Pre-existing can mean anything a vet 'would have' found

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

An insurer can refuse to pay for an illness that nobody noticed or wrote in the vet record before cover began. The policy lets it argue that a routine vet exam “would have” found the illness earlier. This wording is in policies from Spot, ASPCA, Pumpkin, Healthy Paws, Trupanion and Pets Best. Nationwide’s Pennsylvania forms go further on paper: they need no signs at all. But Pennsylvania law says its own, narrower definition applies instead.

How it works

State pet insurance laws define a pre-existing condition by facts: a vet gave advice, the pet was treated, or “verifiable sources” show signs directly related to the illness. Seventeen states have such a law, counting New Jersey from 2027; California’s wording is a little looser (see state laws). Under that definition the insurer has to point to something that actually happened.

The policies on this page add a supposition. In the IAIC policies (Spot, ASPCA, Pumpkin) an illness starts (“occurs”) at the earliest of three moments:

  1. someone noticed signs (including you);
  2. signs were written in the vet record;
  3. the signs “would have been detectable” by a routine vet exam.

Trupanion, Pets Best and Healthy Paws use similar words: “would have been observable”, “reasonably known”, “detectable by a routine physical exam”.

The third moment is a supposition. There may have been no exam. Nobody may have seen any signs. But if the insurer argues that the signs would have been detectable on an exam before the start date or during the waiting period, the illness “occurred” before cover. Where the pre-existing definition rests on this word, the illness then counts as pre-existing and can be excluded along with related conditions.

This wording turns up in two places:

  • In the pre-existing definition itself. That is the case for Spot, ASPCA and Pumpkin in Arizona, Texas and New Jersey, and for Trupanion’s 2019 form. Nationwide’s Pennsylvania definition goes further still.
  • In a separate clause outside the definition. Healthy Paws has it in “Other Exclusions” in every state we checked. In Pennsylvania and Washington the law requires its own pre-existing definition. There ASPCA (Pennsylvania), Spot and ASPCA (Washington) and Pets Best (Washington) swapped in the statutory definition but kept “would have” in another clause. Both states’ laws say they do not limit the types of exclusions an insurer may use.

What this rule does not do. IAIC (Spot, ASPCA, Pumpkin) has a separate clause that lets it cancel or rescind the policy. In the Arizona and Pennsylvania forms the rescission “may” be backdated to the “original policy period effective date”. (In Texas a state endorsement deletes this clause and replaces it with its own list of reasons to cancel.) But rescission needs a misrepresentation: you misrepresented or concealed a material fact that would have affected the insurer’s decision to insure you. If you honestly did not know about the illness, you concealed nothing. Then the “would have found” rule leads to a denied claim, not a rescinded policy. In Arizona the law (A.R.S. § 20-1109) treats answers in an application as representations, not warranties. It names three cases in which a misstatement can prevent payment: it was fraudulent; it was material to the risk; the insurer in good faith would not have issued the policy or covered the hazard. We have not checked whether courts require one of these or all three.

Examples

Spot, ASPCA, Pumpkin: Arizona, Texas, New Jersey

All three brands are underwritten by Independence American Insurance Company (IAIC) on editions of one policy form, PET-P-20000. The key definition is the same:

“Occur or Occurrence: When signs or symptoms related to a condition first were observed by any individual, recorded in your pet’s medical record, or would have been detectable by a routine physical veterinary exam.”

A pre-existing condition is one that “first occurs or shows symptoms before coverage is effective or during a waiting period”. The waiting period is 14 days. Related and secondary conditions are excluded too. There is no look-back limit.

Note “observed by any individual”: if you yourself noticed the dog limping, that counts too.

One concession. If a curable pre-existing illness has been cured and free of symptoms and treatment for 180 days, it counts as a new occurrence and can be covered. That does not apply to chronic conditions or to ligament and knee conditions.

  • Arizona. Spot: Independence American, Accident and Illness Coverage, form PET-P-20000-1024, Definitions, p. 3. The same text is in the ASPCA sample and the Pumpkin sample, March 2026, p. 3 of 11. Arizona has no pet insurance law, so no state definition narrows this wording.
  • Texas. The same form PET-P-20000-1024 with the same definitions, in the Texas samples of ASPCA, Spot and Pumpkin (March 2026). Texas has no such law either.
  • New Jersey. Pumpkin: form PET-P-20000-NJ-1024, March 2026, Definitions, p. 3; Waiting Periods, p. 4. The waiting-period section adds: “Any condition that occurs during an applicable waiting period is a pre-existing condition.” The same definitions and the same sentence are in Spot (PET-P-20000-1024, definitions p. 3) and ASPCA (PET-P-20000-0723, definitions pp. 2–3). New Jersey’s pet insurance law (P.L. 2025, c.224) takes effect on 1 January 2027. It defines a pre-existing condition by three tests: vet advice, treatment, or signs directly related to the illness shown by “verifiable sources” (N.J.S.A. 17:46D-5). The insurer must prove that the exclusion applies (17:46D-8a). In our reading, a sign that “would have been detectable” but that nobody saw or recorded is not information from a verifiable source. The law does not say so expressly. And in other states with such a law IAIC kept the “Occur” definition (see below), so the wording may survive in New Jersey’s 2027 policies.

In Florida the ASPCA sample (PET-P-20000-FL-1024) has the same two definitions. But this edition (10/24) predates Florida’s law (§627.71545, from 1 January 2026), which uses the NAIC model definition and puts the burden of proof on the insurer. It may be outdated.

Spot and ASPCA where there is a law: Pennsylvania, Washington

Here the pre-existing definition is the statutory one, and the main pre-existing exclusion works only through it. A heart murmur nobody heard is not excluded under it just because it “would have been detectable”. But the “Occur” definition with “would have been detectable” stays, and it drives other clauses.

  • Pennsylvania, ASPCA. Form PET-P-20000-PA-0425, Definitions, p. 3; exclusions f and o, p. 6; s, p. 7.
    • Exclusion 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.” “Occurred” includes “would have been detectable” on an exam. No vet record is needed. The typical case is a slipping kneecap (luxating patella).
    • Exclusion f: “Conditions that occur during a waiting period.”
    • ASPCA’s Pennsylvania disclosure (PET-PA-Notice-0424-APHI), p. 4 tells buyers directly that illnesses that “occur during or before a waiting period are considered pre-existing”.
    • The law: 40 Pa.C.S. §4703(c)(1) says nothing in the chapter shall “prohibit or limit the types of exclusions”. So exclusions o and f appear to be allowed. The insurer must prove that the pre-existing condition exclusion applies (§4706(a)(2)). Whether that reaches o and f, which are not labelled pre-existing, is unclear.
  • Washington, Spot and ASPCA. Here they are underwritten by United States Fire Insurance Company: form PET-P-20030-0124-USFWA-(3) with Washington endorsement PET-AE-20060-WA-0918, Definitions, pp. 2–4; exclusions e, n, r, p. 6; Policy Changes, p. 9. The Spot and ASPCA samples are word for word the same. The “Occur” definition is the same. The policy defines a symptom as “Any change in your pet’s state of health, normal function, behavior or appearance, including those that did not require treatment at the time of observation”. “Would have been detectable” works in three places:
    • exclusion e: conditions that “occur” during the 14-day waiting period;
    • exclusion n: if any knee or ligament condition “occurred” before cover or during the waiting period, all knee and ligament conditions are excluded. The policy treats them as “bilateral and related, regardless of cause”. The 180-day rule does not apply to them;
    • policy changes: if a change to the policy leads to a new enrollment, conditions that “occur” before it “will be considered pre-existing”.
    • The law: RCW 48.205.030(2) does not limit the types of exclusions, and RCW 48.205.050(1) puts the burden of proof on the insurer. Exclusions e and n apply a broader test than the statutory definition. That is a tension, not an outright violation.

Illinois has no such law, but IAIC’s Illinois form (PET-P-20000-IL-1024) is built the same way: the three-part pre-existing definition, the same “Occur” definition and the same exclusions.

Healthy Paws: Pennsylvania, Washington, New Jersey, Illinois, Texas, Florida

Healthy Paws is underwritten by Westchester Fire Insurance Company (a Chubb company). Base form LD-50812 (07/18), “Other Exclusions”, item 4.h:

“Abnormalities where clinical symptoms were apparent prior to the pet policy effective date. This includes conditions that are detectable by a routine physical exam by your veterinarian”

Definition V.3 widens it further: clinical symptoms “include any anomaly that is readily detectible by a thorough and complete clinical examination”.

Item 4.h is not called a pre-existing exclusion, and the state endorsements that swap in the statutory pre-existing definition leave it unchanged. There is no look-back limit: what counts is whether symptoms were “apparent”, or detectable on a routine exam, before the policy start date. The waiting period is not part of this test. A heart murmur or a lump found after purchase can be excluded under this item if the insurer says a routine exam would have detected it before the start date.

  • Pennsylvania. Sample LD-50812, form p. 2, §II.4.h and Pennsylvania endorsement PI-50810 (09/24). The endorsement rewrites several sections, including the pre-existing definition (24), but not item 4.h, and says: “All other terms, conditions and limitations of this Policy shall remain unchanged.” It also made the enrollment exam optional (“should”). In our reading, the insurer can argue about what an exam would have found even if none took place. The Pennsylvania disclosure (PI-60362PA) does not mention 4.h; it says only “Other exclusions may apply”. State law says it does not limit the types of exclusions (§4703(c)(1)).
  • Washington. Sample LD-50812, form p. 3, §II.4.h and endorsement LD-50798 (09/23), which does not change section II.4. The law (RCW 48.205.030(2)) does not ban other exclusions. But 4.h works like a second pre-existing exclusion on a looser test: not “verifiable sources” but “what an exam would have found”. In effect it sidesteps the statutory definition and arguably the burden-of-proof rule. A regulator or a court would have to decide. The policy itself (IV.3) promises to conform any clause that conflicts with state law.
  • New Jersey. Healthy Paws’ documents page for the state links the general form LD-50812, p. 3 of 7. The New Jersey endorsement LD-50807 changes only the misrepresentation and fraud clause. From 2027 the state law applies (see above).
  • Illinois and Texas. Item 4.h is the same in the samples, and the state endorsements (LD-50818, LD-51409) do not touch it.
  • Florida. The same item is in ACE form PI-39283 (11/12).

Trupanion: Arizona, Texas, New Jersey, Illinois

Trupanion 2019 sample, form TRU (D) 00001 (V10.201902), American Pet Insurance Company, section 9 B, pp. 14–15. Trupanion’s website serves this file for Arizona and for every state without its own version, including Texas and New Jersey. We did not check whether new policies are still issued on it.

A pre-existing condition is one that began in the 18 months before enrollment or during the waiting period. That includes conditions that “would have been observable or reasonably known to be present by You or Your Veterinarian or that are evidenced by the presence of typical signs even if they are not noted in Your Pet’s medical records.”

The 18-month limit works in the owner’s favour. But two conditions have no limit. Hip dysplasia is 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”. The same goes for intervertebral disc disease (p. 15).

The same wording is in the forms for Illinois (TRU (D) 00001 IL), Massachusetts and New York. The newer edition TRU (D) 00001.1 (V01.202309), which the website serves for Florida, Washington and a number of other states, has no 18-month limit at all.

Arizona has no pet insurance law, so no state definition removes the “not noted” wording.

Pets Best: Washington

Pets Best sample for Washington: American Pet Insurance Company, base form APIC-PBI0001-ILL (12/2015), section 9.A, booklet p. 18; definitions G and T, pp. 20–21; Washington endorsement APIC-PBI0004-AE-ILL-WA (06/2025).

The 2025 endorsement replaced the pre-existing definition with the statutory one. But section 9.A and the definition of “Present” stayed from the 2015 form. A condition is “Present” if it shows signs “that would have been observable or reasonably known to be present by you or your Veterinarian, including those conditions in remission or controlled by medication, whether or not the Condition is noted in your Pet’s medical records.”

For ordinary conditions Pets Best looks at the 18 months before the policy starts. With no time limit, these count as pre-existing:

  1. chronic conditions that were “Present” at any time before the policy or before the waiting period ended;
  2. bilateral conditions, if the pet ever had a pre-existing case of the same condition on either side. The list is open-ended: luxating patella, cruciate ligament events, hip and elbow dysplasia, osteochondritis dissecans, glaucoma, cataracts, entropion, ectropion and cherry eye;
  3. intervertebral disc conditions, if the pet ever had a pre-existing disc condition, from degeneration or trauma.

Example: if a dog had a cruciate injury or a slipping kneecap in one knee before the policy, cover for the same problem in the other knee can be refused.

The Washington disclosure (APIC-PBI0012-WA) mentions neither the 18 months nor the bilateral and disc rules. Washington law allows other exclusions (RCW 48.205.030(2)), but the insurer must prove them (.050(1)). The bilateral and disc rules rely on the term “Pre-Existing Conditions”, which in Washington now has the statutory meaning: vet advice, treatment, or signs directly related to the illness shown by “verifiable sources”. The “Present” test is broader than the statute. That is a tension, not an outright violation. The same section 9.A and the same definition are in Pets Best’s New York sample.

For Arizona, Florida, Illinois, Pennsylvania and Texas, Pets Best cites a different form, IAIC-PB10001-ILL (we read the Texas file). It has the NAIC model definition, no 18-month look-back and no “at any time” rules for chronic, bilateral and disc conditions. But it still defines “Bilateral Condition” and “Present”.

Nationwide: Pennsylvania

On paper, “would have found” is not even needed here. It is enough that the illness “began”.

Nationwide / National Casualty Company, Modular Pet Insurance Coverage Form, VS-G-15-PA (9-24), §2.S, p. 3: a pre-existing condition is “any condition that began or was contracted, manifested, or incurred before the effective date of this policy or during any waiting period, whether or not the condition was discovered, diagnosed, or treated.”

In Whole Pet for Pennsylvania (VS-G-11-PA (9-24), §2.N, p. 3) the look-back is 12 months. But a chronic condition counts as pre-existing with no limit: “A chronic condition is a pre-existing condition unless it began after the effective date of this policy.”

Both forms contradict Nationwide’s own Pennsylvania disclosures (IDIP-MPI-PA and IDIP-POI-PA, 9-24). Those use the statutory definition: vet advice, treatment, or signs shown by verifiable sources. The statutory definition is also in Nationwide’s Pennsylvania My Pet Protection forms (VS-G-13-PA, VS-G-14-PA).

Here the law is on the owner’s side. 40 Pa.C.S. §4703(a): if a policy uses a term from the law, “the definition under section 4702 shall apply”. The insurer must prove the exclusion (§4706(a)(2)). A denial that rests only on the broad policy wording can be challenged. Both forms also leave out another rule of the law: an illness the policy already covered cannot become pre-existing at renewal (§4706(a)(3)).

The same broad Modular wording is in the general form VS-G-15 (9-24) and in the forms for Alaska, Massachusetts and New Hampshire. The Whole Pet wording with 12 months and chronic conditions is in the general form VS-G-11, which Nationwide lists for about 28 states.

What it looks like for an owner

No prices, just the mechanism. A Spot, ASPCA or Pumpkin policy in Arizona or Texas, or an ASPCA policy in Pennsylvania (all IAIC).

  1. You buy a policy for a puppy. The waiting period is 14 days.
  2. Some time after the policy starts, the vet finds a slipping kneecap at an exam. Nobody had noticed anything before, and the record has no entries.
  3. The insurer can say: the signs would have been detectable on a routine exam earlier, before the policy started or in the first 14 days. So the knee condition “occurred” before cover or during the waiting period.
  4. Then the knee and ligament exclusion removes all knee and ligament conditions, including the other leg. The 180-day rule does not apply to knees, so the exclusion does not lapse.

At Healthy Paws the same move goes through item 4.h: a heart murmur or a lump found after purchase can be called “detectable by a routine physical exam” before the start date.

What to do

  • Get a full vet exam before you buy the policy. Ask the vet to record the result system by system: heart, knees, joints, skin, lumps. A “normal” entry right before the policy starts is your argument against “an exam would have found it”. This is our advice, not a rule from a policy. If the exam finds something, it would count as pre-existing anyway, but you learn that before you pay, not when a claim is denied.
  • Read the definitions, not just the pre-existing section. Look for “would have been detectable”, “observable”, “reasonably known”, “not noted”, “whether or not … discovered”, “Occur”, “Present”. Then read the whole list of exclusions: at Healthy Paws the rule sits in “Other Exclusions”; in ASPCA’s Pennsylvania form and the Spot and ASPCA Washington form, in the knee and ligament and waiting-period exclusions.
  • Ask in writing before you buy: “Can you deny a claim on the ground that a routine exam would have detected a condition before the start date, if the vet record has no entry about it?”
  • Know your state’s law. In Pennsylvania, Washington and Florida (and in New Jersey from 1 January 2027) the law defines a pre-existing condition by vet advice, treatment, or signs directly related to the illness shown by verifiable sources, and the insurer must prove that the exclusion applies. Whether that reaches separate clauses such as Healthy Paws’ 4.h or the knee exclusion is unclear. If a claim is denied, ask in writing which record or source shows a sign before the start date. Nationwide customers in Pennsylvania can cite 40 Pa.C.S. §4703(a). More in state laws and pre-existing conditions.
  • Where the wording is narrower. Nationwide’s newer Modular editions VS-G-15 (3-26) for Florida, Texas and several other states use the model-law definition, as do its Pennsylvania My Pet Protection forms. Trupanion’s 2019 sample limits the look-back to 18 months for most conditions, although “not noted” is there too. We have not yet checked other insurers for this wording.
  • Complain to your state regulator if a denial rests only on the claim that an illness “would have been detectable”.

Why pre-existing exclusions keep you from leaving an insurer is explained in the pet insurance trap. State pages: Arizona, Texas, New Jersey, Pennsylvania, Washington, Illinois, Florida. Insurers: Spot, ASPCA, Pumpkin, Healthy Paws, Trupanion, Pets Best, Nationwide.

Sources

History

  1. First published