Pre-Existing Conditions in Pet Insurance: What's Excluded and What You Can Do About It

Pre-existing conditions are the most important concept in pet insurance and the most common reason claims are denied. Understanding how they work helps you make better enrollment decisions and avoid surprise denials.

What Counts as Pre-Existing

A pre-existing condition is any injury, illness, or symptom that existed before your coverage start date or during the waiting period. This includes conditions that were formally diagnosed by a vet, symptoms that appeared in vet records even if no diagnosis was made, and conditions that were observable even if you didn't seek treatment. The key is your pet's veterinary records. When you file a claim, the insurer requests your pet's complete medical history from every vet who has treated them. Any condition or symptom documented before coverage began is pre-existing.

Curable vs. Incurable Pre-Existing Conditions

Some insurers distinguish between curable and incurable pre-existing conditions. Curable conditions (ear infections, urinary tract infections, vomiting/diarrhea episodes) may become eligible for coverage if your pet has been symptom-free and treatment-free for 12-18 months. Not all insurers offer this - Embrace and Spot do. Incurable conditions (diabetes, hip dysplasia, heart disease, cancer history, allergies) are permanently excluded once they appear in vet records. They will never be covered regardless of how long your pet has been symptom-free.

How to Minimize Pre-Existing Exclusions

Enroll as early as possible. The fewer vet visits on record before enrollment, the fewer potential pre-existing conditions. Enrolling a puppy at 8-12 weeks with only an initial wellness exam creates the cleanest record. Enroll before getting anything checked out. If you suspect your pet might have a health issue, enroll in insurance before taking them to the vet for diagnosis. Once a condition is documented, it's pre-existing. This isn't gaming the system - it's planning ahead.

Be aware of bilateral condition clauses. Some insurers treat bilateral conditions as related. If your dog tears the ACL in one knee (pre-existing), they may exclude the other knee too, since bilateral ACL tears are common. Embrace and Healthy Paws are among the companies that don't apply bilateral exclusions. Keep vet records clean. Casual mentions of minor symptoms in vet notes ("owner reports occasional itching") can become the basis for pre-existing condition exclusions later. Discuss only current, relevant symptoms with your vet.

What If Your Pet Already Has Pre-Existing Conditions?

Insurance is still valuable even with exclusions. A dog with pre-existing allergies can still get coverage for cancer, accidents, infections, digestive issues, and everything else. The allergy treatment comes out of pocket, but a $5,000 cancer surgery would still be covered. The only scenario where insurance doesn't make sense is if your pet has so many pre-existing conditions that the remaining covered scenarios are minimal.