What to do if Pet Insurance Company Denies Your Claim

Having medical insurance for pets is a great convenience to owners.  Insurance policies for pets are not as complicated and much easier to understand that those for people.  Some of the clauses and requirements may not be clear – it is up to the buyer to get clarifications on coverage.  If you have insurance in place and filed a claim, some reasons for denial of a claim could be:

  • Your pet is older
  • It has pre-existing health conditions
  • If the condition developed before you bought insurance.  This exclusionary clause will be valid to the period the condition began, not when it was diagnosed. Keep in mind that coverage doesn’t start the day you buy a policy. There is a waiting period. 
  • Incomplete or improperly filled forms
  • Coverage for specific care. Some place include all treatments and others cover just accidents. Check your plan for coverage when filing a claim.

How to contest a Denial:

Every insurance provider has a process in place so that disputes can be resolved amicably.  Look for the information in your insurance policy or claims section to determine what steps have to be taken and the information needed.  Talk to an agent at the company for a review of the claim or how to dispute denial.

  1. Go through the paperwork and make sure there are no mistakes.
  2. Include any documents that you may have forgotten to do so.
  3. If the company claims pre-existing condition for denying a claim, contest it if you can prove otherwise.
  4. Transparency when applying for an insurance policy for your pet is a good idea. Insurance companies are well within their rights to request medical records. 
  5. If you apply for insurance on an older pet, the company could request a physical exam before insuring.

The reasons for denial should be very clearly given in a letter from the insurance carrier.  Details could be offered in the form of exclusions, prior healthy conditions, ineligibility etc. are some of the reasons. 

Insurance companies don’t usually turn down claims.  If you are not happy and believe your claim was turned down unfairly, then filing a complaint with the State Insurance Department is an option.  This is usually free and the State will intervene.  Investigators will talk to the insurance company, gather information about the claim, get copies of the policy and other records and make a decision. 

If you are not happy with the results after approaching the insurance company or the state, you have the choice of filing a lawsuit to get reimbursed.  Winning in court could help you win legal costs as well.