Pet insurance and pre-existing conditions

How insurers define a pre-existing condition

The PetSure-issued PDSs we reviewed (RSPCA, Bupa, Medibank and Buddy) define it as a condition whose signs or symptoms were first noticed or showed before cover started or during a waiting period, or that you or a reasonable person in your position would have noticed, whether or not a vet had diagnosed it.

Two consequences follow. A condition does not need a diagnosis to be pre-existing: an intermittent limp mentioned in a vet note can be enough. And a condition that first appears during a waiting period is treated as pre-existing, not simply delayed. It's one of the first terms to read when you compare pet insurance.

Temporary versus chronic conditions

Some insurers distinguish between conditions that can be cured and those that cannot. In the RSPCA, Bupa and Medibank PDSs, a temporary condition is one that normally resolves with treatment, and the definition specifically leaves out cruciate ligament conditions, intervertebral disc disease, hip and elbow dysplasia, patella luxation, endocrine diseases such as diabetes, and any chronic condition.

Medibank's PDS defines a chronic condition as one that recurs or is present for more than three months in total, even with intervals of remission, and says a chronic condition that is pre-existing will always be excluded. That is the line between a condition you can ask to have reviewed and one you can't.

How to ask for a pre-existing condition review

If your pet has recovered from a temporary condition that was excluded, you can ask the insurer to review the exclusion. With PetSure-issued brands, your vet completes the brand's pre-existing condition review form and provides records showing the condition is temporary and has shown no signs, symptoms or abnormality for 18 months. The insurer then tells you in writing whether the exclusion still applies; Bupa's PDS says an exclusion isn't lifted unless it agrees in writing.

Some insurers work differently. Budget Direct covers a fully cured condition once there have been 12 months without symptoms or treatment, as shown in the vet history. Knose and Petsy list each identified condition on your certificate, with whether it can be reviewed and the earliest date you can ask.

What can never be reviewed

Some exclusions are permanent whatever your vet certifies.

• Chronic conditions, such as diabetes, osteoarthritis and chronic allergies.
• Conditions the PetSure definition never treats as temporary: cruciate ligament conditions, IVDD, hip and elbow dysplasia, patella luxation and endocrine diseases.
• Bilateral conditions: if one knee, eye or ear was affected before cover, the same condition on the other side counts as pre-existing in the PetSure PDSs.
• Recurring and related conditions, which Budget Direct excludes even after 12 months.

Bilateral conditions

Moneysmart lists bilateral conditions among the common exclusions: if a condition affected one side of the body before cover started, such as one knee, eye or ear, the same condition on the other side is often excluded too. Medibank's PDS gives the example of elbow dysplasia in the left elbow before cover, which makes a later case in the right elbow pre-existing. Cruciate ligament disease is the classic case, because a dog that ruptures one cruciate has an increased chance of rupturing the other.

Hereditary and congenital conditions

A hereditary condition is not automatically pre-existing. The RSPCA and Bupa PDSs cover hereditary and congenital conditions as illnesses unless they showed signs before cover or during the waiting period. That is the strongest argument for insuring a young pet of a breed prone to a particular condition, before anything appears. The dog insurance and cat insurance guides list breed-linked conditions.

Switching insurers with a known condition

Moneysmart warns that anything you have previously claimed for will be considered pre-existing by a new insurer. For a pet with an ongoing condition, switching usually means giving up cover for it permanently in exchange for a lower premium.

If your current premium has become hard to afford, first ask your current insurer about a higher excess, a lower benefit percentage or a lower annual limit. Those change the price without resetting what counts as pre-existing. Our guide to pet insurance for older pets goes through the options.

Disclosure and claims

Tell the insurer about any known condition when you apply, and answer its questions accurately. Moneysmart notes that if you don't disclose a pre-existing condition, you may not be covered when your pet has an injury or illness. If a claim is refused and you disagree with how your pet's history has been read, use the insurer's complaints process first and then the Australian Financial Complaints Authority, which is free. The Australian Veterinary Association's policy position is that disputed claims should be reviewed by a veterinarian registered in Australia.