Major Medical Misunderstandings

Far too often, horse owners end up unsatisfied with their coverage, policy and agent. Dunn, Tavarez, Cotton and Nichols all agree it is frustrating for all parties involved and usually can be avoided from a deeper knowledge of the policy prior to the claim. Dunn emphasizes paying close attention to the smaller details.

“Some people go by price alone, and they don’t pay attention to what the policy may actually pay or to major medical co-pays,” Dunn said. “I think the majority of the time where there’s a problem is when people don’t fully understand what they are buying.”

When Nichols’ great barrel horse KN Fabs Gift Of Fame suffered a tendon injury requiring surgery and an extensive rehabilitation program, Nichols thought he knew exactly what to expect. With 15 years experience as an insurance adjuster, Nichols felt he understood all he needed to know about equine insurance. But even for the well-versed businessman, there were valuable lessons learned from the process.

“‘J-Lo’ is actually with a different carrier than our other horses,” Nichols said. “There were some things in the policy that were misunderstood. We had to work through a lot of different things on our policy. It was a total nightmare, to be honest.”

After all was said and done, Nichols and J-Lo came out of the situation very fortunate considering the circumstances, but it was far from seamless.

To save others the headache, Nichols’ main piece of advice is that prior to buying a policy, get acquainted with your agent and coverage. When J-Lo’s tendon surgery was completed, the mare still faced a long road toward recovery. Nichols says he was shocked to find out, although the veterinarian prescribed the rehabilitation program, that his insurance would not cover the boarding fees from the rehab process.

“Here we are with a hurt horse and working through rehab, and even with our major medical policy, the board wasn’t covered,” Nichols said. “Unless the horse is actually at a vet clinic or a vet-assigned hospital, boarding is not covered. That was our biggest awakening.”

KN Fabs Gift Of Fame
The great mare KN Fabs Gift Of Fame required extensive rehabilitation therapy after a successful tendon surgery. Photo courtesy Kenny Nichols

Companies differ in the payment structure of major medical policies, and most have limits. Some may only cover diagnosis until treatment has been determined, while others cover diagnosis and treatment up to the predetermined limit.

“If you want major medical coverage, it could replace the colic endorsement,” Tavarez said of the Plains Horizon policy. “For lameness issues, a major medical policy would cover 60 percent of diagnostic and treatment after the deductible is paid.”

Other major medical claims are usually structured with the insurance company paying between 60 to 80 percent co-pays. Because coverage on major medical differs substantially, Nichols advises grounding your decision based on what’s realistic to your situation.

“Major medical is not for everybody,” Nichols said. “In some ways it can be a gamble, but you still have to look at the dollar amount.”

Clarifying Colic Surgery Coverage

The ever-feared colic surgery is on the forefront of nearly every horse owner’s mind. When it comes to coverage, there are significant aspects concerning colic in your insurance policy, and not understanding the specifics could cost you dearly.

“You must at all times provide proper care to the horse and all reasonable means to protect the horse, immediately at your expense,” Tavarez said. “We don’t ever want a horse to suffer, but you don’t want to put a horse down too soon. If your vet says you need to do a colic surgery because it’s in the best interest of your horse, but you decide not to do the surgery because of cost, you may jeopardize your claim.”

With a colic endorsement, you are in a binding contract to attempt the colic surgery if the vet says it is necessary.

“If you refuse colic surgery and the vet is recommending it, then you have probably voided your whole policy,” Dunn said.

With several standing studs at his facility in Waco, Texas, Nichols often hears the heartache from clients where this exact misunderstanding has caused serious issues.

“I don’t think enough people understand you have to try colic treatment, and before you can make any decisions about surgery or putting the horse down, you have to talk to your agent and you have to get a vet out there,” Nichols said. “When things like colic happen, you’re not thinking you have to call your insurance agent. You are focused on saving your horse and the vets are trying to be realistic and do what is humane. But, you have to get them involved. A lot of the time, your vet has to talk to the agent to tell them, ‘Hey, it’s the humane thing to do right now.’ I don’t think enough people understand you have to try colic surgery.”

Involving your agent in any type of sickness or injury to your horse is crucial, according to Tavarez. First things first, you must take prudent care of the horse and let your agent know the situation. Every company provides clients with a 24-hour contact number in case of emergencies.

“If a horse is sick or injured, notify us as soon as possible,” Tavarez said. “You always have to get a vet or a third party out there. The most important thing on my part is it’s a legal contract, and I have a whole team behind me to make sure everything is documented. I don’t mind taking the phone calls at 10 p.m., it’s like a doctor, you sign up for the hours. It’s very important to have a document trail. That’s us doing diligence so we don’t pay fraudulent claims.”

Mare and foal
A prospective foal policy guarantees a live foal through either seven days or 45 days after parturition, depending on the term of the policy. BHN file photo.

Money doesn’t always pay for a replacement when you lose your winning mount. As Tavarez explains, there is a lot more involved in finding your next match.

“There is more to it than money,” Tavarez said. “You have to start over, maybe you can buy multiple prospects, but when you have that once-in-a-lifetime horse, you can’t replace that horse. A lot of us just get one if we’re lucky.”

The sentimental value attached to your horse can far exceed your bank account, but the benefits to knowing you have the monetary means needed to protect the horse in case of injury is priceless. Don’t risk losing your once-in-a-lifetime partner to any of the inherent risks of owning a horse. Instead, use equine insurance as a safety net to make the best out of a bad situation and preserve the security of your horse.

“You would spend that investment on tack,” Dunn said of insurance premiums. “Why not spent it to protect your horse?”

Key Players

Plains Horizon Equine Insurance:
• Owner: Marvin Tavarez
• Website: gethorseinsurance.com
• Contact: [email protected]

Wilkins Livestock
• Agent: Roger Kimbrough
• Website: www.livestockinsurance.biz
• Contact: 1-800-826-9441

LCI Livestock Insurance Services, LLC
• Owner: Lyndia Cotton
• Website: www.lcihorse.com
• Contact: [email protected]

Dunn Insurance
• Owner: Chuck Dunn
• Website: www.Chuckdunninsurance.com
• Contact: [email protected]

Kay Cassell Equine Insurance
• Owner: Kay Cassell
• Website: www.kaycassell.com
• Contact: [email protected]

Sonora Insurance Group
• Agency principal: R. Paul Hulsebusch
• Website: www.sonorains.com
• Contact: [email protected]

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Author

Kailey Sullins is editor of Barrel Horse News, and an avid barrel racer and breakaway roper. Email comments or questions to [email protected]

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