Why Pumpkin denies claims for this reason
▸A symptom appeared in vet records before your policy start date, even if it was never formally diagnosed
▸The insurer used automated record scanning to flag a keyword, not a licensed vet reviewing the file
▸A related but distinct condition was treated before enrollment
▸The insurer applied a bilateral exclusion, treating the second side of a paired body part as pre-existing
Your strongest appeal arguments
✓Ask the insurer to put in writing exactly which vet record and date they used. Vague denials are not acceptable.
✓A noted symptom is not the same as a diagnosed condition. Push back on this distinction directly.
✓Get a signed statement from your vet confirming the current condition started after your policy effective date.
✓If you live in CA, DE, FL, LA, NJ, OH, PA, or WA, your state has adopted the NAIC Pet Insurance Model Act. The burden of proof is on the insurer, not you. Cite this in your appeal.
✓If the denial came from an automated system, demand a licensed vet review your records before a final decision is made.
Documents to gather before you appeal
✓Complete vet records covering at least 12 months before your policy start date
✓A signed vet statement confirming the condition started after the policy effective date
✓Your policy's exact definition of pre-existing condition
✓The denial letter, specifically the part citing which record they used
Timeline
Most insurers must respond to appeals within 30 to 45 days. File your appeal right away. Many policies have a 30-day appeal window that starts from the denial date.
If your appeal is denied again
If your appeal comes back denied, file a complaint with your state Department of Insurance. In NAIC-protected states, regulators take pre-existing condition denials seriously and insurers know it.
Use PawClaim's DOI escalation tool ›Not sure where to start?
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Other Pumpkin denial types
Pre-Existing Condition at other insurers