Please read this information 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 Tracey Gooda 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 or email one directly to us on firstname.lastname@example.org. When you receive it, complete the owner section promptly, ensuring that the policyholder signs/dates the completed form.
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 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 exclusion 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 on the policy.
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 insurers. The normal process of making a claim includes the insurance company reviewing the patient's previous records. 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 policy holder remains liable for the payment should the insurer fail to pay the costs.
You should fill in your part of the claim form and forward it to your vet for completion and return to your insurers. Do not wait to return the claim form. If treatment is ongoing over several months, you should immediately forward any subsequent invoices you receive to the insurer. This includes all veterinary invoices and any others such as costs of physiotherapy or remedial farriery.
It is the policyholder's responsibility to ensure that the insurer receives a completed claims form and all relevant invoices. If the insurer fails to make payment within a reasonable period of time, our practice policy is to allow two months grace, then we may request that the policy holder pays the claim in full and claims the costs back from the insurer. We reserve the right to request payment in full at any time from the policyholder. You have the option with many policies to pay the bills and be re-imbursed by the insurer or have your vet paid direct. If you chose to pay your vet and claim back the costs you should pay for each invoice within 30 days of receiving the bill each month. If you choose to have your vet paid directly then you should only pay the excess to your vet upon receipt of your first invoice, along with any extras that are stated as not being covered on your policy e.g. hospitalisation/livery fees.
If you have a fixed excess then simply make this payment to the clinic when you receive your first bill along with any extras which are not covered. 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 plus any non-insured items, then you will not know the total amount of the excess until the claim is complete. In order to avoid building up a large excess if the treatment is ongoing over several months and to allow you to pay the excess as it accumulates on these claims, you will need to make a payment to your vet each month you receive a bill. If you need assistance in calculating this amount each month please contact Amy Chamberlin on 01508 558228. Then simply send your make your payment to the clinic each month in the same way you would normally pay your bill.
Whichever type of excess you have, do not wait until the claim is complete before paying your excess each month. This way you will avoid accumulating a substantial bill at the end of the claim.
The insurers will assess the claim once they have received the completed claims 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. From experience these usually relate to non-insurance items such as vaccinations or exclusions to individual parts of the cover such as hospitalisation/livery fees. Any excess, non-insurance items or excluded items should be paid monthly as described above rather than allowing them to build up over several months. 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 their offices to monitor the progress of the claim. You are entitled to know the status of the claim and any payments due. Unfortunately, due to data protection laws, we cannot obtain this information, so it is very important that the policyholder takes responsibility for ensuring that the claim is settled as promptly and efficiently as possible. If you have any queries or concerns about any aspect of the claim then please do not hesitate to contact your insurers or Amy Chamberlin 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 policy holder (i.e. a loss has occurred). As such Chapelfield Veterinary Partnership Ltd (CVP Ltd) requests payment of all invoices within 30 days of their receipt.
However, CVP Ltd 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 60 days of the policy holder receiving the invoice. Please ensure invoices are forwarded to insurers promptly. We reserve the right to request payment in full at any time from the policyholder.
At the start of a claim the policyholder should contact the Insurer and request a claim form promptly.
Claim forms will then be sent to your Insurer along with relevant invoices and clinical records.
All non-insured costs and fixed or variable excesses must be paid to CVP Ltd according to our normal 30-day terms. Our accounts department reserves the right to request copies of insurance policies, if required, if any outstanding non-insurance fees are not paid in full within 30 days of receipt of invoice.
With ongoing claims over two or more months, some insurers require a new claim form to be attached to each subsequent invoice; some just require follow on invoices. Check with your insurer.
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 them regularly (weekly) to check on the progress of your claim.
Please contact Tracey Gooda at Brooke Equine Clinic 01508 558228, if your insurer requests further information or if you have any queries.