Why Pet Insurance Claims Get Denied (And How to Avoid It)
Learn the top 10 reasons pet insurance claims get denied and how to ensure your claims are approved. Expert tips to avoid claim rejection.
Michael Torres
Insurance Analyst
Nothing is more frustrating than paying for pet insurance, only to have your claim denied when you need it most. Understanding why claims get rejected can help you avoid these costly mistakes.
Top 10 Reasons Pet Insurance Claims Get Denied
1. Pre-Existing Conditions
The #1 reason for claim denials.
Any condition that existed before your policy startedâor showed symptoms during the waiting periodâwonât be covered.
How to avoid it:
- Enroll your pet while theyâre young and healthy (read our puppy insurance guide for early enrollment tips)
- Get a vet exam before enrollment to document current health
- Keep detailed health records
2. Filing During the Waiting Period
Every policy has a waiting period (typically 2-14 days for accidents, 14-30 days for illness) before coverage kicks in.
How to avoid it:
- Know your waiting period dates exactly
- Donât schedule non-emergency procedures during this time
- Mark calendar reminders when coverage officially begins
3. Coverage Limits Exceeded
Once you hit your annual, per-incident, or lifetime limit, additional claims are denied.
How to avoid it:
- Choose appropriate coverage limits ($10K minimum, $30K+ for high-risk breeds)
- Track your claims throughout the year
- Consider unlimited plans like Healthy Paws or Trupanion
4. Excluded Conditions or Treatments
Many policies exclude specific conditions, treatments, or services.
Common exclusions:
- Routine wellness care (vaccines, dental cleanings)
- Breeding-related costs
- Cosmetic procedures
- Pre-existing conditions
How to avoid it: Read your policy exclusions carefully before enrolling. See our guide on deductibles and coverage.
5. Late Claim Submission
Most insurers require claims within 60-90 days. Miss this window, and your claim is automatically denied.
How to avoid it:
- Submit claims immediately after each vet visit
- Set reminders if youâre waiting for records
- Use insurer apps for faster submission
6. Incomplete Documentation
Missing vet records, itemized invoices, or claim forms result in automatic denial.
Required documents typically include:
- Completed claim form
- Itemized invoice (not just a receipt)
- Medical records/notes
- Lab results or imaging reports
How to avoid it: Request copies of everything before leaving the vet.
7. Treatment for Neglected Care
If your pet gets sick because you skipped vaccinations or routine care, the claim may be denied.
How to avoid it:
- Keep vaccinations current
- Maintain regular vet check-ups
- Document all preventive care
8. Billing Errors
Sometimes denial isnât your faultâitâs a billing code error from your vet.
Common errors:
- Wrong diagnosis codes
- Missing procedure details
- Duplicate charges
How to avoid it: Review the invoice with your vet before submission.
9. Wrong Pet Information
Outdated information on your policy (wrong age, breed, or address) can cause denials.
How to avoid it: Update your policy whenever information changes.
10. Commercial Use Animals
Standard pet insurance doesnât cover working dogs, breeding animals, or pets used commercially.
How to avoid it: Get specialized coverage for working or breeding animals.
What To Do If Your Claim Is Denied
Step 1: Review the Denial Letter
Understand exactly why the claim was rejected. Common reasons are often fixable.
Step 2: Gather Documentation
Collect any missing records, vet statements, or clarifying information.
Step 3: Contact Your Insurer
Call customer service for clarification. Sometimes denials are simple misunderstandings.
Step 4: File a Formal Appeal
Write a detailed appeal letter with:
- Policy number and claim reference
- Specific reason you believe the claim should be covered
- Supporting documentation
- Vetâs statement if applicable
Step 5: Escalate if Necessary
If your appeal is denied, you can file complaints with your state insurance commissioner.
Red Flags When Choosing Insurance
Avoid insurers that:
- Have vague exclusion language
- Donât clearly explain waiting periods
- Have excessive claim denials in reviews
- Make the claims process overly complicated
For transparent policies, see our Lemonade review and Embrace review.
Claims Success Tips
| Do This | Not This |
|---|---|
| Enroll early, before health issues | Wait until after a diagnosis |
| Read the full policy | Skim and assume coverage |
| Submit claims within 30 days | Wait until the deadline |
| Keep all vet records | Rely on memory |
| Use itemized invoices | Use payment receipts only |
The Bottom Line
Understanding why claims get denied is the first step to ensuring yours get approved. By enrolling early, keeping records organized, and reading your policy carefully, you can avoid the most common denial reasons.
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Frequently Asked Questions
What is the most common reason pet insurance claims are denied?
Pre-existing conditions are the #1 reason for claim denials. Any condition diagnosed or showing symptoms before coverage began is typically excluded.
Can I appeal a denied pet insurance claim?
Yes! Most insurers have an appeals process. Gather supporting documentation from your vet, write a formal appeal letter, and submit within the specified timeframe.
How long do I have to file a pet insurance claim?
Most insurers require claims within 60-90 days of treatment. Check your policy for specific deadlines to avoid automatic denials.