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Taking your pet to the veterinarian is often a stressful event—especially if your pet is really hurt or sick. You want to focus your attention on nursing your pet back to health without worrying about a looming vet bill.
Pet insurance is a financial safety net for situations like this. When you know you’ll be reimbursed for vet charges for accidents and injuries, you can get your pet the care they need—with less stress about how you’ll manage to pay for it.
Understanding how to file a pet insurance claim before you need to can reduce your stress even more. Here’s what you need to know.
How do You File a Pet Insurance Claim?
You’re likely familiar with the process of submitting a (human) health insurance claim. Either you or your practitioner send your claim to your insurance company, which pays the expenses that fall under your coverage and you’re responsible for paying the rest of the balance, if there is any.
With pet insurance, there are usually two ways to submit a claim—by either requesting reimbursement or paying the vet directly.
Request reimbursement
With the reimbursement method—the most common method among pet insurance companies—you first pay out-of-pocket for the vet bill and then the insurance company reimburses you for covered expenses. You will:
- Pay the veterinarian bill right after the visit.
- Complete a pet insurance claim form.
- Submit the claim and supporting documentation to the insurer via an app, online portal, email, fax or mail.
Once you submit a claim and it’s approved, you’ll get reimbursement via direct deposit or cheque.
Pay the vet directly
A few pet insurance companies (like PHI Direct and Trupanion) have the ability to pay the vet directly. This means that you won’t have to pay and then wait for reimbursement. Others, such as Desjardins Pet Insurance and Pets Plus Us, allow for vet direct pay for complex (and therefore more expensive) treatment plans.
Your pet insurer will be able to provide you with specific details about the process.
Avoiding Claim Payment Surprises
It’s also good to be familiar with what your plan will cover, so you’re not surprised by the amount of a claims reimbursement.
For example, you may have forgotten the level of coverage you bought when you originally purchased the pet insurance plan. Pet insurance typically doesn’t cover 100% of vet bills and has a maximum per year or per illness/per accident.
Check your policy for:
- Your deductible: The deductible is the amount you pay out of pocket at the start of each policy year. Deductibles commonly start at $100, though some insurers allow you a choice of a higher deductible.
- Your reimbursement level: Your reimbursement is the amount your insurer will pay and is typically between 70% and 90% of your claim. The co-insurance is the amount you are responsible for paying.
- Coverage maximum: Check for the annual coverage cap, such as $5,000, as reimbursement ends once you’ve reached that maximum cap. Some plans, such as Desjardins Pet Insurance, OVMA Pet Health Insurance, Peppermint, Sonnet Pet Insurance and Petsecure, have per illness/per accident caps, so that $5,000 maximum would be capped at $2,500 per illness and $2,500 per accident. Others, such as Desjardins Pet Insurance, OVMA Pet Health Insurance, Spot Pet Insurance and Trupanion, offer unlimited annual coverage.
- Your waiting periods. The waiting period is the amount of time you need to wait before your insurance kicks in. A typical waiting period for illness coverage is 14 days, so if your dog gets sick on day 10 with an ear infection, you won’t be able to claim any reimbursement for treatment.
What You’ll Need to File a Claim
When submitting a pet insurance claim, here’s what you generally need to include:
- An itemized invoice of the visit and the expenses involved. The veterinarian bill should show all charges, discounts, taxes and all other fees. Make sure to get your invoice at the time you pay, and verify it shows a zero dollar balance.
- Claims form. You (and maybe your veterinarian, depending on the complexity of treatment) complete the claim form per your insurance provider’s instructions. There may be separate claim forms for additional benefits, such as cremation or burial expenses, holiday cancellation or a wellness plan add-on. It’s important to be as complete as possible but not exaggerate any claims; otherwise, your insurer may cancel your policy.
- Veterinary medical records. Since pet insurance coverage excludes all pre-existing conditions, your insurer may request your pet’s medical records to help identify any conditions the pet had before coverage began.
- Banking information. Some pet insurance companies offer electronic reimbursements. If you want to receive an electronic payment, simply sign up for direct deposit.
It’s a good idea to keep a copy of each claim submission for your records.
Wait Time for a Claim Payment
Since the claim process varies by insurer, so will the time it takes to get your reimbursement. Most insurers claim to process your claim “as fast as possible.”
Here are some specifics:
Pets Plus Us: 15 to 20 calendar days.
Desjardins Pet Insurance: 5 to 10 business days (for most claims).
Trupanion: 24 hours for 60% of claims.
Furkin: 24 hours for 50% of claims, 7 to 10 days for the rest.
Fetch By The Dodo: Within 15 days from receipt of all documents.
PHI Direct: Less than 15 days from submission for most claims.
How to Avoid Pet Insurance Claim Problems
There are things you can do to ensure the claim-filing process goes without a hitch.
Be confident that your claim is valid. “Before you submit a claim, make sure it’s for a new condition that occurred after any waiting period expired,” says Alex Stone, CEO of Petinsurer.com. “If your pet was showing signs or symptoms, had been to the vet, or was taking medication for this condition, then understand it’s likely not covered by the insurance company.”
Follow the claim instructions. Every insurance company has a different process for claims. It’s important to follow the claims process and avoid cutting corners on tasks like sending the necessary documents.
Submit your claim right away. Because some insurance companies limit the time they pay out claims after treatment, it’s in your best interest to get the process underway as soon as possible. For example, most insurers give 180 days from the treatment date to submit your claim, but Fetch By The Dodo has a 90-day time limit for claims. Check your policy to verify the plan’s deadline.
Being prompt can ensure you address any claims hiccups immediately. Plus, unless the insurer can pay the vet directly, you’re waiting for your money.
Provide all medical records. This may require making multiple calls, especially if different vets or specialists are involved in your pet’s care. If you don’t provide all the medical records upfront, this can slow down the claim-filing process.
Be communicative. If your pet insurance company requests further documentation, try to send it promptly. Ask your insurance company what kind of waiting time to expect for payment and how you can expedite the claim.
How to Make a Claim on Pet Insurance FAQs
What if my pet insurance claim is denied?
The first step is to appeal if you’re not satisfied after a claim denial. If you find out a claim was denied because the treatment simply wasn’t covered by the policy, you may decide not to pursue the issue. But if you disagree with a denial, ask the insurer what their appeals process is.
For example, with Pets Pets Plus Us, if a claim is denied, you or your attending veterinarian can request a review or reassessment. An appeal must be received within six months from the denied claim notice. You may need to submit supplementary information, such as additional medical documentation, lab results and statements from your vet.
If the claim issue is still not resolved to your liking, and after you have tried to resolve it directly with the insurance provider, the next step may be to contact the office of the Ombudsman of the insurance underwriter. For example, Northbridge Insurance is the underwriter for Pets Plus Us insurance. (This information is available on the insurance company’s website, as well as on your policy.)
If you’re still not happy with the way your complaint was resolved, you can contact the Financial Consumer Agency of Canada (FCAC), an independent regulatory body working to protect Canadian consumers of financial products and services, or the General Insurance OmbudService (GIO), and independent dispute resolution service for Canadian consumers of insurance.
Why would a pet insurer deny a claim?
Being denied a claim for pet insurance, especially after paying good money into your policy, would be upsetting for any pet parent. But before you call the Ombudsman, understand that there are some valid reasons why this happens.
Pet insurance companies do not cover pre-existing conditions, which is an illness or injury that started prior to coverage beginning, including any waiting period. However, your pet does not need to have a diagnosis for an illness or injury to be considered pre-existing. Let’s say your dog starts limping in May and you take your pup to the vet but the cause of the limp is undetermined. If you buy a pet insurance policy in June and your pet is later diagnosed with patellar luxation, you may be denied coverage because the symptoms occurred before your coverage began.
Also, pet insurance companies have a list of exclusions, some more comprehensive than others. For example, Spot Pet Insurance will deny a claim for repetitive preventable behaviour after three incidents. So if your dog tries to wrestle with a porcupine and gets quills in the face, after the third offence, Spot will not cover any more treatment costs for that claim. If you make a claim for a treatment that is specifically excluded from your insurance coverage, your claim may be denied.
Can I make a claim on pet insurance right away?
No. Your insurance provider will stipulate how long you need to wait before your can submit a claim. This is called a waiting period, and is the time between enrollment and when your insurance coverage kicks in. Typical waiting periods are two days for accidents and 14 days for illness, but some insurance providers offer shorter waiting periods. For example, Spot Pet Insurance offers next day accident insurance. Your provider may also have special waiting periods for claims for dental coverage, cruciate ligament injuries and intervertebral disc disease.
Will my deductible go up if I make too many claims?
Your deductible shouldn’t change in response to the number of claims you make. Your deductible may increase as your pet gets older, if your insurance provider applies an age-based deductible. However, some companies, such as OVMA Pet Health Insurance, Petsecure and Peppermint, review all policies every six months for the number and cost of claims (as part of their claims risk management process) and may adjust your co-insurance, or the amount you’re responsible for paying, if you make many or expensive claims.
Should I submit a claim if my vet bill is less than my annual deductible?
Your deductible is the amount you must pay every year before your pet insurance kicks in. If your vet bill is less than your annual deductible, you should submit a claim, even if you won’t receive a payout, because it will work towards satisfying your annual deductible.
For example, say your annual deductible is $200, your reimbursement is 80% (meaning your co-insurance, or the amount you pay, is 20%) and your vet gives you a bill for $125. You should submit a claim for $125 and while you won’t receive any reimbursement, you’ll only have $75 left of your deductible to pay out of pocket. If your next vet bill is for $300, and you submit a claim for that amount, you would be reimbursed $165 ($300 – $60 co-insurance – $75 remaining deductible = $165).
