What To Do If Your Pet Insurance Claim Is Denied
Maybe your dog thought the sock was a snack. Even a minor scratch on your cat’s nose turns into a not-so-minor infection. You rush to the vet and approve the treatment plan without hesitation, confident that your pet insurance will cover it.
Then things change: You submit a claim, and it is denied.
The truth is, sometimes insurers say no. Your pet’s condition may be listed as pre-existing, your application form may be missing important information or the prescribed treatment may not be covered under your policy.
However, you are not without options. Here’s what to do next.
Key Takeaways
- Denials of pet insurance applications often stem from preventable issues such as missing records, waiting periods or filing deadlines.
- Understanding your policy’s terms and exclusions before you file reduces the risk of denial and strengthens your case if you need to file a complaint.
- Denial is not always final. Policyholders can appeal the decision, submit additional documents and request a second review
Why pet insurance claims are rejected
With most pet insurance plans, you pay the vet in advance and submit the claim with a written invoice to your insurer. Then the insurance company reviews it, and reimburses you for all covered expenses.
If your claim is denied, it may be because:
Your plan doesn’t shut you down
Just like car insurance companies won’t charge for oil changes, standard pet insurance policies won’t cover the cost of annual checkups, dental cleanings or other types of routine maintenance.
Remember that your insurance may pay for treatment if your pet develops a preventable illness, such as heart disease or tick-borne disease, but only if you have followed recommended vaccinations and parasite prevention.
The condition precedes your policy
The fine print is important here, because what insurers consider “pre-existing” is not always clear.
Say your dog tore a ligament in his left knee before purchasing pet insurance, and later has the same symptoms in his right knee after purchasing coverage. The insurer will likely treat the new injury as a problem from the previous one, and deny the claim. (In insurance terms, this is called a bilateral pre-existing condition.)
You have selected a limited installation
Some pet owners opt for accident-only coverage, which often costs less than a comprehensive policy.
The result is that these programs do not cover diseases. So even if the trip to the ER starts with a broken bone, you’ll be paying out of pocket if the vet eventually diagnoses hip dysplasia or another underlying medical condition.
You have increased your benefits significantly
When you enroll your pet in insurance, you usually choose how much your insurance will reimburse you each year. Annual coverage limits start at around $2,500, although some policies offer unlimited payouts.
If you reach your policy limit, you will be responsible for any additional charges even if the services are otherwise covered.
You missed the deadline to file a claim
Most insurers require claims to be filed within 90 to 180 days of treatment. If you miss that window, your claim may be denied.
How to challenge a rejected claim
If your pet insurance claim has been denied and you think the decision was wrong, review your policy terms and follow these steps:
1. Start with a negative letter
The denial notice must clearly explain why your request was denied, and describe the process for appealing the decision. Sometimes the fix is a simple paperwork error, like a missing page on your pet invoice.
2. Call your insurance
If you are still unclear as to why the claim was denied or need clarification on next steps, call your pet insurance company directly. Ask what additional information and documents are required and if there is a deadline for filing an appeal. Make notes, including the date and time of the call and the name of the representative you spoke to, in case you need to follow up or transfer the matter later.
3. Gather supporting documents
When you submit a claim, insurers usually require a written invoice and up to 12 months of medical records. Additional documentation — such as diagnostic test results, X-rays or a letter from your veterinarian explaining the diagnosis and treatment — can also help support your case.
“Claims are often denied if adequate health records are not provided,” said Sammi-Jo Nevin, president of the North American Pet Health Insurance Association (NAPHIA).
“If you have recently changed vets and are submitting your first application, we recommend that you obtain medical records from your previous vet. [too],” he said. “This can often help expedite claim review and reimbursement.”
4. File your complaint
With all the necessary documents in hand, you are ready to make your case.
This usually means filling out a complaint form and sending any additional information the company requests online or by email, fax or post.
Complaints are not resolved overnight. In some cases, the insurance company will contact an in-house veterinarian or “other licensed representative” to review the case, according to Nevin. Reviews may take days or weeks, but they will let you know when they have made a decision.
5. Go up the chain
If your appeal is rejected, ask a manager or specialist to review the case. Just be aware that a second appeal usually requires you to provide new information to support your claim — resubmitting the same documents twice is unlikely to change the outcome.
If you’ve gone through the appeals process and don’t agree with the outcome, you can file an appeal with your state’s insurance department.
Revisit your installation
The best way to avoid a denied pet insurance claim is to review your policy at least once a year to make sure your coverage still meets your pet’s needs — and your budget.
If adding coverage will stretch your premiums too thin, Nevin recommends calling your insurance provider.
“Generally, the company can work with it [you] with options,” he said.
Frequently Asked Questions
How do pet insurance claims work?
Most pet insurance policies work with reimbursement. You pay the bill out of pocket and submit a reimbursement claim to your insurer. If the insurer approves your claim, you will receive the money by direct deposit, electronic transfer or paper check. If the claim is rejected, you will receive a letter detailing the reasons. You can appeal the decision within 60 to 90 days from the date you received the letter, although the exact window varies by insurer.
How many pet insurance applications are denied?
There is no specific data available on the number of pet insurance claim denials. However, a 2025 MarketWatch study found that 33% of pet insurance owners had at least one claim during the year, and 82% of those who had a claim had no problems during the claims process.
Do pet insurance premiums go up after a claim?
Most pet insurance companies clearly state that your premiums will not increase if you file a claim. That said, you may see significant rate increases each year after insurers reassess your pet’s medical costs and your pet’s risk due to age and other factors.
