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As the pet insurance industry grows, inevitably, so do issues with coverage denials and delays. If you are a pet owner and find yourself at odds with a pet insurance company, don’t worry, as there are different actions you can take, like filing an insurance report against the pet insurance company.
In this article, we discuss your options, go over who regulates pet insurance companies, and explore other actions you can take if filing a complaint doesn’t work.
Did you know we have a free tool powered by AI that helps you create a demand letter to a pet insurance company? Check out our demand letter tool.
Reasons to File a Complaint Against a Pet Insurance Company
Here are some common reasons to file a complaint against a pet insurance company:
Overcharging scams. The pet insurance company overcharges consumers for premiums that, in reality, cover very little.
Denied claims. The pet insurance company denied your claim in bad faith or does not pay for all costs on a covered claim.
Fraud. The pet insurance company engages in fraudulent business practices.
Delayed claims. The pet insurance company takes an unreasonable amount of time to process your claim, causing you and your pet further hardship.
Who Regulates Pet Insurance Companies?
For the most part, pet insurance companies in the United States are regulated at the state level by each state’s Department of Insurance. Further, pet insurance is usually grouped under other types of insurance like “property.” What this means is that there is no set standard for how pet insurance companies are regulated throughout the United States. This is something that the National Association of Insurance Commissioners (NAIC) has set out to change.
The National Association of Insurance Commissioners: Model Laws
NAIC is a regulatory association comprising the chief insurance regulators from all fifty states. Recently, NAIC worked on creating model laws to address the varying regulatory standards for pet insurance companies across different states. Ultimately, the NAIC leaves it up to each state's lawmakers to decide whether or not to implement these model laws.
Here are some examples of the laws propagated by NAIC in their Pet Insurance Model Act (“the Act”):
Consumer protection laws. Under Section 4 of the Act, pet insurers would be required to disclose if a policy excludes coverage due to the medical history of a pet, this includes preexisting conditions, a hereditary disorder, or a chronic condition. Section 4 also discusses further disclosures that would protect consumers when purchasing pet insurance.
Policy exclusions based on preexisting conditions. Under Section 5 of the Act, a pet insurer can exclude coverage on the basis of one or more preexisting conditions, provided the appropriate disclosures have been made to the consumer. Further, the pet insurer has the burden of proving that the preexisting condition limitation applies.
Regulation of the sales practices for wellness programs. Under Section 6 of the Act, a pet insurer would have to follow specific regulations when it comes to selling wellness programs. For example, a pet insurer cannot market a wellness program as pet insurance (wellness programs need to be delineated from the pet insurance package).
The NAIC passed these model laws with the goal of creating a consistent and comprehensive set of regulations that states could adopt uniformly across the nation.
State Laws Regulating Pet Insurance Companies
When NAIC published its Model Act, California was the only state with laws specifically governing pet insurance under California Insurance Code 12880-12880.6.
The California laws had marked similarities with the NAIC Model laws. For example, under INS 12880.2, a pet insurer in California would be required to disclose if a policy excludes coverage due to a pet’s medical history, this includes preexisting conditions or hereditary disorders. These types of disclosures are also required under the NAIC Model laws.
However, Maine signed their own pet insurance law in 2022 based on a draft version of the NAIC model laws. Maine’s pet insurance law has comparable policy conditions and consumer protections as those outlined in California and the NAIC model laws.
As the pet insurance industry grows, consumers should keep an eye out for changes in legislation in their states. People Clerk will keep updating this article as necessary so consumers are informed of their rights.
File a Complaint Against a Pet Insurance Company With Your State Insurance Department
As discussed above, each state has its own Department of Insurance. These government agencies regulate all types of insurance companies operating within their state, including pet insurance companies.
How to file a complaint with your state Department of Insurance:
Most of these state insurance departments allow consumers to file consumer complaints online, by mail, or over the phone.
For example, the California Department of Insurance allows individuals to file an online complaint against a pet insurance company on their website.
Search online for your state’s insurance department for specific information. Or go on the NAIC website here and find your state’s insurance department to file a complaint.
When filling out these complaint forms, make sure to: (1) provide up-to-date contact information, (2) be detailed when describing your complaint, and (3) include evidence related to your complaint if you can.
Learn more about how to file a complaint against an insurance company in California here.
File a Complaint Against a Pet Insurance Company With Your State Attorney General
An Attorney General is the chief legal officer of a state. Your state’s Attorney General's office is most likely responsible for various legal issues, such as enforcing consumer protection and other regulatory laws.
The Attorney General’s office also handles consumer complaints against businesses such as pet insurance companies.
Filing a complaint with the Attorney General’s office is usually as easy as submitting a form online or calling a hotline.
For example, the New York Attorney General accepts complaints by phone at 1-800-771-7755 and online at the link here.
For more information, here is our 50-state guide on how to file an Attorney General complaint.
File a Complaint Against a Pet Insurance Company With the Better Business Bureau
The Better Business Bureau (BBB) is a nonprofit that serves as an intermediary between insurance companies and consumers. The BBB is not a government agency and does not have any regulatory authority over businesses like pet insurance companies.
The BBB handles a broad range of complaints against insurance companies, including pet insurance companies. Here are some examples:
Your pet insurance company improperly rejected your claim, even though it should have been covered under your policy.
Your pet insurance company takes an unreasonable amount of time to process your claim, which in turn delays your pet’s treatment.
Your pet insurance company does not pay for all costs on a covered claim.
Even though the BBB has no regulatory authority, here are some reasons why a pet insurance company may respond to a BBB complaint:
If the pet insurance company is accredited with the BBB and they don't respond to a BBB complaint, their accreditation may be revoked, and the complaint becomes part of their BBB profile.
If the pet insurance company is not accredited with the BBB, the complaint will become part of their BBB profile.
BBB reviews give other consumers confidence when engaging with a pet insurance company. Pet insurance companies do not want negative BBB complaints.
Learn how to file a complaint with the Better Business Bureau (BBB).
What if Filing a Complaint Doesn’t Work?
If you can’t resolve your dispute against a pet insurance agency after filing a complaint against them with any of the government or nongovernment organizations above, consider taking further action.
Here are at least two options you should consider taking:
Send a demand letter.
Sue in small claims court.
Send a Demand Letter
Consider sending a demand letter to a pet insurance company as a way to resolve your dispute. A demand letter is a formal communication you can send to a pet insurance company if you are seeking money for a claim they improperly denied, or would like them to take some specific course of action.
Here are some other benefits of sending a demand letter:
Sending a written demand letter assures you there is a record of your attempt to settle. This written demand can then be used as evidence if you do end up suing the pet insurance company in small claims court.
A demand letter signals to the pet insurance company that you are serious about resolving the dispute and that you are willing to take action.
By sending a demand letter, you may be able to resolve your dispute against the pet insurance company without having to take legal action (or pay court costs!).
Did you know we have a free tool powered by AI that helps you create a demand letter to a pet insurance company? Check out our demand letter tool.
Sue in Small Claims Court
Small claims court is a type of court that handles disputes involving small amounts of money, typically for up to $10,000. The proceedings in small claims courts are typically more efficient and less formal than in other courts and are often designed for people to represent themselves without the need for an attorney.
Here are some quick facts about small claims court:
How much can I sue for in small claims court? | The amount you can sue for in small claims court is known as the small claims limit. This amount varies by state and even by court but is usually around $10,000. If you want to sue for more than the small claims limit, you will have to waive whatever amount is over the limit or consider suing in a regular court (however, this is going to be more expensive). |
How long do you have to sue in small claims court? | States have set deadlines, called statutes of limitations, that let you know by when you should sue. These deadlines will vary by state and by type of claim. For example, if you are suing for breach of contract, you will want to check the breach of contract statute of limitations in your state. |
How much does it cost to sue in small claims court? | States have made filing in small claims court accessible. Most small claims court charge between $10-$75 to file a lawsuit. Some small claims courts also offer court fee waivers, which means if you apply, you could pay $0 to file and serve your lawsuit. |
Who can represent you in small claims court? | Small claims courts were intended to allow individuals to file, and represent themselves without the need for a lawyer. For example, if you sue a pet insurance company in a California small claims court, you will have to represent yourself as they don’t allow lawyers at the initial hearing. |
Did you know we have a free tool powered by AI that helps you create a demand letter to a pet insurance company? Check out our demand letter tool.
Claudia Diaz
Legal Educator @ People Clerk. Claudia holds a J.D. degree and is a certified mediator in New York and Florida. She has participated in dozens of small claims mediations in New York City courts.