One bad knee can exclude the other, and at Healthy Paws every other leg

From Pet Insurance Wiki · last updated 19 Oct 2026
One of the most dangerous traps. Every example below comes from an insurer or regulator document, linked next to the quote. All traps

If a problem with one knee existed before the policy started, many policies exclude the other knee too, for as long as the policy lasts. Healthy Paws’ policy goes further: after a cruciate ligament problem in one leg, its wording excludes treatment of any injury or condition of any other leg, whether or not it is related to the ligament.

How it works

An ordinary pre-existing exclusion shuts off the condition the pet already had (details in the guide to pre-existing conditions). This rule is wider. In the documents we found three versions:

  1. The same condition on the other side. The left knee ligament tore before the policy started, so a tear in the right knee is not paid either. This is how Fetch, Embrace and Trupanion work.
  2. Every ligament and knee condition in both knees. Any ligament, patella, meniscus or soft-tissue knee problem counts as affecting both sides and as “related, regardless of cause”. A luxating patella on the left before the policy started shuts off a future cruciate tear on the right. This is how Spot, Pumpkin, ASPCA and Figo work; all four are insured by Independence American.
  3. Any other leg, any cause. This is Healthy Paws outside Florida: a cruciate problem in one leg before the policy started, and treatment for any injury or condition of any other leg is excluded.

The spine and the hips follow similar logic. One sign of intervertebral disc disease (IVDD) anywhere in the spine, before cover starts or in its first weeks or months, excludes every future episode along the whole spine at Trupanion, Fetch and Embrace. Trupanion excludes hip dysplasia on a sign from any time before enrollment or in the first 30 days. More on early orthopedic exclusions in Joints and spine: lifetime exclusions.

What the versions have in common:

  • There is no end date. The exclusion lasts as long as the policy does. The “cured, so covered again” rule (180 days without symptoms at Spot, Pumpkin and ASPCA, 365 days at Figo) does not apply to knees.
  • A diagnosis is usually not needed. In most versions a sign, such as a limp, is enough. At Spot, Pumpkin and ASPCA a problem has “occurred” if anyone noticed signs or a “routine physical veterinary exam” would have detected them, even if the dog never saw a vet. Healthy Paws’ contract speaks of cruciate problems that “have been identified”, but its FAQ counts lameness too.
  • The window is wider than “before you bought”. At Fetch, Spot, Pumpkin, ASPCA and Figo it includes the waiting period. At Figo, in its Texas and Illinois forms, the orthopedic waiting period for dogs is six months, unless a vet’s orthopedic exam waives it. Trupanion’s 2019 form counts the first 30 days after enrollment. At Embrace it is the first 180 days of the policy, although Embrace’s illness waiting period is 14 days.
  • The law barely gets in the way. State laws based on the NAIC model say outright that they do not limit the types of exclusions. Texas and Illinois have no pet insurance law at all.

Examples

Healthy Paws: any other leg

Westchester Fire (a Chubb company) policy, form LD-50812 (07/18), section II.4 “Other Exclusions”, item e. Healthy Paws does not reimburse:

“Future treatment for injury or conditions of a leg when cruciate ligament problems to any other leg existing prior to the pet policy effective date, have been identified, regardless of whether or not the new signs or symptoms are related to such cruciate ligament problems”

What follows from it:

  • The trigger: a cruciate problem existed before the policy effective date and has been identified. The clause does not say when it must be identified. Read literally, a problem found after the start date, for example at the first vet visit, can also count if it was there before.
  • What is excluded: “injury or conditions of a leg”, meaning any leg other than the one with the ligament problem. Cruciate ligaments are in the hind knees, but the clause is not limited to the other knee or to the hind legs. Read literally, it includes the front legs.
  • No link is needed: “regardless of whether or not … related”. Read literally, the clause covers a leg broken in a car accident. The fracture is our example; the policy does not name it.
  • No end date: “future treatment”.
  • The policy covers cats as well; the clause is written for any pet.

We found no public evidence of how Healthy Paws applies this clause in practice. This is what the contract says, not a documented practice. The company’s FAQ describes the rule as both narrower and wider than the contract. Narrower: only “the other side” is excluded. Wider: lameness, and a tear during the waiting period, also count as triggers:

“if your pet has shown lameness, or a full/partial tear before enrollment or during any applicable waiting period … on either side prior to enrollment, the other side is also excluded from coverage. The cruciate ligament is the only bilateral exclusion in the policy”

Sources: Westchester Fire, Pet Health Insurance Policy, sample LD-50812 (07/18), section II.4.e, page 2 of 7; Healthy Paws FAQ, “Are cruciate ligament (CL, CCL, ACL) injuries covered?”. More on the company on the Healthy Paws page.

By state:

  • Texas. Healthy Paws’ Texas documents page links the same general form LD-50812. The Texas endorsement LD-51409 (11/18) changes only claims handling, the time limit for a lawsuit, cancellation and governing law, and ends: “All other terms and conditions remain unchanged” (Amendatory Endorsement – Texas, LD-51409 (11/18)). The law does not stand in the way. Since 2021 the Texas Department of Insurance has classed pet insurance as “non-regulated” inland marine (28 TAC §5.5002(QQ)). Insurers do not have to file forms or rates or get them approved, and Texas has no pet insurance law.
  • Illinois. The same general form. Endorsement LD-50818 (09/19) does not touch item e (Amendatory Endorsement – Illinois). Illinois has no pet insurance law: the pet article was removed from HB 3595 before it was enacted.
  • Washington. A state copy of LD-50812 (07/18), item II.4.e on page 2 of 7 (Washington sample). Endorsement LD-50798 (09/23) changes other sections and says: “All other terms, conditions and limitations of this Policy shall remain unchanged” (Amendatory Endorsement – Washington). The required disclosure WA-57980 (10/23) says nothing about this clause beyond “Other exclusions may apply” (Washington disclosure). State law does not help: RCW 48.205.030(2) says the statute’s definitions do not “in any way prohibit or limit the types of exclusions pet insurers may use”. According to the same disclosure, Washington policies may also be issued by ACE American or Indemnity Insurance Company of North America, but their forms are not posted.
  • Pennsylvania. A state copy of LD-50812, item II.4.e on page 2 of 6 (PDF page 3) (Pennsylvania sample). Endorsement PI-50810 (09/24) does not change it (Amendatory Endorsement – Pennsylvania). State law defines a pre-existing condition by signs “directly related” to the condition claimed (40 Pa.C.S. §§4702, 4703(a)). Item e expressly drops that link. But it is drafted as a separate exclusion, and §4703(c)(1) says the law does not prohibit or limit the types of exclusions. We found no regulator ruling on this. More on the Pennsylvania page.
  • New Jersey. The general form; endorsement LD-50807 (07/18) changes only the misrepresentation clause (Amendatory Endorsement – New Jersey).
  • Other states. The same clause is in every Westchester sample on the site: the LD-50812 copies for CA, DE, HI, LA, MD, ME, MS, MT, NE, NH, OH, RI and VT, LD-51216 (04/21) for Massachusetts, LD-51186 (08/18) for New York, and the general form for every other state except Florida. We downloaded and checked all 41 state endorsements and claims-process endorsements: none deletes or changes item e. None of the state disclosures mentions it.
  • Florida is the exception. It has a different policy, ACE Property & Casualty PI-39283 (11/12), and its item II.4.e is narrower: “Pre-existing cruciate ligament problems to one leg as respects the cost of future treatment for problems of the other leg”. There is a single “other leg”, and no “regardless of whether … related” (ACE sample for Florida).
  • Vermont: a possible conflict. This is our reading; there is no regulator ruling. Vermont law limits the pre-existing look-back to 180 days (8 V.S.A. §7153(c)(6)(A)), and Healthy Paws’ Vermont endorsement adopts that. Item e remains in place, and it reaches a cruciate problem from any time before the policy started.

Spot, Pumpkin and ASPCA: every ligament and knee condition in both knees

One Independence American policy, form PET-P-20000. The base version, PET-P-20000-1024, is used in Texas and Arizona and by Spot in New Jersey. State versions: PET-P-20000-IL-1024 in Illinois, PET-P-20000-PA-0425 at ASPCA in Pennsylvania, PET-P-20000-NJ-1024 at Pumpkin in New Jersey. The definition:

“Conditions involving a ligament, patella, meniscus or soft tissue disorder of the knee. These are considered bilateral conditions and related, regardless of cause; meaning an occurrence on one side of the body affects both sides of the body”

The exclusions:

“c. Bilateral conditions of pre-existing conditions.” “o. Ligament and knee conditions, if any ligament and knee condition occurred prior to the first effective date of the applicable coverage or during a waiting period.”

What this means:

  • One problem of any of these kinds before the policy started, or during the 14-day waiting period, is enough. After that, every ligament and knee condition in both knees is excluded, not just the same diagnosis. A luxating patella on the left shuts off a future cruciate tear on the right.
  • They never count as cured: “This does not apply to chronic conditions or ligament and knee conditions” (the rule on 180 days without symptoms).
  • The policy defines “occur” broadly: signs that “first were observed by any individual, recorded in your pet’s medical record, or would have been detectable by a routine physical veterinary exam”. That definition drives exclusion o directly, and exclusion f, “Conditions that occur during a waiting period”, for any condition. Beyond that it depends on the state form. In Texas the pre-existing definition itself uses “occurs”, so “a routine exam would have detected it” can make any condition pre-existing. In Illinois the pre-existing definition requires vet advice, treatment, or signs shown by verifiable sources, so there the “detectable” test works mainly through exclusions o and f. More in Pre-existing means anything a vet “would have” found.

Sources:

Figo: knees and spine are never cured

Figo is also insured by Independence American. Its definition of ligament and knee conditions is almost the same as Spot’s: they are “considered Bilateral and related, regardless of cause” (definition 26 in the Pennsylvania form). Exclusion 4 in the Pennsylvania form:

“Veterinary Expenses or Treatment for any ligament and knee condition, if any ligament and knee condition occurred at any time prior to the Pet’s Original Start Date or prior to the end of any applicable Waiting Period”

They never count as cured. The Texas form: “Genetic Conditions, Ligament and Knee Conditions, Orthopedic Conditions, and Chronic Conditions are not considered curable.” And Figo counts IVDD as orthopedic: “Orthopedic Conditions include IVDD, any condition affecting the intervertebral spaces and osteosarcoma.” Figo’s usual rule of 365 days without symptoms does not apply to them.

The window is long. In the Texas and Illinois forms the waiting period for orthopedic conditions in dogs is six months. It can be waived: a vet does an orthopedic exam, and the waiver form must reach Figo within 30 days of the policy start. A knee problem in those six months excludes all ligament and knee conditions in both knees. In the Pennsylvania form, where state law caps waiting periods at 30 days, the orthopedic waiting period is 30 days.

Sources: Figo, IAIC FPI POL PA 0424, definition 26 page 5, exclusion 4 page 9; Figo, IAIC_FPI_POL_AI_TX_1025, Parts I, III and IV (.docx). The Illinois form (IAIC_FPI_POL_IL_1025) has the same text.

Fetch: the same condition on the other side

Section V “General Exclusions”, item qq.i in the Texas form (pp.i in the New Jersey form):

“If your pet has had Clinical Signs, prior to the policy original inception date or during the waiting period, of an Orthopedic Bilateral Condition on one side of the body, she/he runs a higher risk of the same condition on the other side of the body and future occurrences of the same condition will not be covered”

The policy’s own example: if a cruciate tear in the left leg is diagnosed before the end of the waiting period, a later tear in the right leg “shall be considered pre-existing and not covered”. The waiting period is 15 days in the Texas form; the New Jersey form adds 30 days for orthopedic conditions not caused by an accident. A sign counts if it was “observed by any individual”.

The spine, item qq.ii: “Any pet diagnosed, treated or showing Clinical Signs of intervertebral disk disease (IVDD) prior to the end of the Waiting Period or during the first exam … will not be covered for any in policy term incidences of an IVDD clinical sign(s) or medical condition(s).”

Sources: Fetch, GPTM 050 1125 A with Texas endorsement GPTM 100-TX 0124 A, section V, qq.i and qq.ii, page 13 of 17 (the Texas endorsement does not change item qq); Fetch, GPTM 050 PML NJ 0326 A (New Jersey), section V, pp.i, pages 13–14 of 19. The same text is in the samples for Florida, Pennsylvania, California, Arizona, Illinois and Washington.

Embrace: the first 180 days of the policy count as “pre-existing”

Embrace’s V6 terms, Part IV “Exclusions”. Embrace shows them for every state except Kansas, New Mexico and South Carolina. The bilateral rule applies to any bilateral condition, not only orthopedic ones:

“If your Pet has had Clinical Signs, prior to being insured or during the first 180 days after the Pet Original Start Date, of a Bilateral Condition on one side of the body, … future occurrences of the same condition will not be covered”

And separately, for dogs:

“The following canine Orthopedic conditions that occur or show Clinical Signs during the first 180 days after the Pet Original Start Date are excluded and are Pre-existing Conditions for the life of the policy”

The list: cruciate ligament disease, IVDD, patellar luxation, hip dysplasia. Embrace’s illness waiting period is 14 days. So a dog’s cruciate problem first noticed on day 100 of the policy is excluded for the life of the policy. For IVDD separately: a diagnosis, treatment or sign before the pet was insured or in the first 180 days excludes future episodes “in any area”.

Where this is open to challenge. Pennsylvania law defines a pre-existing condition as one with signs before the policy starts or during the waiting period, and caps the orthopedic waiting period at 30 days (40 Pa.C.S. §§4702, 4706(b)). Embrace calls a condition first seen on days 15 to 180 pre-existing. That works like an orthopedic waiting period longer than 30 days. In New Jersey the same question will arise from 1 January 2027, when its law takes effect (N.J.S.A. 17:46D-5, 17:46D-8b). There is no regulator ruling; this is an open question, not a proven violation.

Source: Embrace Pet Health Insurance V6, Part IV “Exclusions”.

Trupanion: either side, and no look-back limit for hips and spine

The 2019 form, TRU (D) 00001 (V10.201902). Trupanion’s site serves it for Texas and most states. For most pre-existing conditions Trupanion looks back 18 months. The knee has its own rule, and for the hip and the spine there is no limit:

  • Knee and several other conditions, section 9.B.IV, page 14: treatment of luxating patella, elbow dysplasia, several eye conditions, and “disease, weakness, instability, tear, partial tear, or rupture of the cranial cruciate ligament” is excluded if signs “presented on either side of Your Pet” in the 18 months before enrollment or in the first 30 days after it.
  • Hip dysplasia, section 9.B.V, page 14: excluded if there was “any sign or evidence of the potential manifestation of the Condition any time prior to the Policy Enrollment Date through to and including the 30 days following the Policy Enrollment Date”.
  • IVDD, section 9.B.VIII, page 15: treatment is excluded if there was a sign “in any part of the spine prior to the Policy Enrollment Date” or in the first 30 days after it.

The newer form TRU (D) 00001.1 (V01.202309), which the site serves for FL, ME, LA, NE, MS, WA, DE, MD, VT, MT, RI and HI (PA and OH have their own versions), folds this into item 9.A.I.1.c. It excludes luxating patella, hip dysplasia, IVDD, cruciate ligament problems, elbow dysplasia and several eye conditions if signs were present “on either side or any location on Your Pet prior to the policy Effective Date or during any applicable Waiting Periods”. This form has no 18-month window for any pre-existing condition. In Vermont, an “any time” look-back may conflict with the 180-day legal limit (8 V.S.A. §7153(c)(6)(A)); this is our reading, and there is no regulator ruling.

Sources: Trupanion, Medical Insurance for the Life of Your Pet, TRU (D) 00001 (V10.201902), sections 9.B.IV and 9.B.V (page 14) and 9.B.VIII (page 15); Trupanion, TRU (D) 00001.1 (V01.202309), section 9.A.I.1.c. More on the company on the Trupanion page.

Nationwide (Pennsylvania): knee ligaments are carved out of accident cover

This is not a bilateral rule, but it hits the same spot. Nationwide’s Modular plan, form VS-G-15-PA (9-24):

  • Section 3, page 4: “Cruciate and/or meniscal issues (regardless of cause) are not eligible for benefits under accident coverage.” So accident coverage does not pay even for a ligament torn in an accident.
  • Section 8, page 5: the separate cruciate coverage “is only available for enrollment 12 months after the initial policy inception date”.
  • Section 13.N, page 8: everything related to damage or rupture of the cruciate ligaments or menisci is excluded if clinical signs occur “during the first term that the policy is in effect”. This holds even after cruciate coverage is added.

Pennsylvania law caps the orthopedic waiting period at 30 days (40 Pa.C.S. §4706(b)). Nationwide’s rule is drafted as an exclusion, and the law does not limit exclusions (§4703(c)(1)). But it works like a 12-month wait, and Nationwide’s own Pennsylvania Whole Pet form (VS-G-11-PA, section E) calls its 12-month cruciate exclusion “another twelve (12) month waiting period”. There is no regulator ruling. Sections 3, 8 and 13.N are the same in the general VS-G-15 (9-24) form.

Source: Nationwide, Modular Pet Insurance Coverage Form VS-G-15-PA (9-24), sample, sections 3, 8 and 13.N.

One dog, different policies

A dog was limping on its left hind leg before the policy was bought. In the first days of the policy, the vet found a partial tear of the cruciate ligament in the left knee. Under each of these policies the left knee itself would be excluded as an ordinary pre-existing condition. The question is what happens next.

Two years later two things happen: (a) the ligament in the right knee tears; (b) the dog is hit by a car and breaks a front leg.

  • Healthy Paws (general form LD-50812): read literally, item II.4.e excludes both (a) and (b). Both are “other” legs, and no link to the ligament is needed. The company’s FAQ mentions only “the other side”, that is, (a).
  • Healthy Paws in Florida (PI-39283): (a) is excluded as “problems of the other leg”. The clause names a single “other leg” and has no “regardless of whether … related”, so it gives a much weaker basis for excluding (b).
  • Spot, Pumpkin, ASPCA, Figo: (a) is excluded, because all ligament and knee conditions in both knees are. (b) is not excluded by this clause: a broken leg is not a knee condition. At Figo in Texas and Illinois (a) would be excluded even if the first limp had appeared in the first six months of the policy, unless an orthopedic exam had waived the waiting period.
  • Fetch: (a) is excluded as the same condition on the other side. (b) is not excluded by this clause.
  • Embrace: (a) is excluded. It would be excluded even if the first limp had appeared on day 100 of the policy. (b) is not excluded by this clause.
  • Trupanion: (a) is excluded, because signs of a cruciate problem were present “on either side” before the policy started (in the 2019 form, within the 18 months before enrollment or the first 30 days after). (b) is not excluded by this clause.

What to do

  • Insure before the first record of a knee problem or a limp. The younger the dog, the less likely its record already has one. At Spot, Pumpkin and ASPCA even what “would have been detectable by a routine physical veterinary exam” counts.
  • Before buying, download the sample policy for your state and search it for “cruciate”, “bilateral”, “ligament”, “knee”, “leg”, “IVDD” and “hip”. See what is excluded: the same condition on the other side, every ligament and knee condition, or any other leg. How to read a policy: what is in a policy.
  • Check the window. Besides the time before the policy, it can include the waiting period (six months for dog orthopedics at Figo in Texas and Illinois) or the first 180 days of the policy (Embrace). The longer the window, the more likely you fall into it.
  • At Healthy Paws, ask in writing what exactly is excluded after a cruciate problem in one leg: only “the other side”, as the FAQ says, or any other leg, as item II.4.e says. Keep the answer.
  • On Nationwide’s Modular plan, remember that knee ligaments are not part of accident cover. The separate coverage can be added no earlier than 12 months in, and signs in the first policy term are still excluded.
  • If a claim is denied under such a clause, ask the insurer to name the policy clause and the record entry it relies on. In Pennsylvania, and in New Jersey from 2027, the law defines a pre-existing condition by signs “directly related” to the condition claimed, before the end of the waiting period. If a denial calls something pre-existing outside those limits, you can complain to the state insurance department.
  • Do not switch insurers after a knee entry in the record. A new policy will almost certainly exclude that knee as pre-existing, and under these rules it can exclude the other one too. Why leaving is so hard is covered in the pet insurance trap.

A rule about the other side, or about every ligament and knee condition, is in the forms of Healthy Paws, Spot, Pumpkin, ASPCA, Figo, Fetch, Embrace and Trupanion. Every brand whose forms we checked for this page has at least one special rule for the knee, the spine or the hip. Healthy Paws’ own Florida policy is narrower than its other forms: a single “other leg” and no “regardless of whether … related”. We have not yet checked Pets Best, Lemonade or MetLife for this rule.

Sources

History

  1. First published