12/02/2021 | News release | Distributed by Public on 12/02/2021 15:25
This was a claim relating to the health of an insured horse. Suspicions rose given the timing of the claim, relative to when the insurance policy began.
The policy started on 28 July. The loss date under the policy was just a few days later on 12 August of the same year. Crawford Legal Services (CLS) became involved in the matter following insurers concerns around the timing.
The policyholder had previously changed her story in relation to the claim and made complaints prior to CLS' involvement. The policyholder also had not provided insurers with proof of purchase to demonstrate inception coincided with when she bought the horse.
Our Crawford investigator obtained a detailed statement from the policyholder, as well as separate statements from the horse instructor and vet.
During our investigations, it transpired that an animal physiotherapist had treated the horse on 12 August (the first day of the policyholder's insurance cover for the horse after the qualifying period) but, according to the policyholder, this was simply a treat/massage for the animal.
We obtained the animal physiotherapist's medical notes which alluded to the horse having been "stressy/grumpy".
The policyholder's statement provided to our investigator also wasn't consistent with information she'd initially and previously provided to insurers regarding onset of symptoms. Furthermore, the vet's comments contradicted the policyholder's version of events.
Despite CLS' requests, the policyholder was never forthcoming with any proof of purchase to demonstrate when the horse was purchased. The policyholder also would not provide any messages that were exchanged with the physio, prior to the physio treating the horse.
As this point, concerns still remained as to the legitimacy of the claim. Insurers issued a challenge letter to the policyholder in view of all the discrepancies, to which an unsatisfactory response was received.
Upon our advice, insurers then proceeded to decline the claim on the basis that the condition occurred prior to inception of the policy, or at least during the first 14 days of cover.
A claim saving of £5000 was achieved for our client.
If you would like to discuss equine claims please contact:
Head of Property Fraud, Crawford Legal Services UK