Maybe your dog mistook a sock for a snack. Or a small scratch on your cat’s nose turned into a not-so-small infection. You rush to the vet and approve the treatment plan without hesitation, confident your pet insurance will cover it.
Then things take a turn: You submit a claim, and it’s denied.
The reality is, sometimes insurers say no. Your pet’s condition may be labeled pre-existing, your claim form could be missing a key detail or the prescribed treatment may not be covered under your policy.
Still, you’re not out of options. Here’s what to do next.
Key Takeaways
- Pet insurance claims denials often stem from preventable issues like missing records, waiting periods or missed 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 appeal
- A denial isn’t always final. Policyholders can appeal the decision, submit additional documentation and request a second review
Why pet insurance claims get denied
With most pet insurance plans, you pay the vet upfront and submit a claim with an itemized invoice to your insurer. Then the insurance company reviews it, and reimburses you for all covered expenses.
If your claim is denied, it could be because:
Your plan doesn’t cover it
Much like car insurers won’t foot the bill for an oil change, standard pet insurance policies won’t cover the cost of annual checkups, dental cleanings or other types of routine care.
Keep in mind that your insurer may pay for treatment if your pet develops a preventable illness, like heartworm or a tick-borne disease, but only if you’ve kept up with recommended vaccines and parasite prevention.
The condition predates your policy
The fine print matters here, because what insurers consider “pre-existing” isn’t always obvious.
Say your dog tore a ligament in his left knee before you bought pet insurance, and later develops similar symptoms in his right knee after you purchased coverage. The insurer will likely treat the new injury as a complication from the earlier one, and deny the claim. (In insurance terms, this is called a bilateral pre-existing condition.)
You chose limited coverage
Some pet owners opt for accident-only coverage, which generally costs less than a comprehensive policy.
The drawback is that these plans don’t cover illnesses. So even if a trip to the ER starts with a broken bone, you’ll be paying out of pocket if the vet ultimately diagnoses hip dysplasia or another underlying medical condition.
You’ve maxed out your benefits
When you enroll your pet in an insurance policy, you typically choose how much your insurer will reimburse you yearly. Annual coverage limits start around $2,500, though some policies offer unlimited payouts.
If you hit your policy’s cap, you’ll be responsible for any additional costs even if the services are otherwise covered.
You missed the deadline to file a claim
Many insurers require claims to be filed within 90 to 180 days of treatment. If you miss that window, your claim could be denied.
How to challenge a denied claim
If your pet insurance claim was denied and you think the decision was wrong, review your policy terms and follow these steps:
1. Start with the denial letter
The denial notice should clearly explain why your claim was rejected, and outline the process for appealing the decision. Sometimes the fix is a simple paperwork error, like a missing page from your vet’s invoice.
2. Call your insurer
If you’re still unclear why the claim was denied or need clarity on the next steps, call your pet insurance company directly. Ask what additional details and documentation are needed and if there’s a deadline for filing an appeal. Take notes, including the date and time of the call and the name of the representative you spoke with, in case you need to follow up or escalate the issue later.
3. Gather supporting documents
When you submit a claim, insurers typically require an itemized invoice and up to 12 months of medical records. Additional documentation — like diagnostic test results, X-rays or a letter from your vet explaining the diagnosis and treatment — can also help support your case.
“Claims are commonly denied if sufficient medical records aren’t provided,” says Sammi-Jo Nevin, president of the North American Pet Health Insurance Association (NAPHIA).
“If you’ve recently changed vets and are submitting your first claim, we recommend getting medical records from your previous vet [too],” she says. “This can often help speed up claim review and reimbursement.”
4. File your appeal
With all the necessary paperwork on hand, you’re ready to make your case.
This usually means filling out an appeal form and submitting any additional information the company requests through its online portal or by email, fax or mail.
Appeals aren’t resolved overnight. In some cases, the insurance company will tap an in-house vet or “another licensed representative” to review the case, according to Nevin. Reviews can take days or even weeks, but they’ll let you know once they’ve made a decision.
5. Go up the chain
If your appeal is denied, ask for a supervisor or specialist to review the case. Just know that a second appeal usually requires providing new information to support your claim — resubmitting the same documents twice probably won’t change the outcome.
If you’ve gone through the appeals process and still disagree with the outcome, you can file a complaint with your state’s insurance department.
Revisit your coverage
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 fits your pet’s — and your budget’s — needs.
If adding coverage would stretch your finances too thin, Nevin recommends calling your insurance provider.
“Commonly, the company can work with [you] on options,” she says.
FAQs
How do pet insurance claims work?
Most pet insurance policies work via reimbursement. You pay the bill out-of-pocket and submit a reimbursement claim with your insurer. If the insurer approves your claim, you’ll get the money via direct deposit, electronic transfer or a paper check.
If the claim is denied, you’ll get a letter detailing the reasons. You can appeal the decision within 60 to 90 days from the date you received the letter, though the exact window varies per insurer.
How often are pet insurance claims denied?
There isn’t specific data available on the rate of pet insurance claim denials. However, a 2025 MarketWatch study found that 33% of pet insurance policyholders had at least one claim during the year, and 82% of those who had a claim had no issues during the claims process.
Do pet insurance premiums go up after a claim?
Most pet insurance companies plainly state that your premiums won’t go up if you file a claim. That said, you may still see a significant rate increase year-over-year after insurers reassess the cost to treat your pet and your pet’s risk due to age and other factors.
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