Is there an equine insurance agent in the house?
June 16, 2009 8:23 AM   Subscribe

This may be a longshot, even for the diverse crowd here at AskMeFi. My daughter's horse was diagnosed with Lyme Disease in January. We caught it very early and the horse has made a full recovery and is back to normal in every way. However, the annual renewal on our Life/Major Medical policy for the horse includes this clause. An exclusion for any loss or expense due to Lyme disease or any underlying related condition will apply to all coverages. Diagnosing Lyme is a bit of a judgment call as it is, and this seems like a huge get-out-of-ever-paying-any-claim-again loophole as pretty much anything that may ever affect the horse in the future could conceivably be blamed on Lyme Disease. The question for anybody that may have experience with there any reason to maintain a policy with that loophole?
posted by COD to Pets & Animals (9 answers total) 1 user marked this as a favorite
One reason would be that such clauses might be standard practice in the industry.

But I think you're misreading the clause a little bit. What they're actually saying is that the exception for Lyme disease applies to all applicable coverages. Insurance policies provide multiple forms of coverage as a matter of course: accident, illness, travel, etc. What they're saying is not that if your horse gets Lyme disease they never have to pay anything ever again, but that any expenses which arise from Lyme disease will preclude payment under any of the various coverage types.

I'm not a large animal veterinarian, but the idea that every subsequent medical condition can be blamed on Lyme disease strikes me as unlikely. Your veterinarian would probably be the one who makes that call anyways, not the insurance company, unless they have reason to suspect that he's covering something up.

But again, I think that you're likely to find that such clauses are standard for the industry. If companies are permitted to exclude something from their coverages, they often do.
posted by valkyryn at 8:34 AM on June 16, 2009

Not sure about the insurance issue, but maybe request a Lyme titer to prove that the horse has cleared the infection, and therefore future conditions can't be blamed on Lyme Disease? Just a thought, because then the diagnosis (or lack thereof), isn't subjective.
posted by bolognius maximus at 8:41 AM on June 16, 2009

IANYIB (I am not your insurance broker), but the language seems problematic to me in that it is very vague. I've never seen Lyme in horses, but in people it can create a whole heck of a lot of symptoms, and the one I am thinking of is joint pain.

Now a horse (showing? jumpers? or just flatwork?) can get a variety of foot/joint problems for unknown causes (they get hurt out in the field, no one sees it happen). I think a policy that allows exclusion of any symptom arguably shared with Lyme is not worth the paper its printed on. Sure, you could trust the insurance company to apply that fairly and rely on the vet to ascribe causes, but the number of problems I've heard with those issues for PEOPLE make me think.....

I would at least shop your policy around and determine whether that is standard language you'll be stuck with anyway. If it isn't, to me personally, it would be worth paying a bit more to have a policy lacking that huge loophole.
posted by bunnycup at 8:52 AM on June 16, 2009

Response by poster: Bunnycup hits the issue head on. Just like in people, once exposed, the antibodies for Lymes will likely be present in the horse's blood forever. So if the horse (which does dressage, hunt seat, judged trail and show jumping) comes up lame the blood work will almost certainly show the presence of antibodies related to Lyme. It's an easy out for the insurance company to blame the problem on Lyme and not pay up.
posted by COD at 9:02 AM on June 16, 2009

That kind of language is standard in the horse industry. Often they will exclude an entire leg or whatever. They usually will pay up on other stuff though, it is not a get-out-of-jail-free card for the insurer in my experience.

Whether or not its worth keeping the policy is up to you and your savings account. Offhand I can think of dozens of things that are not Lyme related but are common and expensive to treat, colic being numero uno. You probably need Life to get MM coverage and colic surgery is awful expensive so if your premiums are reasonable I'd say keep it just for that. Let your vet know about the exclusion and with them as needed.

Loss of Use coverage (if you have that) may no longer be worth the cost though as that is typically related to lameness and if your horse has a history of Lymes related lameness it might be tricky to get them to pay out on it.
posted by fshgrl at 9:09 AM on June 16, 2009

Drop the insurer and either don't insure or switch to another insurer, even though an alternate insurer will likely have a similar exclusion. The point being that the insurance company should not be rewarded with a continuation of your business when they are removing most of the reason for having insurance.

Another way to look at it is that Lyme is, potentially and arguably, a lifelong infliction and that the insurer is dropping coverage for an illness that is ongoing. That may be the grounds for a lawsuit.
posted by bz at 9:16 AM on June 16, 2009

bunnycup may be correct--I don't know enough to be able to give a sound judgment there--but bz is probably not: insurance companies will almost never include clauses in their policies which will subject them to liability, because they have to submit all of their policy forms and exclusions to the insurance commissioner for every state in which they write insurance. It's a solid bet that if they're excluding Lyme disease, they're allowed to do it.

From the facts you've given, the only way I seem the exposed to potential liability is if they deny a claim on the basis of Lyme disease when there's good reason to think that the claim isn't actually related to the disease. But even a successful lawsuit there wouldn't force them to pay for a Lyme-related claim, it would simply reclassify a claim as non-Lyme related.

You may not like this, but I don't think there's any real way around it. Certainly talk to your insurance broker and shop around, but this is probably something you're just stuck with.
posted by valkyryn at 9:30 AM on June 16, 2009

Response by poster: I don't think horses have the same legal coverage that people so when it comes to pre-existing or ongoing conditions! IIRC from insurance shopping 2 years ago, a lot of life policies include a colic rider - so I'm thinking fshgrl might be on the right track. I think I'm going to get a few quotes for life with a colic rider and consider foregoing the major medical.
posted by COD at 9:32 AM on June 16, 2009

bz- it's an insurance policy for a horse not health insurance for a person. The company is basically insuring you against financial loss of your livestock and the value of a horse is tied directly to it's soundness and health so it's entirely reasonable for them to exclude chronic conditions.

COD you might also want to look into what happens to the horse if you claim loss of use or other major medical when making this decisions. The ownership may revert to the insurance company at that point.
posted by fshgrl at 9:09 AM on June 17, 2009

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