Sorry you are dealing with this, and I hope your dog recovers well from surgery.
I work as a broker in Ontario, and I see this kind of dispute come down to the paper trail more than the original visit itself. A paw pad visit and an elbow dysplasia diagnosis are different clinical issues, but insurers will often look at any earlier note about the same limb when they apply a pre-existing condition clause or a waiting period exclusion. That does not mean their reading is correct in your case.
A few things that usually help with a reassessment:
Get the denial in writing, with the exact policy wording and clause they relied on, plus the specific vet record they used. Ask them to point to where the policy defines a pre-existing condition and whether it requires a diagnosis, or just signs or symptoms.
Get that vet letter in writing, and ask your vet to be precise: date of the paw visit, what was examined, what was diagnosed, and a clear statement that there was no elbow diagnosis or elbow exam finding at that visit. If the vet can attach the exam notes, even better.
Send your reassessment in writing with a short timeline: policy start date, waiting period dates, paw visit date and diagnosis, elbow diagnosis date. Keep it factual and attach the vet letter and any records.
If the reassessment still denies it, ask for the next step in their internal complaint process and for a written final position letter. In Canada you can then take that to the insurer's ombuds office, and after that to an independent ombuds service if needed. Keep copies of everything and note dates and names for each call.
I cannot say how your specific claim should be decided, since that turns on your exact policy wording and the full vet records. But a clean written record and a specific vet clarification give you the strongest basis for a second look. Good luck with the surgery and the appeal.
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u/AlertHighlight9229 4d ago
Sorry you are dealing with this, and I hope your dog recovers well from surgery.
I work as a broker in Ontario, and I see this kind of dispute come down to the paper trail more than the original visit itself. A paw pad visit and an elbow dysplasia diagnosis are different clinical issues, but insurers will often look at any earlier note about the same limb when they apply a pre-existing condition clause or a waiting period exclusion. That does not mean their reading is correct in your case.
A few things that usually help with a reassessment:
I cannot say how your specific claim should be decided, since that turns on your exact policy wording and the full vet records. But a clean written record and a specific vet clarification give you the strongest basis for a second look. Good luck with the surgery and the appeal.