Missing records or exam: the waiting period moves and the claim fails

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

At some insurers, if the pet had no vet exam at enrollment, or you do not provide the record of that exam when the insurer asks for it at claim time, the illness waiting period does not end after two weeks. It is stretched to a later exam, as far as the first vet visit for the illness you are claiming. Anything that began before that date can be excluded, and the claim is not paid, even after years of premiums.

How it works

A policy starts with an illness waiting period: 14 days at Embrace, 15 at Healthy Paws and Fetch. Illnesses are not covered during those days. An illness that begins in the waiting period is excluded; Embrace and Fetch count it as pre-existing.

Some insurers tie the end of that period to a vet exam:

  1. At purchase, the pet needs a vet exam, either within a set time before the policy starts (usually 12 months) or in the first 14 to 30 days after. The windows differ by insurer.
  2. If there was no exam, there is no illness cover until it happens (Healthy Paws in Illinois pays nothing at all until then). At Embrace the waiting period then ends on the day of the exam, and anything that showed up before it can be excluded.
  3. If there was an exam, but at claim time the insurer asks for its record and you do not provide it, the insurer moves the end of the waiting period to the date of the first vet visit for the illness you are claiming. The illness lands “inside” the waiting period, and the claim is not paid.

Embrace reviews the records not at purchase but at the first illness claim, unless you ask for a review earlier. By then you may have paid premiums for a year or more. If a record is lost, the clinic has closed or you forgot to name one of your vets, you may find out only when the pet is already sick.

Examples

Embrace: without an exam the policy becomes accident-only

Embrace’s V6 policy requires an exam in the 12 months before the policy starts or within 14 days after. Otherwise the policy turns into an accident-only policy: “Failure to do so will result in your policy defaulting to an Accident only policy.” The premium for illness cover is refunded.

Illness cover can be added back after an exam, once Embrace has its detailed record. The policy says this “will result in your Illness Waiting Period end date changing to the date of the first exam.” No new 14-day period starts. Instead, the waiting period now runs from the start of the policy to the exam. Anything that showed up in that time, and anything recorded at the exam itself, can be excluded as pre-existing: “Pre-existing Conditions, if any, may be determined upon the date of the qualifying Veterinarian’s Enrollment Exam.”

The requirement is not hidden: it is also in the pre-purchase disclosure (Insurer Disclosure of Important Policy Provisions, section “Medical Examination”). Whether Embrace actually tells owners when a policy is switched to accident-only, we did not check.

Where it applies: the terms selector on Embrace’s site sends 47 states and DC to V6. Kansas, New Mexico and South Carolina get V5, which has the same rule.

Source: Embrace Pet Health Insurance V6, Part II – Conditions, item 1; Embrace V5, Part II; Embrace, Insurer Disclosure of Important Policy Provisions (01/23), “Medical Examination”, pp. 2–3.

Embrace: no records at claim time, the waiting period moves and the claim is refused

Embrace tries to collect the vet history when the policy starts but does not review it until the first illness claim, unless you ask: “we will not review the medical history until your Pet’s first Illness Claim is submitted, or you request a Medical History Review.” You can ask for that review any time after the 14-day waiting period.

When you claim, Embrace “may ask” for the records of the prior 12 months and all written records of the enrollment exam. If Embrace cannot get the records itself, the job is yours: “If we cannot obtain your Pet(s) medical history, it is your responsibility to provide the information.”

If you do not provide the records: “Failure to provide such records, will result in your Illness Waiting Period end date changing to the date of the first Physical Examination performed for the conditions covered by this policy that resulted in your Claim. Therefore, your Claim will not be covered as this policy does not cover Illnesses that occur during the Illness Waiting Period.”

What matters:

  • The refusal is automatic. If Embrace asked for records and you did not provide them, that is enough. Embrace does not have to show that the illness began before the policy.
  • The policy makes no exception for records you cannot get (for example, because the clinic has closed).
  • By the policy’s own definition, illnesses that begin in the waiting period are excluded as pre-existing. So this illness will likely stay excluded on later claims too. That is our inference; the policy does not say so directly.
  • You must name every vet the pet saw from 12 months before the policy started to the end of the waiting period. Leaving one out “is considered concealment”. For failing to disclose a material fact the policy “will be cancelled” (Part VI, item 5).
  • After the first 60 days, Embrace may also cancel the policy for “Failure to provide us with information we have requested that is directly relevant to the Coverage provided under this policy or any Claim” (Part VI, item 2 “Cancellation”). So records you do not hand over can cost you the policy, not just the claim.

Where it applies: V6, so every state except Kansas, New Mexico and South Carolina. The V5 policy used in those three has no such claim-time records rule. It does have the concealment rule and the review of history at the first claim.

What the law says:

  • Pennsylvania. The law caps the illness waiting period at 30 days (40 Pa.C.S. §4706(b)(2)(i)) and puts on the insurer the burden of proving that the pre-existing condition exclusion applies to the claimed condition (§4706(a)(2)). Embrace’s rule can move the end of the period by months, and the refusal rests on missing records, not on a proven pre-existing condition. On its face this conflicts with both provisions. V6 has a “Conformity to State Statutes” clause: provisions that conflict with the law of the state where the policy is issued are amended to conform to it, so in a dispute the law should prevail. This is our inference: we found no regulator ruling or court case.
  • Washington. The law has the same two rules: the insurer has the burden of proving that the pre-existing condition exclusion applies, and the illness waiting period may not exceed 30 days (RCW 48.205.050(1) and (2)(a)). The same questions arise as in Pennsylvania. See Washington. Other states with a law based on the NAIC model have similar rules; we did not check each one.
  • New Jersey. The Pet Insurance Act (P.L. 2025, c.224) takes effect on 1 January 2027. From that date the insurer has the burden of proving that the pre-existing condition exclusion applies (C.17:46D-8a), and the illness waiting period may not exceed 30 days (C.17:46D-8b). The same questions arise as in Pennsylvania. See New Jersey.
  • Texas. There is no pet insurance law, and we found nothing in Texas law that overrides the records rule. General rules do limit the concealment clause. A policy provision that makes the policy void for false statements in the application “has no effect” unless the false statement was material to the risk or contributed to the event claimed for (Tex. Ins. Code §705.004). To use a misrepresentation as a defense, the insurer must have given notice that it refuses to be bound by the policy within 90 days of discovering it (“before the 91st day”, §705.005). These rules limit using a vet you did not name to refuse a claim; they do not deal with cancelling the policy going forward. See Texas.
  • Arizona and Illinois. No pet insurance law. We found no law that limits this rule. See Arizona and Illinois.

Source: Embrace Pet Health Insurance V6, Part II – Conditions (paragraphs on vets, medical history and records at claim time), Part VI, items 2 and 5. The same text, word for word, is in form PET00 (02/24) filed in California (file 26-812, SERFF AMMH-134910014): Part II items 7, 9, 10 on p. 5 and Part VI item 5 on p. 11.

Healthy Paws: without the exam record the claim “will not be processed”

In Illinois a separate endorsement on the claims process applies (Claims Process Endorsement PIM-52784). Every pet needs a complete exam at enrollment:

  • under 6 years: in the 12 months before the policy starts or in the first 15 days after;
  • 6 or older: in the 30 days before the start or in the first 15 days after.

Until that exam happens, Healthy Paws pays nothing (item 5.c). When you claim, Healthy Paws “may ask” for the record of that exam. If you do not provide it, the waiting period ends on the later of two dates: its normal end or “the date when the clinical examination was conducted for the conditions covered by this policy that resulted in your claim; and, your claim will not be processed.” Formally this is not a “denial” but “not processed”. In practice there is no payment.

Illinois has no pet insurance law. The Illinois amendatory endorsement (LD-50818) does not change this rule.

The same records rule (items d–f) is in the general endorsement PIM-52552 (08/19), which the document pages for Arizona, Colorado, New Jersey, New York and Texas link to. Item c there is different: a missing exam “may void the policy”, and the premium is refunded. The pages for California, Florida, Louisiana, Pennsylvania and Washington link no such endorsement. There the base policy LD-50812 likewise says only that a missing exam “may void the policy”.

There is also a general condition in the Healthy Paws sample policies for Pennsylvania, California, Florida, Louisiana, Washington and the general sample (Texas), Section III, item 10: “In the event information relating to the history of the pet is missing or incomplete, the claim will not be processed.”

Source: Healthy Paws, Claims Process Endorsement – Illinois, PIM-52784 (10/19), Section II.5, items a–f; Claims Process Endorsement PIM-52552 (08/19), linked from the Arizona document page; Westchester sample policy LD-50812 (07/18) for Pennsylvania, Section III, item 10.

Fetch: anything found at the “first exam” is excluded

Fetch does not move the waiting period, but the effect is similar. Its Washington policy adds a fourth time window to the definition of a pre-existing condition: “during your pet’s first exam”. The first exam is the earliest comprehensive exam of all body systems documented in a written vet record.

If the pet has not had one in the 12 months before the policy starts or the 30 days after, you must get one at your own expense “as early as possible”. The policy warns: “Failure to have a first exam may reduce coverage provided by your policy”. Exclusion mm begins: “Any amount if you failed to satisfy, or comply with, the conditions set forth in the GENERAL CONDITIONS, CARE FOR YOUR PET (VII.6) section of this policy, including, but not limited to, a first exam for your pet.”

The illness waiting period is 15 days. So the first exam can come after the waiting period is over and, if you are late, weeks or months into coverage.

Whatever that exam finds is excluded by the same Exclusion mm: “Any medical condition(s), clinical sign(s), behavioral disorder(s) or illness(es) observed or recorded during the first exam, and all costs associated therewith, are automatically excluded from coverage.” Anything related to those findings or caused by them is excluded too.

Exclusion mm sets no end date. But the policy’s definition of “Curable Exclusionary Period” says a curable condition seen at the first exam is excluded for one year. If in that year it is not treated and shows no signs, it becomes eligible for coverage; if it is treated or shows signs in that year or at any time later, it is excluded for life. The main clause on curable conditions (V.e.iv) does not mention the first exam at all. The policy contradicts itself, and ambiguity in a contract is normally read against the insurer. For chronic and incurable findings there is no such limit: they stay excluded with no end date.

The waiting period can be waived with a comprehensive exam in the first 15 days. If the pet had no comprehensive exam in the 12 months before the start, that exam is likely to count as the “first exam”, and its findings are excluded too.

What Washington law says: RCW 48.205.020(6)(a) defines a pre-existing condition only by the time before the policy starts and the waiting period, and an insurer that uses the term must use that definition (RCW 48.205.030(1)). But the same law says these definitions do not limit the types of exclusions insurers may use (RCW 48.205.030(2)), and it allows a required exam if the insurer discloses before purchase that the exam records may lead to a pre-existing condition exclusion (RCW 48.205.040(6)). So exclusion mm itself is probably lawful. Only the wording of the definition is open to challenge.

Where it applies: the same exclusion mm and the same exam requirement appear in Fetch forms for Arizona and Texas, Florida, Illinois, New Jersey, Pennsylvania and in the California filing 25-2417. In the Pennsylvania and California forms the first exam must be in person; telehealth does not count.

Source: Fetch, Washington sample policy, GPTM 050 WA 1125 A: definitions “Curable Exclusionary Period” (p. 3), “First Exam” (p. 4), “Pre-existing Condition(s)” (p. 5); Exclusion mm (pp. 12–13); Condition VII.6.b (p. 14); RCW 48.205.

Figo and Nationwide: records as a condition of payment

These two insurers do not move the waiting period, but they also make vet records a condition.

  • Figo (Pennsylvania). “Upon submission of Your first Claim, You must include twenty-four (24) months of medical or adoption records unless the Claim is for routine care only.” Exclusion 35 removes cover for “any loss” when a policy condition was not met. The same 24 months appear in the Washington form. The newer forms for Arizona, Texas and Illinois (1025) have no fixed period: you agree to obtain or allow the release of all records needed to support the claim.
  • Nationwide (Pennsylvania). It can demand any records “relating - or even possibly relating - to your pet’s health”, an exam by a vet it selects, an interview and an examination under oath. Not complying with policy terms is a ground to cancel or non-renew the policy (item 17.C). The form does not say a claim is denied for missing records. The “even possibly relating” wording is also in the forms for Arizona, California, Florida and Texas.

Pennsylvania’s pet insurance law does not bar demands for records, vet exams or examinations under oath, and it does not limit how far back the records can go.

Source: Figo / Independence American, IAIC FPI POL PA 0424, Part II.1 (p. 5), Exclusion 35, Part VII “Documents Required” (pp. 13–14); Nationwide / National Casualty, VS-G-15-PA (9-24), section 14.C–D (p. 9), 17.C (p. 10).

What it looks like for an owner

Two cases with Embrace. The time limits come from the V6 policy; the rest is an illustration.

No exam. The dog has not seen a vet for over a year. The policy starts on day 0. The owner does not get to an exam within the first 14 days, and the policy becomes accident-only. The exam happens on day 40. Once Embrace has the exam record, the owner adds illness cover back, but the waiting period now ends on day 40, not day 14. If the dog had diarrhea on day 20, or the vet recorded a heart murmur at the exam, it can be excluded as pre-existing.

An exam, but no record. At purchase the owner declared an exam 10 months before the policy started. In month 8 of the policy the dog gets sick, and the owner claims. Embrace asks for the record of that exam, but the clinic has closed, and neither Embrace nor the owner can get the record. The end of the waiting period moves to the date of the first visit for this illness, in month 8. The illness counts as starting in the waiting period, and the claim is not paid. Eight months of premiums have been paid.

What to do

  • Before you buy, ask: is an exam required at enrollment, by when, and what happens if there was none. The answer should be in the policy, not just on the phone.
  • Get the exam before the policy starts or in its first days. At Embrace, no later than 14 days after the start; at Healthy Paws, 15 days; at Fetch, 30 days. For pets 6 or older, Healthy Paws accepts an exam no more than 30 days before the start. Fetch requires a comprehensive exam of all body systems; in Pennsylvania and California it must be in person.
  • Remember that what the exam finds can be excluded. At Fetch directly through Exclusion mm, at Embrace as pre-existing on the exam date. Read the exam record: everything in it is what the insurer will see at the first claim.
  • Keep your own copy of the exam record. The full record with the vet’s findings, not just the invoice. Keep it for as long as the policy runs. A clinic can close or lose its files.
  • Give the insurer every vet from 12 months before the policy started to the end of the waiting period, including one-off visits and emergency clinics. At Embrace, leaving one out counts as concealment.
  • At Embrace, request a Medical History Review right after the 14-day waiting period. That way you can learn what Embrace treats as pre-existing, and whether it has the records, while the pet is healthy rather than at the first claim.
  • If a claim is refused over records, ask in writing which policy clause the refusal relies on. In Pennsylvania and Washington (and in New Jersey from 2027), you can point to the 30-day cap on the waiting period and to the rule that the insurer must prove a pre-existing condition. This is our inference; we found no court or regulator ruling on it. File a complaint with the state regulator.
  • Where we did not find this rule: Embrace in Kansas, New Mexico and South Carolina (V5) does not move the waiting period over records at claim time, though the enrollment exam requirement is there. Healthy Paws in California, Florida, Louisiana, Pennsylvania and Washington: the document pages link no claims endorsement, and the base policy does not move the waiting period, but a claim with missing or incomplete history “will not be processed”. Nationwide’s Pennsylvania form does not say a claim is denied for missing records, but not complying with policy terms is a ground to cancel or non-renew. We did not check other insurers for this page.

How pre-existing exclusions work is in the guide to pre-existing conditions. Why they make it hard to switch insurers is in the pet insurance trap. Insurers: Embrace, Healthy Paws, Fetch, Figo, Nationwide.

Sources

History

  1. First published