Pet insurance pre-existing conditions: what counts

If your dog once limped for a week or your cat had a bout of cystitis, it's natural to wonder whether that history will count against you when you claim. Insurers can decline a claim that's related to a pre-existing condition, so it helps to understand how they work before you buy, switch or renew. This guide covers dogs and cats in general terms. It can't tell you how your own policy will treat your own pet, because the wording of that policy decides.

What counts as a pre-existing condition

A pre-existing condition is a health problem that falls within an insurer's definition of something present before cover began. That definition can include earlier signs or symptoms, advice, medication or treatment, so a condition may count as pre-existing even without a diagnosis.

Imagine a dog was seen for intermittent limping in June, a new policy began in July, and a diagnosis followed in August. The insurer may investigate whether the August treatment relates to the earlier problem, because a diagnosis made after the start date doesn't automatically make a claim eligible. The policy wording, the medical evidence and what you knew at the time all matter, and the example doesn't tell you how any particular claim would be decided.

The exact definition can vary between insurers, and an insurer may define a condition more broadly than a single diagnosis. Most policies don't cover pre-existing conditions, though some products make provision for certain previous conditions, with their own eligibility rules and limits.

Waiting periods at the start of a policy

A separate check is the waiting period. A common initial waiting period for illness is 14 days, and conditions that first appear during an initial waiting period may not be covered. Accident rules can differ, so check illness and accident waiting periods separately. The Financial Ombudsman Service (FOS) expects insurers to explain the important limits when you buy, and pre-existing conditions should be mentioned at the point of sale. Don't assume cover starts the moment payment is taken, or that it carries straight on from a previous policy that ended the day before.

It helps to write down your policy start date and the end of each waiting period. That gives you a clearer question for the insurer than simply asking whether your pet is covered.

None of this is a reason to delay care. Contact your vet promptly if you're worried about your pet's health, rather than waiting for a waiting period to end or a claim decision to come through. If it's urgent, phone your vet or their out-of-hours service straight away.

Bilateral conditions

Some body parts come in pairs, such as knees or eyes. A bilateral condition affects both sides of the body. Insurance disputes can arise when one side is affected first and the other later. Some insurers treat the second side as pre-existing, or say a 12-month time limit began when the problem was first seen on the other side.

When a bilateral dispute reaches the FOS, it looks at the vet's evidence on whether the second side is linked. It's likely to agree with the insurer if the evidence suggests the underlying issue is the same, such as a disease process, and the owner was aware of symptoms for some time. It might think it's fair for the insurer to treat the second side as a separate issue if a significant period of time has passed since the initial condition, and the vet notes show the vet examined the other side when the problem first appeared and found nothing wrong. When you read a policy, check whether it mentions paired body parts and how it treats the second side.

Changing insurer

This is where owners can be caught out. A condition covered under your current policy may be considered pre-existing by a new insurer, and a new lifetime policy doesn't automatically carry over the protection of the old one. Compare the exclusions as carefully as the premium.

Before you cancel anything, get the proposed cover and any exclusions in writing. You could ask whether an exclusion is permanent or can be reviewed, and on what evidence. Ask too whether it affects one named condition, related problems or both sides of the body. Check the start date and waiting periods before cancelling existing cover, and keep the quotation answers, schedule and correspondence together. For the differences between policy types, see our guide to types of pet insurance in the UK.

Answering insurer questions

When you apply, answer the questions asked accurately and completely. If you're unsure whether an earlier event belongs in an answer, describe it and ask the insurer. That includes relevant advice or symptoms even if no claim was made, because buying insurance doesn't erase your pet's veterinary history. Don't hide genuine health concerns from your vet either, just to keep your records tidy for an insurer.

A useful enquiry gives dates, what you noticed, what the vet recorded, any investigation or treatment and the current position. You're clarifying the history, not asking anyone to rewrite it to fit a policy. This matters because the FOS looks at the information you gave your insurer when you took out the policy. If an insurer adds an exclusion mid-term, it may say that's because you gave inaccurate information, and the FOS then asks it to show that its questions were clear and that you answered incorrectly or without reasonable care.

What you knew and what the vet records show

If an insurer declines a claim because they say your pet already had signs and symptoms of the illness, the FOS looks at what the policy says and your pet's medical history. It also asks whether the condition is the same as, or related to, one your pet had before, and what you knew or should have known when you took the policy out.

The FOS considers evidence from your vet and the insurer's vet, especially clinical notes. The notes your practice keeps therefore matter, so it's worth asking your practice for a copy of your pet's records.

If a claim is declined

Start by asking the insurer for the precise policy clause and the medical evidence it has used. If the facts look wrong, ask your vet to explain the clinical history accurately. Then use the insurer's formal complaints process. You should complain to the company first, and if it doesn't send a final response within eight weeks, or you're unhappy with its answer, you can take the complaint to the FOS. The service is free to use.

The deadline for doing so is usually six months from the date of the insurer's final response, so check that response for your referral rights and any deadlines that apply to you.

Nothing here predicts how a particular claim would turn out. Keep your policy wording, schedule and vet records together and read them closely before you buy or renew.