some policies also have exclusions/limits on the cost of particular aspects of veterinary care such as hospitalisation fees, admin fees, clinical waste etc. It is very important that you let your vet know any limits/exclusions in place.
Whether or Not to Make a Claim
There is no benefit in choosing not to make a claim. Most policies require you to inform the insurance company of any illness/injury, irrespective of whether or not you make a claim (exclusions may still be placed on future cover). Only if the total bill comes to less than your policy excess is it not worth making a claim, although you should still inform the insurance company. The normal process of making a claim includes the insurance company reviewing the patient's previous clinical history. A failure to declare information may invalidate a future claim.
Unless an illness/injury involves only one or two visits, after which the condition has healed, there is often considerable paperwork to complete, involving communications between the policyholder, the Insurer/Broker and your vet/admin staff. It is important to remember that having insurance cover does not equate with any guarantee that the costs of veterinary investigations and treatment will be covered. The contract is between the policyholder and the Insurer/Broker. At all stages of the claim, the policyholder remains liable for the payment, should the Insurer fail to pay the costs.
You should fill in your part of the claim form and send it in for the vet to complete, and then we will send it off to your insurance company (along with the clinical history for your horse and the relevant invoices). We must receive your completed claim form within 3 working days of us first seeing your horse for the condition.
In some situations, you may need to send off the policyholder section of the form to the insurance company yourself before the vet fills out their section (check with your insurance company if you are unsure). If treatment is ongoing over several months, we will forward any relevant subsequent invoices to the insurance company along with your horse’s clinical history. This includes all veterinary invoices and may include any other invoices such as costs of physiotherapy or remedial farriery (these can be emailed or posted to us, or dropped off in person). Some insurance companies will also require you to complete a continuation claim form to be sent to them along with these (please check with your insurance company if you are unsure). This must be received by us within 3 working days of the treatment it is for being carried out.
If the Insurer fails to make payment for an insurance claim within a reasonable period of time, then we may request that the policyholder pays the claim in full and claims the costs back from the Insurer. Our practice policy is to allow three months grace from when we submit the claim.
We reserve the right to request payment in full at any time from the policyholder. You can either submit an indirect claim or a direct claim for your horse’s treatment (as detailed in the relevant section above). If you chose to pay us and claim back the costs, you should pay for each invoice within 7 days of the date of the invoice. If you choose to have us paid directly, then you should pay the following to us upfront: your excess; our £22 insurance form completion fee; and any non-insured items or extras that are stated as not being covered on your policy e.g. vaccinations, routine dental treatment and hospitalisation/livery fees, etc.
If you have a fixed excess, then simply make this payment to the clinic upfront, along with any non-insured items, and your £22 insurance form completion fee. When you send in any payment for part or all of a claim, please make sure you inform the admin staff that the payment relates to the current claim.
If you have a policy with variable excess, then you will not know the total amount of the excess until the claim is complete. If treatment is ongoing, then following each claim made for a condition, we will contact you to let you know of any deductions made (including the variable excess), so that these costs can be paid promptly (within 7 days of date of invoice), and so do not accumulate.
The Insurers will assess the claim once they have received the completed claim form and will start to make payments only once the claim has been approved and invoices related to the claim are submitted.
Usually the bulk of the costs are at the start of the claim. Once the Insurer has made all payments, there may be some remaining unpaid amounts on the account (deductions). You should check all payments made by the Insurer, but usually these remaining amounts will need to be paid by the policyholder.
Complex conditions or those requiring ongoing assessments and treatment over several months are very common. Payment of such claims is frequently made on several occasions during the claim period.
The process of making a claim should be relatively straightforward. However, when the claim extends over a period of time and involves at least three parties, things can get complicated. Keep a copy of everything you send to the insurance company. It is useful to keep in regular contact with your insurance company to monitor the progress of the claim. You are entitled to know the status of the claim and any payments due. In addition to this we will contact your insurance company on a regular basis to enquire about the progress of the claim. This also allows us to answer any queries that your insurance company may have in relation to your claim. It is, however, ultimately the policyholder’s responsibility to ensure that the claim is settled as promptly and efficiently as possible, and they remain liable for the outstanding fees at all times.
If you have any queries or concerns about any aspect of the claim, then please do not hesitate to contact your Insurers or Emma Cooper at the Equine Clinic on 01508 558228. It is much better to resolve any issues promptly, before they become a real problem, months down the line.
Technically, an insurance claim for veterinary fees can only be made once the fees have been paid by the policyholder (i.e. a loss has occurred). As such, Chapelfield Veterinary Partnership (CVP) requests payment of all invoices within 7 days of the date of the invoice.
However, CVP will allow delayed payment of insured fees, until settled by the Insurer, if prior arrangement is agreed by the accounts department and only where the timescale is reasonable - we consider this to be within three months of the claim being submitted to the insurance company. Please therefore ensure that at the beginning of your claim, we receive your completed claim form within 3 working days of us first seeing your horse for the condition. For continuation claims, please make sure we receive your completed continuation claim form within 3 working days of the treatment it is for being carried out.
At the start of a claim, the policyholder should contact the Insurer and request a claim form promptly, and once they have filled in their sections and signed/dated the form, they should then send it to us. As previously stated, we must receive your completed claim form within 3 working days of us first seeing your horse for the condition being claimed.
Claim forms will then be completed by the relevant vet and then sent to your insurance company, along with relevant invoices and clinical history.
Fixed excesses must be paid to us upfront, along with our £22 insurance form completion fee, and any non-insured costs. Deductions and variable excesses must be paid to CVP according to our normal 7-day terms once the claim has been settled by your insurance company. Our accounts department reserves the right to request copies of insurance policies, if required, if any outstanding non-insurance fees/deductions are not paid in full within 7 days of the date of the invoice.
With ongoing claims over two or more months, some Insurers require a continuation claim form with each subsequent invoice; however some just require follow on invoices. Check with your Insurer. As previously stated, your continuation claim form must be received by us within 3 working days of the treatment it is for being carried out.
Please be aware that many years of experience has taught us that documents occasionally go missing during processing and transit, resulting in delays in the processing of claims. We advise that you keep copies of all documents and that you contact your insurance company regularly (weekly) to check on the progress of your claim.
We charge a £22 insurance form completion fee per direct claim, which should be paid upfront to us along with your excess and any non-insured items. This applies to new claims with us only (not to continuation claims).
Please contact Emma Cooper at Brooke Equine Clinic 01508 558228, if your Insurer requests further information or if you have any queries.