Joints and spine: lifetime exclusions from the first 180 days, every disc, never an accident

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 your dog limps or has back pain in the first months of a policy, a knee, hip or disc condition can stay excluded for the life of the policy. At some insurers the other leg or every other disc goes with it. And to Fetch and Pets Best a cruciate tear after a jump off the couch is not an accident: they treat it as an illness.

How it works

The trap is built from four rules. Each insurer uses its own mix.

  1. A window at the start of the policy. An orthopedic condition (ligaments, joints, spine) that appears in the first 180 days (Embrace, four conditions, dogs only; Fetch in some states) or the first 6 months (Figo, dogs only) counts as pre-existing. For a condition that appears in this window, cover does not start when the window ends: it is excluded for the life of the policy. Healthy Paws has a similar rule for hip dysplasia with a 12-month window: hip dysplasia that occurs in those months is excluded, not just delayed.
  2. The other side. Some conditions can affect both sides of the body (a bilateral condition): the cruciate ligament, hip or elbow dysplasia, a luxating kneecap. If there were signs on one side before the policy or at its start, the same condition on the other side is not covered either.
  3. Every disc. A sign of intervertebral disc disease (IVDD) before the policy or at its start excludes IVDD at every other disc in the spine.
  4. Never an accident. Fetch and Pets Best say it outright: cruciate ligament disease and disc disease are not accidents, even when they start suddenly. So the accident exception does not apply to them, and Pets Best’s Texas accident-only policy excludes them outright.

Most of these rules need no diagnosis. Embrace defines Clinical Signs as changes observed by “you, a Veterinarian, or other observer”. A limp the owner mentioned at a vet visit is already a sign.

The law helps little. Arizona, Texas and Illinois have no pet insurance law at all, so these clauses apply as written. The NAIC model law caps orthopedic waiting periods at 30 days, but says it does not limit the types of exclusions insurers may use. The general rules are in the guide to pre-existing conditions.

Examples

Embrace: four conditions, the other side and every disc

Embrace policy V6, underwritten by American Modern. The terms selector on Embrace’s site opens it for Arizona, Illinois and most other states. Embrace’s guide to orthopedic waiting periods lists Arizona, Illinois and New Jersey among the states where the 180-day rule applies.

  • 180 days, dogs only. If cruciate ligament disease, IVDD, patellar luxation or hip dysplasia occurs or shows signs in a dog’s first 180 days, that condition is excluded for the life of the policy: “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”. Only the condition the signs belong to is excluded, not all four at once.
  • No exam helps. V6 has no exam that shortens the 180 days. Its exam waiver covers only new illnesses in the 14-day illness waiting period.
  • The other side. This rule applies to any pet and any Bilateral Condition, which Embrace defines as one “that affects both sides of the body”. Signs from before enrollment count too: “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”.
  • Every disc. “Any Pet diagnosed, treated or showing Clinical Signs of intervertebral disk disease (IVDD) prior to being insured or during the first 180 days after the Pet Original Start Date … will not be covered for any future incidences of this condition in any area”. A first IVDD episode after day 180 is not caught by this rule.
  • Injuries too. The clause covers conditions that “occur”, so it may also catch an orthopedic injury in those 180 days. Embrace’s help article says the same: “Orthopedic accidents may be subject to the full orthopedic waiting period”.
  • Not in the disclosure. Embrace’s national disclosure INDPP (01/23), linked from the V6 page, never mentions the 180-day rule. It says hereditary, chronic and congenital conditions are covered unless they showed before the start date or during the 14-day illness waiting period. It only adds that other exclusions may apply.
  • In the filed form. The same text appears word for word in policy form PET00 (02/24), Part IV Exclusions, page 7 of 14. We saw it in American Modern Home’s California filing 26-812 (SERFF AMMH-134910014, pending).

States differ, and Embrace’s own pages contradict each other. Embrace’s guide gives California, Louisiana, New Hampshire, Pennsylvania, Vermont and Washington a 30-day window for the same four conditions, while the terms selector sends them to the same V6 page that says 180 days. Kansas, New Mexico and South Carolina get V5: a 6-month orthopedic waiting period that an orthopedic exam can shorten.

The law. Arizona and Illinois set no limits. New Jersey’s pet insurance law (P.L.2025 c.224) takes effect on 1 January 2027. It will cap illness and orthopedic waiting periods at 30 days, define a pre-existing condition as one that arose before the policy began or during a waiting period, and put the burden of proof on the insurer. Signs on days 31 to 180 fall outside that definition, so this exclusion could be challenged. But the same law says it does not limit the types of exclusions, so the outcome is not clear-cut. In ten states with NAIC-model laws (Delaware, Florida, Hawaii, Maryland, Maine, Mississippi, Montana, Nebraska, Ohio, Rhode Island), Embrace’s guide still applies 180 days, framed as an exclusion.

Source: Embrace Pet Health Insurance V6, Part IV Exclusions, items 1 and 2(a), 2(b); Part I Definitions.

Fetch: 180 days, the other side, IVDD and “not an accident”

Fetch policies, underwritten by AXIS Insurance Company. In Arizona, Texas, Illinois and California, all four rules at once.

  • 180 days. “Orthopedic conditions that occur during the first one hundred eighty (180) days after the original inception date are excluded and are pre-existing conditions for the life of the policy.” Fetch’s definition of orthopedic conditions includes hip and elbow dysplasia, patellar luxation, ruptured cruciate ligaments and “intervertebral disc degeneration”. The exclusion does not cover injuries from an accident: “This does not apply to Orthopedic conditions resulting from an accident.”
  • Knees can be saved, the spine cannot. Knees are covered if a vet examines the pet within the first 180 days and the record specifically says there are no pre-existing knee conditions: “coverage will be afforded for orthopedic conditions of the knees if your pet is examined by a veterinarian between the original inception date and one hundred eighty (180) days of the policy”. There is no such way out for hips, elbows or the spine.
  • Not an accident. “degenerative disorders, including but not limited to, cruciate ligament disease and IVDD will not be covered as accidents. Though the clinical sign(s) may become apparent acutely, they are degenerative disorders, not accidents.” So a cruciate tear or a disc episode in the first 180 days falls under the lifetime exclusion, even if it started with a fall. For the knee, only the knee exam above helps.
  • The other side. If there were signs on one side before the start date or during the waiting period, later occurrences of the same condition are not covered, including on the other side. The policy’s own example: “if a dog has been diagnosed with a cruciate tear in his left leg before the end of the Waiting Period, a subsequent cruciate tear in his right leg shall be considered pre-existing and not covered by this policy”. Signs include what the owner noticed.
  • IVDD. “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).” The clause labels IVDD pre-existing, so it stays excluded at renewal.
  • The first exam. Fetch requires a full vet exam from 12 months before the start date to 30 days after it. If there was none, the owner must arrange one as early as possible, and that exam counts as the first exam. So it can take place after the waiting period. Anything observed or recorded at it is excluded: chronic conditions for good, curable ones for at least a year.

Where each rule applies:

  • Arizona and Texas (form GPTM 050 1125 A), Illinois (GPTM 050 IL 0326 A), California (GPTM 050 CA 0325 A): all four rules, including the 180 days.
  • Washington (GPTM 050 WA 1125 A): the form contains the 180-day clause, but the Washington amendatory endorsement GPTM 100-WA 0124 A deletes it. Instead, the form has a 30-day orthopedic waiting period, which can be waived for the knees by an exam in the first 30 days. The other-side, IVDD and “not an accident” rules stay.
  • Pennsylvania, New Jersey, Florida: no 180-day clause; a 30-day orthopedic waiting period instead. In Florida and Pennsylvania it can be waived for the knees by an exam in the first 30 days. In New Jersey IVDD falls under this 30-day orthopedic wait, not the 15-day illness wait. In these three states and in Washington, a condition with signs observed during the waiting period is still excluded as pre-existing. The other-side, IVDD and “not an accident” rules have the same wording in all eight states.

The law. Arizona, Texas and Illinois set no limits. Washington’s law (RCW 48.205) does not limit the types of exclusions either. But it defines a pre-existing condition by signs “directly related to the condition for which a claim is being made” and puts the burden of proof on the insurer. If a claim for the other leg, which never had signs, is denied, that gives you grounds to dispute it. In New Jersey from 2027, a condition first recorded at a first exam held after the waiting period falls outside the law’s definition of a pre-existing condition. But that law does not limit the types of exclusions either, so the dispute would not be simple.

Sources: Fetch, Arizona, GPTM 050 1125 A, sec. I (Orthopedic Conditions, p. 5), V.h (p. 11), V.mm and V.qq.ii (p. 13), VII.6; Fetch, Texas, GPTM 050 1125 A with GPTM 100-TX 0124 A, V.h and V.n (pp. 10–11); Fetch, Illinois, GPTM 050 IL 0326 A, V.h (p. 11), V.n (p. 12), V.pp.i–ii (p. 13); Fetch, Washington, GPTM 050 WA 1125 A with GPTM 100-WA 0124 A, V.n, V.qq.i–ii, endorsement p. 18; Fetch, New Jersey, GPTM 050 PML NJ 0326 A, V.m, V.pp.ii, Waiting Period.

Figo: IVDD and osteosarcoma count as orthopedic

Figo policies, underwritten by Independence American Insurance Company (IAIC). Forms for Texas (IAIC FPI POL AI TX 1025) and Illinois (IAIC FPI POL IL 1025); the Arizona and Indiana forms have the same wording.

  • A wider idea of orthopedic. “For the purposes of this Policy, Orthopedic Conditions include IVDD, any condition affecting the intervertebral spaces and osteosarcoma.”
  • Six months of waiting, even after an accident. For dogs the orthopedic waiting period is 6 months, “including Orthopedic illnesses and Orthopedic Conditions caused by an Accident”. Fractures too: “Orthopedic Accidents, including fractures are subject to the Orthopedic Waiting Period”. Cats have the usual waits: 1 day for accidents, 14 days for illnesses. Anything that occurs during the waiting period is excluded as pre-existing.
  • Never “cured”. “Genetic Conditions, Ligament and Knee Conditions, Orthopedic Conditions, and Chronic Conditions are not considered curable.” The rule that lifts the pre-existing exclusion after 365 days without signs or treatment never applies to them. If the waiver below was not used, a disc problem or osteosarcoma in the first 6 months stays excluded for as long as the dog is on this policy.
  • Osteosarcoma twice. A separate exclusion covers a type of cancer diagnosed before the start date or before the end of any waiting period.
  • There is a way out. The orthopedic wait can be waived if a vet does an orthopedic exam and fills in Figo’s form: “The Orthopedic Exam must be completed and the Orthopedic Waiver Form must be submitted to Us within thirty (30) days of the Policy effective date.” Miss the 30 days and the full 6 months apply.

Unlike Fetch, Figo does not say that IVDD is never an accident. Its trap is different: the 6-month wait applies to accidents too.

The law. Texas and Illinois set no limits. In Figo’s forms for Washington (IAIC FPI POL WA 0724 AI2) and Pennsylvania (IAIC FPI POL PA 0424), both NAIC-model states, orthopedic does not include cancer, the wait for orthopedic illnesses is 30 days, and there is none for orthopedic injuries. Even there, orthopedic conditions are “not considered curable”.

Sources: Figo, Texas, IAIC FPI POL AI TX 1025, Part I (Orthopedic Condition, Waiting Period), Part II, Part III; Figo, Illinois, IAIC FPI POL IL 1025, Part I nos. 25 and 43, Part II no. 6, Part III 2.k, Part IV no. 3.

Pets Best: cruciate ligaments and discs are never an accident

Pets Best, underwritten by IAIC.

  • Accident-only policy (Texas, IAIC-PB10001-ACCv2). Cruciate ligaments and discs are excluded outright: “We do not cover the costs, fees, or expenses associated with Cruciate Ligament Events” and “… with Intervertebral Disc Conditions”. The definition: “Cruciate ligament events are always considered medical Conditions, as opposed to a Condition caused by an Accident or injury.” The definition of disc conditions says the same. This policy does not cover cancer either. If a dog tears a cruciate ligament falling down the stairs, this policy will not pay. The same text is in the Arizona and Washington samples and in the Florida and Pennsylvania booklets. The California form (IAIC-PBI0001-ACC) excludes cruciate ligament events but has no separate disc exclusion.
  • Accident and illness policy (New Jersey, IAIC-PB10001-ILL). “Intervertebral Disc Conditions are always considered medical Conditions, as opposed to a Condition caused by an Accident or Injury.” The form says the same about cruciate ligament events. Here they can be covered as illnesses. This form has no lifetime IVDD rule. Cruciate ligament events have a separate 6-month waiting period. From 1 January 2027 New Jersey law caps orthopedic waiting periods at 30 days, and the 6-month cruciate wait in the current sample would conflict with it.

The law. Texas has no pet insurance law: it treats pet insurance as non-regulated inland marine.

Sources: Pets Best Accident Only Policy Form, Texas, IAIC-PB10001-ACCv2, sec. 4.B.4–4.B.6 (p. 4), 10.H and 10.L (p. 10); Pets Best Accident and Illness Policy Form, New Jersey, IAIC-PB10001-ILL, sec. 12.J and 12.N (p. 14).

Healthy Paws: hip dysplasia

Healthy Paws, underwritten by Westchester Fire Insurance Company. The general form LD-50812 (07/18), which Healthy Paws links for Arizona (and also uses for Texas, Illinois, New Jersey and Colorado).

  • 12 months. Not covered: “Illness related to hip dysplasia that occurs or recurs within the first twelve (12) months following the pet policy effective date.” The policy also lists these 12 months among its waiting periods, but the exclusion sets no end date for hip dysplasia that occurred in them: it is an exclusion, not a delay. Complications of excluded conditions are excluded too. In Arizona no exam can shorten the 12 months.
  • Age 6. “For pets six (6) years of age or greater on the date of enrollment, no coverage shall apply for illness related to hip dysplasia.” What counts is age at enrollment: a dog insured at 2 keeps hip cover at 8.

The law. Arizona sets no limits. In California (LD-54156), Pennsylvania (PI-50810) and Washington (LD-50798), amendatory endorsements cut the 12 months to 30 days and waive them after an exam. The Florida (PI-59918) and Louisiana disclosures also say 30 days, although the sample policies posted for those states still show 12 months. No endorsement we read changes the age-6 rule (the New Jersey endorsement is a scan, and we did not check it).

Sources: Westchester Fire Insurance Company, Pet Health Insurance Policy, LD-50812 (07/18), II.1)d (p. 2), II.4)g, II.5)b (p. 3); Claims Process Endorsement PIM-52552 (08/19), II.5)g; Healthy Paws documents page for Arizona.

What it looks like in practice

There are no dollar amounts here, because the documents give none. Only days and policy clauses.

  1. Illinois, Embrace V6. On day 120 of the policy the owner notices the dog favoring its left hind leg and tells the vet. The vet records cruciate ligament disease in the left knee. Result: cruciate ligament disease is excluded for the life of the policy (item 1), and so is the right knee (the other-side rule). Hip dysplasia, IVDD and patellar luxation are not excluded by these rules unless they too occurred or showed signs in the first 180 days (for IVDD, also before enrollment). An exam at the start of the policy would not have helped: V6 has no orthopedic exam waiver.
  2. Texas, Fetch. On day 60 the dog jumps off the couch, yelps, and has back pain. The vet diagnoses IVDD. For Fetch this is not an accident (V.n), and it occurred in the first 180 days, so it is excluded for the life of the policy (V.h). A knee exam would not help: the knee exception does not reach the spine. Fetch’s Pennsylvania form has no 180-day clause: it has a 30-day orthopedic waiting period, and the IVDD rule applies only if IVDD was diagnosed, treated or showed signs before that wait ended or at the first exam.
  3. Texas, Figo. On day 40 the dog falls and breaks a leg. It is an accident, but a fracture is orthopedic, and dogs have a 6-month orthopedic waiting period. If the Orthopedic Waiver Form was not sent in the first 30 days, the fracture is excluded as pre-existing.

What to do

  1. Find the orthopedic clauses before you buy. In the sample policy for your state, search for “180”, “orthopedic”, “bilateral”, “IVDD”, “intervertebral”, “hip dysplasia” and “accident”. Check that the form is for your state: Embrace and Fetch rules differ by state. How to read a policy is in the guide to what is in a policy.
  2. Ask in writing which form applies to you. Embrace’s pages contradict each other: for California, Pennsylvania, Washington and Vermont its guide says 30 days, while its terms selector opens V6 with 180 days. Keep the answer.
  3. Use an exam where one works, and do not miss the deadline.
    • Fetch (where the 180-day rule applies): a knee exam in the first 180 days. The record must specifically say there are no pre-existing knee conditions. It does not protect hips, elbows or the spine. In Washington, Pennsylvania and Florida a knee exam in the first 30 days waives the 30-day orthopedic wait for the knees.
    • Figo: an orthopedic exam and the Orthopedic Waiver Form within the first 30 days.
    • Healthy Paws in California, Pennsylvania and Washington: an exam waives the 30-day hip dysplasia period.
    • Embrace V6: there is no way. V5 (Kansas, New Mexico, South Carolina) lets an orthopedic exam shorten the 6 months.
  4. Remember that a sign can be your own words. At Embrace and Fetch, a clinical sign includes what the owner noticed. What you tell the vet can end up in the record. So compare policies before a limp or back pain appears, not after.
  5. Do not buy an accident-only policy for ligaments and the spine. Pets Best’s accident-only policy does not pay for the cruciate ligament, and in Texas, Arizona, Washington, Florida and Pennsylvania it does not pay for discs either.
  6. Enroll before age 6 if you are looking at Healthy Paws. After that, hip dysplasia is never covered.
  7. Compare where the rule is softer. In the documents we read: Fetch in Washington, Pennsylvania, New Jersey and Florida has a 30-day orthopedic waiting period instead of the 180-day lifetime exclusion (the other-side and IVDD rules remain). Figo in Washington and Pennsylvania has 30 days for orthopedic illnesses and no wait for injuries. Pets Best in New Jersey has no lifetime IVDD rule.
  8. Dispute an other-side denial. In Washington the law requires the signs to be directly related to the condition you claimed for, and the insurer must prove it.

The bigger picture is in the pet insurance trap.

Sources

History

  1. First published