Pet insurance laws by state: the rules that can strengthen your claim

The national model law

Pet insurance is regulated state by state, like home and auto insurance, not like human health insurance. In August 2022 the National Association of Insurance Commissioners, the organization of state insurance regulators, adopted a Pet Insurance Model Act. It is a template, not a law: it takes effect only in states whose legislatures pass their own version. It was modeled largely on California's pet insurance law, the first in the country, passed in 2014.

States with laws based on the model act

As of mid-2025, these 15 states had enacted the model act in substantially similar form, according to the NAIC's adoption report as summarized by Legal Clarity: Delaware, Florida, Hawaii, Louisiana, Maine, Maryland, Mississippi, Montana, Nebraska, New Hampshire, Ohio, Pennsylvania, Rhode Island, Vermont and Washington.

California has its own earlier law, and other states, including New York, have considered bills. The list grows, so confirm your state's position on its insurance department's website or consumer line before you rely on it in an appeal.

What the model act requires of insurers

Where a state has adopted it, these protections typically apply. States can vary the details, so check your own state's statute for its exact terms.

• The insurer must prove a pre-existing condition exclusion applies. You do not have to prove your pet was healthy.
• A condition the policy already covered cannot be excluded as pre-existing when the policy renews.
• An insurer cannot require a new veterinary examination as a condition of renewal.
• Exclusions, waiting periods, deductibles, coinsurance and limits must be clearly disclosed before purchase.
• Waiting periods are limited: typically no waiting period for accidents and a maximum of 30 days for illness and orthopedic conditions. Mississippi's version does not restrict waiting periods.
• Buyers typically get a 15-day free-look period to review and return a new policy if no claim has been filed.
• Wellness plans cannot be marketed as if they were insurance.

How to use the law in an appeal

If your state has adopted the model act and the denial is for a pre-existing condition, add one sentence to your appeal: “Under [state]'s pet insurance law, the insurer bears the burden of proving that a pre-existing condition exclusion applies. Please provide the specific records on which you rely.” That request changes the conversation from “prove your pet was healthy” to “show us your evidence.”

If the insurer paid for the same condition in an earlier policy year, point that out too; in model-act states it generally cannot reclassify that condition as pre-existing at renewal. If your state has not adopted the model act, do not cite it as law. Your appeal rests on your policy's wording and your evidence, which is where most appeals are won. Our guide to pre-existing condition denials shows how to build that case.

Every state has a free complaint process

Whether or not your state has a pet insurance law, its insurance department takes consumer complaints about insurers, including pet insurers. Filing is free and most departments accept complaints online. You can find yours through the NAIC's directory of state insurance departments at content.naic.org/state-insurance-departments.

A complaint typically goes to the insurer, which must respond to the department in writing. Complaints are recorded and tracked, which often prompts a more senior review of your file. The department is not a court, and it rarely orders payment on medical merits alone. It is most effective where the insurer broke a rule, ignored your evidence, missed deadlines, or applied the policy unfairly.

What to put in the complaint

Keep it to the facts. Regulators read a lot of angry complaints; a clear one gets read properly.

• Your insurer, policy number and claim number.
• A dated timeline: policy start, treatment, claim, denial, your appeal, and the insurer's response or silence.
• Two or three sentences on why the decision is unfair, tied to evidence. For example, that the insurer relied on an unrelated visit and did not address your vet's written statement.
• What you are asking for: a review of how the claim was handled and payment in line with your policy.
• Copies of the denial letters, your appeals, the vet statement and the relevant records.

Before you file

Most departments expect you to have given the insurer a chance to fix the problem first. File after you have sent a written appeal and received a decision, or after the insurer has failed to respond within a reasonable time. Our step-by-step appeal guide covers the appeal itself.

Denied? The Pet Insurance Appeal Kit includes a chapter on state rules, a ready-to-paste state complaint template, and the appeal letters that should come before it.