What is a Bilateral Exclusion in Pet Insurance?

Bilateral exclusions are one of the most misunderstood and financially painful clauses in pet insurance. Many pet owners only discover this exclusion after their claim is denied, often for thousands of dollars in surgery costs.

A Real-World Example

Imagine your Labrador had a torn ACL (cranial cruciate ligament) in their right knee two years ago, before you enrolled in pet insurance. You get a policy, pay premiums faithfully for a year, and then your dog tears the ACL in their left knee.

With a bilateral exclusion, your insurer can deny the claim for the left knee, even though it was a completely new injury that occurred after your policy started. The logic is that bilateral conditions have a high likelihood of affecting both sides, so the prior injury on one side is considered predictive of the other.

Which Conditions Are Commonly Subject to Bilateral Exclusions?

• Cruciate ligament tears (ACL/CCL)
• Hip dysplasia
• Elbow dysplasia
• Patellar luxation (kneecap dislocation)
• Cataracts
• Ear conditions

Which Pet Insurance Companies Use Bilateral Exclusions?

Most major pet insurance companies apply bilateral exclusions. However, the exact language varies significantly between policies. Some apply bilateral exclusions only if both conditions are hereditary. Others apply them any time a prior injury affected one side of the body.

Before enrolling, ask your insurer directly: "If my pet has a condition on one side of the body before enrollment, does that exclude the same condition on the other side?"

Can You Appeal a Bilateral Exclusion Denial?

Yes, and it's worth trying. Strong grounds for appeal include:

• The two conditions are not related and occurred in different circumstances
• Your vet can provide documentation that the new injury is traumatic rather than hereditary
• The insurer applied the bilateral exclusion incorrectly under the policy terms
• The condition does not qualify as bilateral under the policy's own definition

A veterinarian's written statement that the new injury is a distinct, traumatic event, not a continuation or development of the pre-existing condition, can be very helpful in these appeals.

How to Protect Yourself From Bilateral Exclusions

• Enroll your pet before any orthopedic conditions develop
• Choose a policy with limited or no bilateral exclusions
• Read your policy's exclusion section before signing
• Ask your insurer to confirm in writing whether bilateral exclusions apply to your pet