Major Medical, Surgical and Loss of Use

Major Medical

Coverage is provided for the cost of the medical and surgical procedures including diagnostic tests as a result of accident, illness, injury or disease. Limits available up to $25,000

Surgical Coverage

Provides for surgical procedures done under a general anesthesia. Coverage is for the cost of the surgery and for up to 50% of the cost of non surgical veterinary aftercare. Limits available up to $10,000.

Full Loss of Use

Provides coverage if your horse becomes permanently unable to proform its insured use as a result of and accident, illness, injury or disease. Pays up to 70% of the insured value (depending on company).

Accidental Loss of Use

Provides coverage if your horse becomes permanently unable to perform its insured use as a result of visible injury caused by external, accidental and violent means. Pays up to 70% of the insured value (depending on company).

Why Horse Owners Add Medical Cover to a Mortality Policy

Mortality insurance answers one question: what happens financially if you lose your horse. For most owners, though, the more common worry is the other scenario — the horse survives, but the veterinary bill is severe. Colic surgery, hospitalisation, diagnostic imaging and a long lameness work-up can become a serious financial strain very quickly, and that strain often arrives at the worst possible moment, when you are already making difficult decisions about your horse’s welfare.

Major Medical and Surgical endorsements exist to take that financial pressure out of the decision. Added to a mortality policy, they mean the treatment conversation with your veterinarian can be about what is best for the horse rather than about what you can afford this month. Loss of Use, meanwhile, addresses a third scenario that mortality cover deliberately excludes: the horse recovers and lives comfortably, but can never again do the job you bought it for.

One structural point matters before anything else. None of these coverages can be purchased on their own. Major Medical/Surgical, Surgical Only and Loss of Use are all available exclusively as endorsements attached to an active equine mortality policy. If your goal is protection against veterinary costs, the starting point is still a mortality policy on the horse.

Major Medical Coverage in Practice

Major Medical is the broadest of the veterinary endorsements. It responds to the cost of medical and surgical procedures, including the diagnostic testing needed to reach a diagnosis, where the underlying cause is accident, illness, injury or disease. Limits are available up to $25,000.

Because it includes diagnostics, Major Medical is the endorsement that tends to matter most in the drawn-out cases — the lameness that needs blocks, radiographs and ultrasound before anyone can name it, or the recurring illness that requires bloodwork over several weeks. It is worth understanding how these claims are settled: Major Medical claims are paid on a reimbursement basis. You pay the veterinarian directly, then submit the invoices to us promptly, and the carrier reimburses you within the terms and limits of the endorsement. Keeping clean, itemised invoices and submitting them without delay is the single best thing an owner can do to keep a medical claim moving.

Surgical Coverage

Surgical Coverage is the narrower, more affordable alternative for owners whose principal concern is a catastrophic surgical event such as colic surgery. It provides for surgical procedures performed under general anaesthesia, covering the cost of the surgery itself and up to 50% of the cost of non-surgical veterinary aftercare. Limits are available up to $10,000.

The aftercare element is easy to overlook and often significant. A surgical recovery rarely ends when the horse leaves the clinic, and the follow-up care, medication and monitoring that follow can add meaningfully to the total bill. Because Surgical Coverage is tied to procedures done under general anaesthesia, it does not respond to medical management of the same condition — which is precisely the gap Major Medical is designed to fill. Owners who want both the diagnostic and the surgical exposure covered generally choose Major Medical rather than Surgical Only.

Full Loss of Use

Full Loss of Use applies when your horse becomes permanently unable to perform the use described on the policy, at any level, as a result of accident, illness, injury or disease. Where the claim is accepted, the carrier pays a percentage of the insured value — usually in the region of 50% to 70%, depending on the company and the policy written.

The claim process is medical rather than administrative. A veterinarian must advise the claims department that the horse is permanently disabled for its insured use. The carrier may then have its own veterinarian examine the horse to confirm the diagnosis. If the two veterinarians do not agree, a third veterinarian may be brought in to mediate the difference of opinion. This is why the accuracy of the “use” stated on your policy matters so much: the whole assessment is measured against that declared use.

Equally important is what Loss of Use does not do. It does not apply to a horse that is laid up for an extended period following injury and then returns to work. The trigger is permanent inability to perform the insured use, not a long rehabilitation.

Accidental Loss of Use

Accidental Loss of Use covers the same outcome through a narrower door. It responds where a horse becomes permanently unable to perform its insured use as a result of visible injury caused by external, accidental and violent means, and likewise pays up to 70% of the insured value depending on the carrier.

The practical difference is the cause. A career-ending injury sustained in a fall or a paddock accident, where the damage is visible and clearly traumatic in origin, is the classic Accidental Loss of Use claim. A progressive degenerative condition or a disease process that ends a horse’s career would not meet that narrower trigger, but could fall within Full Loss of Use. Owners choosing between the two are generally trading premium against the breadth of causes covered.

Which Horses Qualify

Eligibility for these endorsements is assessed alongside the mortality application, and a few boundaries are worth knowing before you apply:

• Age. Major Medical and the other endorsements typically become available from around 30 days of age, while mortality cover can begin as early as 24 hours old. The minimum age for coverage outside mortality varies from carrier to carrier.
• Discipline. Loss of Use is not available for every discipline. It is usually eligible for hunter/jumper and dressage horses, and sometimes for reining horses. Your agent can confirm what is available for your horse’s declared use.
• Colic and surgical history. A horse treated for colic can often still be insured, depending on the type of colic and the number of episodes. A horse that has had colic surgery may also qualify, provided there was no bowel resection and no repeated episodes — although exclusions may apply to mortality and to the medical endorsements as a result.
• Health at inception. As with mortality, the horse must be clinically normal and warranted in good health, supported by a veterinary certificate or a Statement of Health depending on the insured value.

Reporting a Medical or Loss of Use Claim

Timing is the part of the process owners most often get wrong, and it is the part most likely to affect the outcome. We ask for immediate notification of a claim, or within 24 hours at the very latest. In non-emergency situations it is best to make contact within that window, or even before a potential claim arises, so that we can flag any time limitations or exclusions that might apply. If the situation is serious enough for the veterinarian to come out, make contact immediately.

Your policy is issued with 24-hour claim cards. Carry one and leave one at the barn or with your trainer, so that the emergency number is available to whoever is with the horse. Crucially, the carrier must be notified before surgery is performed and before euthanasia is carried out where it has been recommended. Failure to notify the agency and the carrier can void coverage on a claim that would otherwise have been paid.

Building the Right Combination for Your Horse

There is no single correct answer for every horse. A young prospect being campaigned in the hunter ring, an established dressage horse at the top of its value, a broodmare and a retired schoolmaster all carry different exposures, and premium is driven by age, breed, use and value. What matters is that the combination of mortality cover and endorsements reflects how the horse actually lives and works today, and that the declared use and stated value are kept up to date as that changes.

Equine Insurance, a division of Parker General Insurance, has been placing equine coverage for over 40 years, and our agents spend their days comparing what different carriers will and will not write. If you would like help matching endorsements to your horse, request a free quote, review the equine mortality policy these endorsements attach to, or read our frequently asked questions for more on claims, values and renewals.