Understanding Colic Exclusions in Equine Insurance
Colic. It’s a word no equestrian wants to hear and a horse-health issue we all dread facing. And when it comes to insurance, few topics create more confusion for horse owners than colic exclusions.
The following information explains how colic exclusions typically work and what horse owners should expect. But, let’s first start with some basic background.
What Is a Colic Exclusion?
A colic exclusion is something added to a policy that excludes coverage for future colic- related claims. Carriers generally add a colic exclusion whenever a horse experiences a colic episode, even if no insurance claim was submitted.
The presence of a colic exclusion does not mean a horse is uninsurable. It simply means future colic-related expenses may not be covered while the exclusion is in place.
Why Do Insurance Carriers Impose Colic Exclusions?
From an insurance perspective, colic presents a unique challenge because it is one of the most common medical emergencies affecting horses and one of the most expensive conditions to treat. While many horses experience only a single episode during their lifetime, others may have recurring colic events that result in significant veterinary expenses.
When a horse has experienced a colic episode, carriers view that horse as having a potentially higher risk of future colic-related claims. A colic exclusion allows the carrier to continue providing coverage for many other illnesses and injuries while limiting its exposure to a condition that may be more likely to recur.
It is important to understand that a colic exclusion is not a penalty for filing a claim. In fact, carriers generally impose colic exclusions regardless of whether a claim was submitted. The exclusion is based on the horse's medical history and the carrier’s assessment of future risk, not on whether insurance benefits were paid.
For this reason, even horses that experienced a relatively minor colic episode and never submitted a claim may still receive a colic exclusion at renewal or when applying for new coverage.
How Long Does a Colic Exclusion Last?
The answer depends on the type and severity of the colic, as well as the insurance carrier’s underwriting guidelines.
Are All Colics Treated the Same with Regard to Removal?
The short answer is no, they aren’t. Here are some special considerations you should know about that could impact your coverage:
1. Medical Colic
Most medical colic exclusions can be reviewed for removal approximately six
months after the incident, provided the horse has not experienced any additional colic episodes.
If the colic was particularly severe – say, requiring an extended hospitalization or resulting in a substantial claim payment – a carrier may require a longer waiting period, often up to one year, before considering removal.
2. Surgical Colic
If a horse underwent colic surgery but did not require a bowel resection, carriers will often consider reviewing the exclusion after one to two years, assuming there have been no additional colic-related issues.
3. Resections
If a horse underwent a bowel resection as part of colic surgery, the colic exclusion is generally considered permanent and will not be removed.
4. Multiple Colic Episodes
A horse with multiple medical colics, or a combination of medical colic and colic surgery, may have a significantly lower likelihood of having the exclusion removed. Each case is evaluated individually, but repeated incidents indicate a higher risk profile to the carrier.
How Does Emergency Colic Surgery Coverage Work?
Many policies include Emergency Colic Surgery (ECS) coverage. When a covered colic surgery occurs, ECS coverage is typically applied before Major Medical or any supplemental medical coverage.
It is important to understand that once ECS coverage has been utilized for a surgical colic claim, it generally cannot be added back to the policy in the future.
Does Moving to a New Insurance Carrier Change Anything?
Many horse owners assume that if a colic exclusion has been removed by one carrier, it will remain removed forever. Unfortunately, that is not always the case.
If you move your horse to a different insurance company, the new carrier may review the horse’s complete medical history and reapply a colic exclusion, even if a previous carrier had removed it.
How Are Exclusions Removed?
A carrier will never remove an exclusion automatically meaning the policyholder or agent must request a review. In most cases, the carrier will require a Colic Statement of Condition completed by the owner and/or veterinarian. Additional veterinary records or documentation may also be requested.
At LEGIS, we make every effort to review eligible exclusions at renewal. Whenever possible, we send a Colic Statement of Condition form with renewal paperwork so that reviewable exclusions can be evaluated for removal.
If you would like an exclusion reviewed before renewal, we are happy to submit that request on your behalf.
Must I Disclose All Colic Episodes?
One of the biggest mistakes horse owners make is failing to disclose a prior colic episode when applying for coverage. Even if the previous incident seemed minor, it should be reported.
If a future colic claim is submitted, the carrier will typically obtain and review the horse’s veterinary records. If an undisclosed prior colic is discovered, the carrier may deny the claim and could potentially take additional action regarding the policy.
This principle applies not only to colic claims but to all insurance claims. Complete and accurate disclosure is always the best approach.
How Long Do I Have to File a Claim?
Every carrier has deadlines for claim reporting. If a claim is submitted outside the carrier’s required reporting window, there is very little chance it will be covered, regardless of the type of claim. When in doubt, notify your agent and carrier as soon as possible after an incident occurs.
The Most Important Advice
Read your policy!
Insurance policies contain important details about exclusions, waiting periods, claim requirements, coverage limits and reporting deadlines. If something is unclear, ask questions before a claim occurs. A few minutes spent understanding your policy today can prevent significant frustration and unexpected expenses later.
SNAPSHOT/AT A GLANCE SECTION:
A colic exclusion can be added even if no claim was filed. Any documented colic episode may trigger an exclusion.
Most colic exclusions are not permanent. Depending on the type and severity of the colic, carriers may review the exclusion for removal after six months to two years.
A bowel resection typically results in a permanent exclusion. Carriers generally will not remove a colic exclusion following a resection.
Exclusions are never removed automatically. Owners must request a review and usually provide a Colic Statement of Condition and, in some cases, veterinary records.
Always disclose a horse’s full colic history. Failure to report prior colic episodes can jeopardize future claims and potentially affect coverage.