Pet Insurance for Pre-Existing Conditions (Can You Still Get Cover?)

What Counts as a Pre-Existing Condition?

A pre-existing condition in pet insurance is any illness, injury, or symptom that was present, diagnosed, or showing signs before your policy’s start date or during the waiting period. This is the single most important concept in pet insurance, as pre-existing conditions are the number one reason claims are rejected in Australia.

Pre-existing conditions include not just formally diagnosed conditions, but also:

• Symptoms noted by a vet: If your vet recorded lameness, skin irritation, ear infections, or any other symptom in their clinical notes, even without a formal diagnosis, the insurer may consider it pre-existing.
• Conditions during the waiting period: Any illness or injury that develops during the waiting period is typically classified as pre-existing for the life of the policy.
• Related conditions: If your pet had a knee issue on the left leg before the policy, the insurer may also exclude knee issues on the right leg as a related condition.
• Recurring conditions: If your pet had ear infections before the policy, future ear infections may be excluded even if they appear to be new episodes.

Can You Still Get Insurance With Pre-Existing Conditions?

Yes, you can still purchase pet insurance even if your pet has pre-existing conditions. However, those specific conditions will be excluded from your cover. The policy will cover new, unrelated conditions that develop after the policy starts.

For example, if your dog has been treated for skin allergies before you take out insurance:

• Skin allergy treatment will NOT be covered (pre-existing)
• A broken bone from an accident WILL be covered (new, unrelated condition)
• Cancer treatment WILL be covered (new, unrelated condition)
• A potentially related condition like ear infections MAY be excluded if the insurer links it to the existing skin condition

How Insurers Check Your Pet’s History

When you make a claim, the insurer will typically request your pet’s complete veterinary history from all vets your pet has visited. They use this history to determine whether the claimed condition is genuinely new or pre-existing.

The process usually works as follows:

1. You submit a claim for a condition
2. The insurer contacts your vet(s) and requests the full clinical history
3. A claims assessor reviews the history for any prior mention of the condition or related symptoms
4. If no prior evidence is found, the claim proceeds
5. If prior evidence is found, the claim is rejected as pre-existing

This is why it is important to keep track of your pet’s veterinary visits and understand what is recorded in their clinical notes.

The 18-Month Pre-Existing Condition Review

Some Australian pet insurers have a policy that reviews pre-existing condition exclusions after a period of 18 months with no symptoms or treatment. Under this provision:

• If the pre-existing condition has had no symptoms, treatment, or medication for a continuous 18-month period, the insurer may remove the exclusion
• The 18-month period must be continuous, meaning no related vet visits or symptoms during that time
• This is not automatic and you may need to request the review
• Not all insurers offer this provision, and not all conditions are eligible

Conditions that are chronic, hereditary, or permanent in nature, such as hip dysplasia, heart disease, or diabetes, are unlikely to have the exclusion lifted even after 18 months. This review is more applicable to conditions like resolved infections or temporary injuries.

Tips for Getting Better Coverage

If your pet has pre-existing conditions, these strategies can help you maximise your insurance value:

1. Insure as early as possible: The younger your pet is when you start a policy, the less likely they are to have pre-existing conditions. Eight weeks old is ideal.
2. Get a clean bill of health: Before taking out a policy, have your vet do a thorough check-up. This establishes a clean baseline health record that supports future claims.
3. Be honest on your application: Never hide or misrepresent your pet’s health history. Insurers will access vet records and any dishonesty can void your entire policy.
4. Understand your vet’s notes: Ask your vet what they have recorded in your pet’s clinical notes. Sometimes casual observations are noted that could be interpreted as pre-existing conditions.
5. Compare providers: Different insurers assess pre-existing conditions differently. Some are more generous with the 18-month review rule than others.
6. Consider the overall value: Even with exclusions, insurance can still be valuable for covering new conditions, accidents, and illnesses that develop after the policy starts.

Common Pre-Existing Conditions in Dogs and Cats

These are the most frequently encountered pre-existing conditions that affect pet insurance claims in Australia:

Dogs

• Skin allergies and dermatitis
• Ear infections (otitis)
• Cruciate ligament problems
• Hip and elbow dysplasia
• Gastrointestinal issues (chronic vomiting, diarrhoea)
• Lumps and masses
• Eye conditions (cherry eye, dry eye)

Cats

• Urinary tract issues (FLUTD, cystitis)
• Dental disease
• Skin conditions and allergies
• Kidney disease
• Hyperthyroidism
• Respiratory infections (cat flu)

What About Bilateral Conditions?

Bilateral conditions are those that can affect both sides of the body, such as cruciate ligament injuries or hip dysplasia. If your pet has a pre-existing condition on one side, many insurers will also exclude the same condition on the other side. For example:

• Left knee cruciate ligament injury before the policy = right knee cruciate ligament injury also excluded
• Left eye cherry eye before the policy = right eye cherry eye also excluded

This is a common area of dispute between policyholders and insurers. If you disagree with a bilateral exclusion, you can lodge a complaint through the insurer’s internal dispute process or escalate to AFCA.

Frequently Asked Questions

My pet had a condition years ago that resolved. Is it still pre-existing?

Potentially, yes. If the condition was ever noted on your pet’s vet records, the insurer may classify it as pre-existing regardless of when it occurred. However, some insurers offer an 18-month symptom-free review that may lift the exclusion if there has been no recurrence.

What if I switch insurers? Do pre-existing conditions carry over?

Yes. Pre-existing conditions are based on your pet’s medical history, not the insurer. Switching to a new provider will not erase pre-existing conditions. In fact, any conditions that developed during your previous policy will also be assessed by the new insurer.

Can I dispute a pre-existing condition ruling?

Yes. If you believe the insurer has incorrectly classified a condition as pre-existing, you can request a detailed explanation, lodge an internal complaint, and if unresolved, escalate to the Australian Financial Complaints Authority (AFCA) for free external resolution.

Will my pet be denied insurance altogether because of pre-existing conditions?

No. Australian pet insurers do not deny coverage based on pre-existing conditions. They will issue a policy but exclude the pre-existing conditions from cover. Your pet will still be covered for new, unrelated conditions.

Should I get insurance if my pet already has health issues?

Yes. Even with exclusions for existing conditions, insurance protects you against new and unexpected health problems. A dog with pre-existing skin allergies can still benefit from insurance that covers a future cruciate ligament injury, cancer diagnosis, or emergency surgery.