Pre-existing conditions and pet insurance

Sometimes, knowing what your pet insurance doesn’t cover is just as important as knowing what it does. In this article, we’ll look more closely at one reason claims sometimes get declined to help avoid nasty surprises.

Pet insurance is designed to cover vet charges for treatment of unexpected injuries and illnesses, like when your dog cuts his foot on broken glass, or your cat gets into a nasty fight with another feline.

But pet insurance doesn't cover injuries or illnesses (or symptoms or signs of those injuries and illnesses) that occurred before your policy started or happened during the stand down period. These are called pre-existing conditions and, like all pet insurers, we exclude these from our cover.

That’s why, when you apply for pet insurance, we need you to tell us if your pet has any pre-existing conditions. We’ll ask you to let us know about conditions or health events that your pet might have experienced, and whether you’ve taken your pet to the vet for something other than routine vaccinations or health checks (or if there was a time when you thought you probably should’ve taken them to the vet).

When we know this, our team can request and review your pet’s full medical records from the vet clinics you’ve taken your pet to. We’ll then assess the risk of a pre-existing condition recurring and decide if it should be excluded from cover. Doing this up front avoids the disappointment of a claim being declined later if a pre-existing condition is only discovered at the time of treatment.

In this article you’ll learn:

Let’s dig in...

Why doesn’t pet insurance cover pre-existing conditions?

It’d be great if pet insurance covered every single scenario and health condition - including the ones that had already occurred (and might come back) - wouldn’t it?

But that’d be like taking out car insurance and expecting it to cover the costs of repairing a ding that had happened before your policy started.

It’s just not how insurance works.

Insurance is a financial tool designed to help people manage risk and protect them against financial losses from unexpected or unforeseen events. If it covered everything, our premiums would be incredibly expensive.

So, if your pet has already had a particular health condition, and if it’s likely that health condition (or a related one) will occur in the future, then it’s highly likely that the treatment of it will be excluded from your policy because it’s a pre-existing condition (or a foreseeable event).

What are some examples of pre-existing conditions?

Life gets busy and it can be easy to forget about some of the injuries and illnesses your pet has had. So here are just a few examples of health conditions we’d want you to tell us about. Some of these are a bit different for pets than for human health!

• Skin conditions, allergies, cancer, epilepsy, diabetes or any ongoing condition your pet has been diagnosed with, is showing symptoms of or is taking medication for.
• Ear infections, urinary tract infections, cruciate ligament ruptures, tummy problems, or any other condition that might reoccur.
• Limping, vomiting, skin lesions or masses or any symptom that could be an early sign or symptom of a health condition
• If your pet was in a car accident and suffered an injury
• If your pet has needed vet treatment for gastroenteritis, or for eating something like poison or a non-food item more than once in the last 12 months
• If your pet has been involved in more than one fight in the last 12 months with another animal – regardless of who started it!

Different types of pre-existing conditions (including those that you can ask to be reviewed)

Not all pre-existing conditions are the same.

For example, a minor injury is more likely to be a one-off event; while conditions like allergies and diabetes are likely to be ongoing or can happen again.

So, when a pre-existing condition is listed as excluded on your certificate of insurance, we’ll make it clear whether it’s reviewable or associated with a specific event. In both cases you can request a review if your pet hasn’t had a recurrence or any further symptoms for a period of time, and your vet medical records show no further treatment has been provided for that condition.

What happens if a pre-existing condition isn’t declared (even if you don’t know about it)?

When you make a claim, we may request your pet’s full medical history from your vet (and any previous vets). We’ll review everything to see if your pet has had any previous health issues, including any related to the treatment the claim is for.

If we discover that your pet had a pre-existing condition we’ll do the following:

• Decline the claim if it’s related to a pre-existing condition;
• Note any pre-existing conditions we discover on your certificate of insurance as an exclusion; and
• Decline any future claims that relate to an identified pre-existing condition.

Letting us know about pre-existing conditions at the time you apply is the best way to go and won’t affect the premium you pay or your eligibility for insurance. Instead it will give you clarity about what will and won’t be covered under your policy.

Got a question?

Letting us know about any pre-existing conditions when you apply for pet insurance is really important for both you and us – we both need to know what your policy covers and what it doesn’t. So, if there’s a condition you’re not sure about, just contact one of our pet-loving team members.