More and more, pet owners are coming around to the value of pet insurance. Owning a pet unfortunately means that there can be many unexpected healthcare costs for your furry friend. Not only will routine checkups be much more affordable, but if your pet ever needs a lifesaving procedure that costs thousands of dollars, pet insurance is designed to cover some or all of the bill.
That said, not all pet insurance is reliable. Most pet insurance agencies are unfortunately designed to function like regular health insurance agencies in that they can unfairly deny claims or offer a low settlement amount.
If this has happened to you, do not panic – there are many strategies that you can take to get the settlement your pet deserves. Call Wallace Law for a free consultation to learn how we can help you with your case.
How Pet Insurance Claims Work
Health insurance for pets works similarly to the same way that it works for people. Many different insurance agencies offer pet insurance, and there are usually a variety of policies to choose from based on the level of care you anticipate needing and how much you’re able to spend per month.
Once the waiting period has ended, your coverage will go into effect and you will begin paying monthly premiums. In some cases, the insurance company may pay the vet directly, but in most cases, pet insurance works on a reimbursement system where you pay for a vet visit up front and the insurance reimburses you later.
All claims will be reviewed by the insurance company. If there are any issues, a representative may contact you for more information or to deny your claim if they believe that a service is not covered by your policy.
How Soon After You Get a Pet Insurance Policy Can You File a Claim?
It depends on the specific policy. Some pet insurance has no waiting period at all, while others require two weeks or even more. There is also usually a difference in how long you’re required to wait based on the type of treatment your pet needs.
For example, if your pet has an accident (such as being hit by a car), the policy may require waiting two days from the purchase date before you can make a claim. However, the same policy may require a two-week waiting period before filing a claim for an illness.
Common Reasons Why Pet Insurance Claims Are Denied
Beyond filing a claim before the waiting period is over, many other things can cause an insurance company to deny your pet’s claim. Here are a few examples:
- The condition or injury is not covered. If your policy does not cover your pet’s specific illness or injury, the insurance company will not reimburse you for your medical expenses.
- Clerical error. In some cases, there may be errors introduced into the claim by you, your veterinarian, or an insurance representative managing your case. In these situations, it is always good to keep copies of all documentation and communication between you, the insurance company, and your pet’s vet.
- You’ve reached your coverage limit. Most pet insurance policies have a limit on the amount of reimbursement you can claim. Once you reach this limit, your coverage will be on pause until the next enrollment period.
- Your claim was filed late. There is usually a specific window of time that you will be allowed to initiate a claim – typically 60 – 90 days, but sometimes less. If you do not file your pet’s claim in time, it will likely be denied.
Lastly, it’s important to remember that there may be nothing wrong with your claim at all. The insurance representative handling your pet’s claim may even purposefully try to prevent you from getting the reimbursement you are owed by falsely representing the details or testimony in your claim. If this happens, the most effective action you can take is to contact a lawyer experienced in handling pet insurance cases.
Can You Be Denied if Your Pet Has a Pre-Existing Condition?
Pet insurance usually will not reimburse you for pre-existing conditions. Because of this, it is always good practice to purchase a pet policy claim as soon as you can from the date of adoption.
That said, just because an insurance representative says that your pet is suffering from a pre-existing condition, that does not automatically make it so. The insurance company must have proof if they choose to deny based on a pre-existing condition.
How to Appeal a Pet Insurance Claim
If you believe that your pet was unfairly denied coverage, there is an appeals process that allows you to contest the insurance company’s decision. The appeals process will look slightly different depending on what insurance company you’re filing the appeal against.
The first step is to gather all documentation you have that relates to your pet’s insurance policy including medical records, x-rays, or even pictures or videos of your pet’s condition. More importantly, you’ll also likely need a letter or email from your vet that states why they believe that denial was unjustifiably made.
Once all of the necessary paperwork and documentation is sent to your pet’s insurance company, you should hear back with a final decision in the coming weeks. In most cases, you will either receive an approval or a denial, but they may also contact you if they need more information to process your appeal. If the appeal is denied, or you need help filing or gathering the necessary documentation, a lawyer can help you through the process.
Can You Sue a Pet Insurance Company if They Deny Your Claim?
Sadly, sometimes the only way to get a fair settlement is to pursue legal action against the insurance company assigned to your case.
Insurance companies often automatically deny claims regardless of whether they are valid or not. They may even purposefully go out of their way to misrepresent the claim so that the company does not have to pay a settlement. This is known as a bad faith claim which is not only unethical, but it is also illegal.
If you believe that your pet’s claim was wrongfully denied, you have the right to challenge it in court. In many cases, however, making an appearance in court can be avoided altogether simply by having a lawyer reach out to the company on your behalf.
Filing a Complaint Against the Pet Insurance Company
If you choose not to take legal action against the insurance company assigned to your pet’s case, you still have the option to file a complaint. Though this is not usually as effective as filing a suit or appeal, filing a complaint results in a documented grievance that can be used as evidence, should you decide to file a suit against the insurance company in the future.
There are a few different state and local entities that hear insurance consumer complaints including the Better Business Bureau, your state’s insurance department, and your state’s Attorney General. Complaints can usually be filed online, over the phone, in person, or by mail.
Our Lawyers Can Help You Appeal a Denied Pet Insurance Claim
If you’re feeling ignored by your pet’s insurance company and frustrated by constant pushback, you’re not alone. The pet insurance industry is rapidly growing and as a result, many claimants are feeling as if they have no control over their pet’s well-being as a result of poor management and unethical practices by the insurance company handling their case.
Regardless of whether you’re waiting on a decision regarding your claim or considering suing or filing an appeal, hiring a lawyer who understands how to deal with the insurance company is almost always the best decision you can make for your pet. If you’re ready to get started, contact Wallace Law for a free consultation today. Our lawyers have over a decade of experience negotiating insurance claims and have recovered millions of dollars in settlement money for our clients.
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