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November 2006

Veterinary Fees Insurance

For many ordinary horse owners, the availability of insurance, especially to cover veterinary fees, is a modern development that provides a level of comfort in facing injury or disease.  In short, it makes it possible for some to consider ownership on a calculated budget who otherwise might not be able to.

With the advent of technology, as in human medicine, veterinary costs have spiralled and many procedures come with a high inbuilt cost element to represent even the capital involvements of a practice.

Companies

There are two leading UK insurers in this field who set the standards for all others, namely NFU Mutual and Petplan.  These both operate to a high ethical standard and settle their claims quickly and with little fuss or controversy - I have encountered none with either company.

There are others whose standards are equally admirable and no one can have any quibble as long as a contract states clearly what benefits are provided and these are adhered to when a situaton arises where a claim has to be made. 

Responsibilty

It is encumbent on any insurer to ensure that terms and conditions are transparent and clearly stated.  If you are given particular cover, your claim should be met if your animal has a problem that meets the clause covering it.  It is not for the insurer to come up with excuses to avoid payment, or to generate new conditions when a claim is made.  To do this, is to risk a charge of misrepresentation.

Likewise, the terms of a contract must be fair to you, the consumer.  No conditions are acceptable that contravene the requirements of the Unfair Contract Terms Act 1977 and its subsequent Orders.

In other words, if the policy states vets fees are covered, they should be and no amount of prevarication on the part of the insurer should alter that. 

If a company decides that your vet is not a vet for the conditions of their policy, this needs to be clear from the time a contract is created.  If, as in some of my recent cases, an insurer wishes to classify me as a physiotherapist, or suggests that, in doing my work, I'm over-charging, or over-treating, then you, the policy holder, will have a problem when claiming.

However, as well as reliable and reputable insurers there are those who are difficult to claim from.

Motivation

The purpose of this piece is to answer a letter from one company with whom I have never had what could be termed satisfactory dealings.  In fact, the only claim for an animal (I treated) to be settled by them, without complication, was for a policy holder who happened to be a solicitor.

Kbis Equine Insurance

A recent case I treated involved a horse with a broken pelvic shaft.  The diagnosis was made clinically, on the basis of lameness and crepitation in the fractured area.  There was no cost in expensive diagnostic testing the insurer would have had to pay for.

Fortunately, the horse, named Kinver, was amenable to being confined and his progress was monitored on a regular basis.  Essentially, I kept a close eye on the repair process and Kinver was doing so well I thought we might get him out after about six weeks.  I even allowed for the possibility the injury might not have been as bad as I originally thought - but there was immediate re-aggravation and the crepitation returned.  He had to be returned to the tiny box he could barely turn round in. 

Kinver was insured with Kbis Equine Insurance and an initial claim was settled, though Kbis have the possibly unique habit of asking the claimant to pay the excess directly to them before they pay the vet - which may well be a benefit to veterinary practices, but no other company I've encountered takes the same approach.  In this case, they got the excess but, through some administrative glitch, didn't seem to know they had it.  That was a problem for the policy holder, but was eventually sorted out.

When a second account was submitted in the case, Kbis sent me a letter (on notepaper that boasts 'Quality, Affordable Cover') saying 'underwriters have requested a full breakdown of the work carried out on each visit in order to process the claim correctly.'  The last time I got such a request from them, Kbis didn't even acknowledge my detailed explanation, simply decided I wasn't a vet for the purposes of the claim and acted accordingly towards the claimant. 

No payment for travel, diagnosis, attendance, treatment or drugs.

In Kinver's case, to answer Kbis' letter, I travelled approximately 45 miles to the yard and saw the horse a total of 12 times over a period from June to October this year.  In most cases, the travelling costs were shared, and, on most occasions, I spent a considerable amount of time correcting the soft-tissue implications of the injury.  In other words, making sure the horse could use the limb again. The charges covered my time as a vet.

Kbis, like some other insurers, are underwritten (for this type of insurance by Allianz Cornhill Insurance PLC), who may well dictate terms and conditions.

In Kinver's situation, Kbis, as they have in the past, are likely to say that in treating these soft tissue elements, I am not a vet, but a physiotherapist, therefore they are liable for my fees only to a physiotherapy limit of £500.  They have done this repeatedly over the years and the only exception was where the policy holder was a solicitor, as already mentioned.  The consumer is left with a major headache and what would appear to be a deliberate contractual breach on the part of the insurer.

When is a vet not a vet?  

For the information of Kbis, and others like them, my training as a vet covers not only my university training, but my years of experience, the knowledge I have acquired of subjects like pathology, orthopaedics, etc, as well as the repair processes and the mechanics of movement.  With due respect, no equine physiotherapist has a comparative background and each time I visit and treat an animal I am applying my knowledge of its injuries as well as my understanding of what is needed to return it to full working soundness.  Kbis might say fine, but you could delegate the labour element.  No, I couldn't, because I deal in an area where this is not possible as the situation stands today.  I am acting as a vet, fulfilling my ethical obligations to owner and animal, and it is my ability to gauge improvement and decide on the extent of tissue damage, and its reversal, that is critical.

For Kbis to suggest I'm not a vet under the terms of their policy is in clear contravention of the Unfair Contract Terms Act, especially if they have not written this escape in their initial contract with the consumer. 'Pays 100% vets fees after the excess' means precisely that under contract terms unless some qualifying statement states otherwise.  Irrespective of whether or not they don't cover a list of alternative treatments, they have to cover veterinary costs so that your animal can be treated for its problems, as per the policy document.  That doesn't allow any arbitrary decision on fees, either, unless written into the contract.

THB British Equestrian

THB is another company, underwritten by Allianz Cornhill, who take the same precise approach to settlement. 

THB are even prepared to be libellous in the letters they send to their policy holders, a matter for which they will be obliged to answer before too long.

Prospective Insurers

If you are taking out insurance to cover veterinary fees, it is advisable to consider these implications before making a decision on where to put your money.

I would be interested in hearing from those who have had bad experiences.  There is a need for people to be made aware of the different standards that apply.  Your premium may be wasted if you're treated summarily, arbitrarily, or dishonestly.

It's completely lost if you don't get cover for injuries or illnesses you are led to believe are covered in the policy.

Letter

In an email last weekend (18th November), the Managing Director of Kbis, Mr Prest, says: ' - - it is not normally our approach to look for conflict.' 

This has not been my experience of his company; there is no conflict, perhaps, if there is no room for argument.

'By the nature of things our industry has to have a symbiotic relationship with yours but we are not and never have been a catch all for every thing that happens to an insured horse.'  Take what meaning you like from that, but an unfortuante choice of words.  'Symbiosis' is a term from parasitology and describes a relationship between two species of parasite.  Whatever way Kbis might see themselves, I feel quite sure my profession doesn't see itself in that light, or that it should have a relationship with an insurer that would be both unethical or illegal.

Also, he says: 'Historically vets fee insurance has been a major loss leader - - -.'  In consequence ' - - most companies have offered a cheaper more limited cover which the customer can choose - - .'  Evidently, with fewer benefits.  Fine, as long as customers are aware and not left to feel robbed when they try to make a claim that is subject to the (possibly illegal) interpretations of the insurer. 

The major companies all define veterinary treatment as any treatment administered by a qualified veterinary surgeon.  This cannot leave any room for interpretation  A contract might exclude specific acts of veterinary surgery at the outset, but it cannot decide a vet (especially one with forty years experience) is not a vet simply to suit its own purposes, or that you, the consumer, should be denied the right to claim for treatments which the vet considers essential to the well-being of your horse.

Of course, this is a matter that may have to be brought before a court, which it is likely to be, soon.

Kbis, and their ilk, should take note.

UPDATE

At 3.20 pm on Friday 1st December, an email arrived here from Allianz Cornhill as follows:

Dear Mr Gray

Re: www.petergray.org.uk

I act for Allianz Cornhilllnsurance plc.
I am enclosing herewith the contents that were posted on the news page of your website on
the 27th November2006.

You have made various statements that my client considers amounts to libel. You are
therefore requested to remove the enclosed article from your website or alternatively
remove all references to my client and the insinuations which you have made that it is
acting in an underhand manner.

If you fail to carry out the above request within the next 24 hours my client will have no
option but to apply for an injunction against you, which will involve unnecessary legal costs
for which you will be liable.

Yours sincerely
Ms A. B.
Solicitor
Legal Department

We're still here, but watch this space!  Things will shortly get hotter.

Peter Gray

(copyright reserved)

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