Pet Insurance Claim Denied? What Pet Owners Can Do When Coverage Is Refused
- Jeremy Cohen
- 2 days ago
- 4 min read
You paid for pet insurance because you wanted peace of mind.
Vet costs are on the rise, and one illness or accident can bankrupt pet owners, or force them to make an unthinkable decision about their furbaby. Protecting yourself and your pet with insurance seemed like the smart thing to do.
But when a pet insurance claim is denied — often after thousands of dollars in veterinary care — that peace of mind disappears fast. Especially when the explanation makes no sense.
We're seeing more pet owners reach out after their insurer refuses to reimburse a claim, usually with an explanation that feels vague, technical, or simply wrong.
If your pet insurance claim was denied, here's what you should know.
Why Pet Insurance Claims Are Commonly Denied
Most pet insurance denials fall into a few categories:
"Pre-Existing Condition" Claims That Stretch Logic
We've seen insurers argue that a propensity for something — like a dog eating a toy — counts as a pre-existing condition. Even when the actual injury never happened before.
Late Filing Technicalities
Miss a deadline by a small margin, and the insurer uses it as grounds to deny coverage entirely.
Ignoring Veterinary Opinion
Even when a veterinarian provides documentation explaining why a condition is not pre-existing, some insurers refuse to reconsider.
For pet owners, this feels maddening — and deeply unfair.
Why Appealing a Pet Insurance Denial on Your Own Often Fails
Many people do exactly what they're told to do:
They file an appeal.
Their vet writes a letter.
They provide records.
And the insurer still says no.
That's because insurers are not neutral decision-makers. They are businesses, and they often rely on the fact that consumers don't know what standards they're legally required to meet when handling claims.
Is Pet Insurance Regulated in Massachusetts?
Pet insurance is not regulated the same way in every state.
Only 14 states — including New Hampshire, Maine, and Vermont — regulate pet insurance as a distinct insurance product with specific statutory requirements. Massachusetts is not currently one of those states.
That means pet insurance policies issued in Massachusetts are not subject to a dedicated set of pet-insurance statutes governing policy language or claims-handling standards. In states with specific regulation, policies tend to be clearer about what is covered, and insurers can be held to defined claims-handling guidelines.
Massachusetts Consumer Protection Law and Pet Insurance
In states without pet-specific insurance laws, pet owners are still consumers—which means Massachusetts pet owners have certain protections.
When a pet insurance company acts unfairly, deceptively, or inconsistently in how it markets coverage or handles claims, those actions may fall under the Massachusetts Consumer Protection Act.
In practice, this means insurers can still be held accountable for:
Misleading or unclear policy terms
Inconsistent or unsupported claim denials
Unfair or deceptive claims-handling practices
While Massachusetts does not regulate pet insurance as a unique product, consumer protection law can still provide a framework for challenging improper pet insurance denials.
One of our broader goals is to see pet insurance regulated consistently in all states. Until that happens, we advocate for pet owners case by case, using the legal tools that are currently available.
How Boston Dog Lawyers Handles Denied Pet Insurance Claims
We don't start by rushing to court. Like any legal strategy, patience and fact-gathering can make all the difference when looking at pet insurance claims.
Our approach to appealing denied pet insurance claims typically focuses on:
Reviewing whether the insurer followed state regulations
Evaluating whether a "pre-existing condition" determination is medically legitimate
Consulting with veterinarians when appropriate
Pressing the insurer to justify its decision under the law
This work is largely document-based and focused on accountability, not drawn-out litigation. For many clients, that matters both financially and emotionally.
We evaluate insurance denials with the same consumer-protection lens we apply in other pet owner disputes.
When It Makes Sense to Get Legal Help for a Pet Insurance Denial
Legal review may be worth considering if:
The denied claim is in the thousands of dollars
You've already appealed and been rejected
The explanation you received doesn't align with medical reality
The insurer refuses to engage meaningfully
A pet insurance denial isn't always the final word — even when the insurance company wants you to believe it is.
If your pet insurance claim was denied and you can't understand why, it may be worth having someone evaluate whether the insurer followed the rules — and whether pushing back makes sense.
Frequently Asked Questions About Pet Insurance Denials
Can pet insurance deny coverage for a pre-existing condition?
Yes — but the condition must actually qualify as pre-existing. Insurers often stretch this definition when denying pet insurance claims.
Is pet insurance regulated in Massachusetts?
Pet insurance is not regulated in Massachusetts as a distinct insurance product with its own set of statutes or claims-handling rules.
However, pet owners in Massachusetts are still protected as consumers. When a pet insurance company engages in unfair or deceptive practices — such as misleading policy language or unsupported claim denials — those actions may be subject to the Massachusetts Consumer Protection Act.
In other words, while Massachusetts does not have pet-specific insurance regulations, consumer protection law can still apply to how pet insurance policies are marketed and claims are handled.
Should I hire a lawyer for a denied pet insurance claim?
It may be worth a legal review or consultation when the claim is substantial and the denial seems unjustified.
