When the second sock isn't covered: repeat-incident and behavior exclusions

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

If your dog keeps swallowing socks, getting into fights or getting hit by cars, the insurer can stop paying for that kind of incident. At Pets Best two similar incidents in 18 months can be enough, at Figo three similar claims, with no time limit on the count, and at Fetch and Embrace a second anesthetic removal of a swallowed object in the same policy period is not paid. Fetch, Embrace and Healthy Paws also exclude behavior from before the policy: a dog that persistently ate rocks or showed any signs of aggression before the policy may not be covered for similar incidents from day one.

How it works

The usual pre-existing condition exclusion looks at the vet record before you bought the policy. These are separate clauses. They look at repeats: the same kind of incident, the same behavior. We found four kinds.

  1. A repeat counter. Pets Best counts incidents in the 18 months before the treatment date, including those before the policy started. Figo counts “similar incidents” and after three calls such injuries and illnesses “preventable”.
  2. Behavior before the policy. Fetch and Embrace do not cover “similar episodes” if the dog “persistently” ate rocks or foreign objects before the policy. A dog that showed “any signs of aggression” before the policy is not covered for aggression or for fights. Healthy Paws excludes conditions from an activity that happened before the policy and “displayed the propensity” to recur.
  3. A warning from the insurer. Healthy Paws excludes conditions from a repeat of an activity after it has sent you written notice about it.
  4. A cap on foreign-body removals. Fetch and Embrace pay only for the first anesthetic removal of a swallowed object in each policy period. This applies to every pet, even one with no history. It is not about earlier behavior, but it hits the same dogs that swallow everything.

What the first three kinds share: the insurer decides what counts as “similar”, “repetitive”, “persistently” or a “propensity”. The policies do not define these words. State pet insurance laws protect owners at renewal and make the insurer prove a pre-existing condition exclusion, but these protections are written for pre-existing conditions. These clauses stand apart from the pre-existing condition exclusion, even where Fetch and Embrace call one of them “pre-existing behavioral problems”. So it is unclear whether the protections reach them.

Examples

Pets Best: twice in 18 months, Arizona and other states

Clause 5.A.6(g) in Pets Best’s Arizona sample policy (the insurer is Independence American, IAIC):

“Conditions arising from a repetitive and specific activity that leads to decontamination (e.g., the induction of vomiting), medical or surgical Treatment of your Pet, if the same or a similar activity occurred two times within 18 months prior to the Treatment date, whether before or after the Policy Effective Date.”

What it means:

  • The clause is not only about swallowed objects and not only about injuries. It covers any “Condition”, meaning illness or injury, from a repeated activity.
  • Incidents before the policy count. The policy does not require the earlier incidents to have been treated or insured.
  • The window is 18 months before the treatment date. Two incidents three years ago do not trigger the clause.
  • The policy does not say whether the current incident counts. The behavior that brought you to the vet today also happened before the treatment date. So the clause can be read to allow a denial from the second incident, not the third. At the latest, from the third.
  • Pets Best decides what a “similar activity” is.

Pets Best’s Arizona accident-only policy has the same clause, worded for behavior: “Injuries arising from a repetitive and specific behavior, if the same or a similar behavior occurred two times within 18 months prior to the Treatment date, whether before or after the Policy Effective Date.” So an accident-only policy, which we suggest considering when the record already shows an illness (the pet insurance trap), does not protect you from repeats either.

Arizona has no pet insurance law. The only limit is the general rule that forms must not be misleading (A.R.S. 20-398). More on the Arizona page.

Sources: Pets Best, Accident and Illness sample policy, IAIC-PB10001-ILL, Arizona, section 5.A.6(g), p. 6; accident-only sample policy IAIC-PB10001-ACCv2, Arizona, Other exclusions C.5, p. 5.

The same clause is in Pets Best’s samples for other states:

What the laws say. California (Cal. Ins. Code 12880.2(b)(2)), Florida (627.71545(4)(a)), Pennsylvania (40 Pa.C.S. 4701–4711), Washington (RCW 48.205) and New Jersey (from 2027) have pet insurance laws. But each says it does not prohibit or limit the types of exclusions an insurer may use. None limits how far back repeats can be counted. The laws do make the insurer prove that an exclusion applies, but only the pre-existing condition exclusion. Their renewal protection is also written for pre-existing conditions. This clause is not labeled that way. So it is unclear whether these protections reach it, including incidents that happened while the policy was in force. That is our inference. Illinois and Texas have no pet insurance law: Illinois, Texas.

Figo: three similar incidents, Pennsylvania and other states

Exclusion 16 in Figo’s Pennsylvania policy (the insurer is also IAIC):

“Any Illness or Injury that arises due to repetitive activity that results in Your Pet requiring repeated medical Treatment. After three (3) separate but similar incidents of such Claims, Coverage for these Illnesses or Injuries would be considered or diagnosed preventable, such as, but not restricted, to foreign body ingestions, porcupine quills, fight/bite wounds/lacerations, motor vehicle Injuries and poison ingestions.”

What it means:

  • These are ordinary accidents: bites, a swallowed sock, a car. After three similar ones Figo calls them “preventable” and stops covering them.
  • The incidents must be of the same kind. One sock, one fight and one car do not add up to three.
  • The list of examples is open: “but not restricted”. Figo decides what counts as “similar” and “repetitive”.
  • The text implies the first three similar claims are paid and later ones are not. The policy never says so outright: the sentence is garbled.
  • The Pennsylvania form has no time window, so the count never resets.

Pennsylvania law (40 Pa.C.S. 4701–4711) does not ban such exclusions. But there is a contradiction. The law requires the insurer to disclose “Whether the pet insurer will reduce coverage or increase premiums based on the insured’s claim history” (§4705(a)(6)). Figo’s Pennsylvania disclosure says: “We do not reduce coverage or increase premiums based on the policyholder’s claim history.” Yet exclusion 16 turns coverage off once the count of “incidents of such Claims” reaches three. Figo could argue that the trigger is preventability, not claim history. It is still a question worth putting to the regulator. More on the Pennsylvania page.

Sources: Figo, sample policy IAIC FPI POL PA 0424, Pennsylvania, Policy Exclusions, no. 16, p. 9; Figo’s Pennsylvania disclosure of important policy provisions, p. 3.

In other states:

Fetch: earlier behavior and one removal per period, Illinois and New Jersey

Fetch’s Illinois policy (the insurer is AXIS Insurance Company) has two rules about behavior before the policy, both in exclusion qq:

“Treatments for injuries or illnesses arising from any Pre-existing behavioral problems or persistent occurrences. For example, a dog that has persistently eaten rocks or foreign objects prior to the Pet’s Original Inception Date shall not be covered for Treatment during the policy period(s) for similar episodes.”

And in the same exclusion:

“A dog who has shown any signs of aggression prior to the pet’s original inception date shall not be covered for aggression or dog fights.”

What it means:

  • One episode before the policy is not enough: it has to be “persistently”. The policy does not say how many times makes “persistently”.
  • For aggression the bar is lower: “any signs” will do. The exclusion covers both treatment for the aggression itself and injuries from fights. It lasts as long as the policy and applies to dogs only.
  • Fetch defines Clinical Signs as changes in the pet’s health, bodily functions or behavior “as observed by you, a veterinarian, and/or recorded in your pet’s medical records”. So your own remark at the vet, “he growls at other dogs”, can become the evidence.
  • A narrow exception: the Adoption Support benefit (pp. 7–8) pays for medications only, up to $1,000 a year, for a newly adopted pet that showed behavioral signs in the 30 days before the policy, if they were noted at an exam. It does not cover fight injuries. How it fits with exclusion qq is unclear.

Separately, for every pet, exclusion oo:

“More than the first submitted anesthetic removal of an ingested foreign body in one (1) policy period.”

This is a cap, not a penalty for the past. Only the first removal under anesthesia in a policy period, usually a year, is paid. A second one in the same period is not, whether it is surgery or endoscopy.

Source: Fetch, Pet Health Insurance Policy Terms and Conditions, GPTM 050 IL 0326 A, Illinois, Section V General Exclusions, oo and qq, p. 13.

Illinois has no pet insurance law: bill HB 3595 was rewritten and enacted as P.A. 104-0480 with no pet provisions. No state statute limits these clauses (Illinois page, Fetch page).

New Jersey. Policy GPTM 050 PML NJ 0326 A has the same clauses: oo on p. 13, qq on p. 14. New Jersey’s law (P.L. 2025, c.224, from 1 January 2027) says outright that it does not limit the types of exclusions: “Nothing in this act shall in any way prohibit or limit the types of exclusions pet insurers may use in their policies” (C.17:46D-6b). There is one opening, and only for qq: Fetch itself calls it “Pre-existing behavioral problems”. For a pre-existing condition exclusion, the law puts the burden of proof on the insurer (C.17:46D-8a). And where the insurer relies on signs or symptoms, they make a condition pre-existing only if they are “directly related to the condition for which a claim is being made” (C.17:46D-5). That may make it harder to deny a fight injury on the basis of “any signs of aggression” that are unrelated to it. But the question is not settled. More on the New Jersey page.

The same wording is in Fetch’s forms for Florida (GPTM 050 FL 1125 A), Washington (GPTM 050 WA 1125 A) and in the base form GPTM 050 1125 A used in Texas and Arizona. The Florida form uses the same letters as Illinois, oo and qq. In the Washington and base forms the foreign-body cap is pp and the behavior clause is rr.

Embrace: the same three clauses, nearly every state

Embrace’s V6 terms, Part IV Exclusions:

“Treatments arising from any pre-existing behavioral problems. For example, Treatment(s) for a dog that has persistently eaten rocks or foreign objects prior to the Pet Original Start Date shall not be covered during the policy period for similar episodes;”

“A dog who has shown any signs of Aggression prior to the Pet Original Start Date shall not be covered for Treatment for Aggression or dog fights;”

“More than the first submitted anesthetic removal of an ingested foreign body in one (1) policy term of insurance;”

Per Embrace’s own index, V6 applies in Illinois, New Jersey and every other state except Kansas, New Mexico and South Carolina. Those use V5, which has the same aggression, rocks and foreign-body wording.

Source: Embrace, Pet Health Insurance Policy V6, Part IV – Exclusions.

Healthy Paws: “propensity” and a written warning, Illinois

Healthy Paws’ sample policy (the insurer is Westchester Fire Insurance Company), section II.4 Other Exclusions, has two clauses. Item d:

“Conditions arising from a specific activity if the same or a similar activity occurred prior to the pet policy effective date and displayed the propensity for the activity to recur and cause injury or illness to your pet;”

Item l:

“Conditions arising from any specific activity if the same or similar activity occurs after you have received written notice from us regarding the specific activity;”

What it means:

  • Item d is the only clause we found that may need just one incident before the policy. The one condition is that the incident “displayed the propensity” to recur. The policy does not say who judges that, or how.
  • Item l works while the policy is in force. The insurer sends a letter about the activity, and the next same or similar incident is not covered. The policy does not say whether the letter must name the pet or whether it expires.

The Illinois amendatory endorsement LD-50818 (09/19) and the Illinois claims process endorsement do not change these items. Illinois has no pet insurance law. Healthy Paws’ Louisiana and Texas documents contain the same sample LD-50812, and the New Jersey endorsement (LD-50807) changes only the misrepresentation and fraud section.

Source: Healthy Paws, Pet Health Insurance Policy, sample LD-50812 (07/18), II.4.d, p. 2; II.4.l, p. 3, linked from Healthy Paws’ Illinois documents page.

What it looks like for an owner

A dog that swallows socks. There are no dollar amounts here: the documents we read give no prices for foreign-body removal, and we will not make them up.

  1. Two months before the policy, the vet once induced vomiting after a sock.
  2. You buy a policy. Six months later, another sock, and vomiting is induced again.
  3. Eight months after that, a third sock, and this time it needs surgery.

What happens at each insurer:

  • Pets Best. In the 18 months before the surgery there were two similar incidents, the first one before the policy. The surgery is not covered. On the stricter reading, even the second incident could have been refused: the behavior behind it also happened before the treatment date.
  • Figo. Exclusion 16 counts incidents “of such Claims”. The pre-policy incident was not a claim, so on the text it does not count. That is our inference. Here there are only two claims, so exclusion 16 does not apply yet. On its text it applies after three similar claims, and in the 1025 forms the count is lifelong.
  • Fetch and Embrace. One incident before the policy is not yet “persistently”. The surgery is the first anesthetic removal in the policy period, so the cap does not exclude it. If a second surgery or endoscopy is needed in the same period, it is not paid.
  • Healthy Paws. If the insurer decides the pre-policy incident “displayed the propensity” to recur, it can refuse the second incident already. If a notice about the activity arrived after the second incident, the third is not covered.

If the same record notes “growls at dogs” before the policy, Fetch and Embrace may treat that as a sign of aggression and not cover fight injuries for as long as the policy runs.

What to do

  • Before buying, search the policy for “repetitive”, “similar activity”, “similar incidents”, “persistent”, “behavioral problems”, “aggression”, “foreign body” and “written notice”. Read the whole list of exclusions, not only the pre-existing conditions section.
  • Ask in writing whether the current incident counts toward the repeats, what “similar”, “persistently” and “propensity” mean, and who decides.
  • Before buying Healthy Paws, ask what a notice under item II.4.l looks like, whether it must name the pet, and whether it ever expires.
  • Know that your words at the vet go into the record. Fetch’s definition of Clinical Signs includes changes “observed by you”. A recorded remark like “sometimes snaps” may be read as a sign of aggression and shut off cover for fights.
  • If your dog swallows everything, factor in the Fetch and Embrace cap: one anesthetic removal per policy period. Pets Best has no such cap, but it has the two-in-18-months counter. All five insurers whose policies we read here have at least one clause of this kind.
  • An accident-only policy does not get you out. Pets Best’s Arizona accident-only policy has the same repeat counter.
  • If a claim is denied, ask the insurer in writing to name the policy provision and the records it relies on. In states with a pet insurance law, the insurer must prove that a pre-existing condition exclusion applies. In Pennsylvania, ask the regulator how Figo’s exclusion 16 fits with its promise not to reduce coverage based on claim history.

Related guides: the pet insurance trap, pre-existing conditions. Insurer pages: Pets Best, Figo, Fetch, Embrace, Healthy Paws.

Sources

  • Pets Best, Accident and Illness sample policy, IAIC-PB10001-ILL, Arizona: PDF. Section 5.A.6(g), p. 6. Accident-only policy IAIC-PB10001-ACCv2, Arizona: PDF, Other exclusions C.5, p. 5. Both samples are linked from petsbest.com/faq/download-sample-policy.
  • Pets Best, samples for Illinois, Texas, New Jersey (IAIC-PB10001-ILL, 5.A.6(g)), Florida and Pennsylvania (IAIC-PB10001-ILL with state endorsements, 5.A.6(g)), California (IAIC-PBI0001-ILL, exclusion 14), Washington (APIC-PBI0001-ILL, exclusion 14).
  • Figo, sample policy IAIC FPI POL PA 0424, Pennsylvania: PDF. Policy Exclusions, no. 16, p. 9. Pennsylvania disclosure of important policy provisions: PDF, p. 3.
  • Figo, policy IAIC FPI POL WA 0724 AI2, Washington: PDF. Figo, policy IAIC FPI POL IL 1025, Illinois: DOCX. The same “during Your Pet’s lifetime” wording is in the 1025 editions for Arizona, Texas and Indiana.
  • Fetch, Pet Health Insurance Policy Terms and Conditions, GPTM 050 IL 0326 A (sample dated 8.13.26), Illinois: PDF. Section V, oo and qq, p. 13; Clinical Sign(s) definition, p. 3; Adoption Support for behavioral disorder(s), pp. 7–8.
  • Fetch, GPTM 050 PML NJ 0326 A (sample dated 9.21.26), New Jersey: PDF. Section V, oo (p. 13), qq (p. 14).
  • Fetch, forms GPTM 050 FL 1125 A, GPTM 050 WA 1125 A, GPTM 050 1125 A (Texas, Arizona).
  • Embrace, Pet Health Insurance Policy V6, Part IV – Exclusions: page.
  • Healthy Paws / Westchester Fire Insurance Company, sample policy LD-50812 (07/18): PDF. II.4.d, p. 2; II.4.l, p. 3. Illinois documents: endorsements LD-50818 (09/19) and claims process. New Jersey endorsement LD-50807 (07/18).
  • Pennsylvania: 40 Pa.C.S. §§4701–4711 (Act 2024-19), §4705(a)(6), §4707(2): text of the act.
  • New Jersey: P.L. 2025, c.224 (N.J.S.A. 17:46D), C.17:46D-5, C.17:46D-6b, C.17:46D-7, C.17:46D-8a; in force from 1 January 2027.
  • Pet insurance laws: Cal. Ins. Code 12880.2(b)(2); Fla. Stat. 627.71545(4)(a); RCW 48.205. Arizona: A.R.S. 20-398. Illinois: HB 3595, enacted as P.A. 104-0480 with no pet provisions.

History

  1. First published