New York | Insurance Law
Legal Question
Insurance terms
I have pet insurance and my dog recently had surgery on her patella. The exact wording of the clause in question is:
“Any treatment associated with damage or rupture of cruciate ligaments, or defects of the patella during the first six (6) months that the policy is in effect. Except that coverage will be provided if a certificate of health stating that your pet has been examined and does not have any pre-existing conditions relating to the cruciates or patellas is provided by a licensed veterinarian within 30 days of the effective date of the policy.”
I read this to say that the certificate of health needs to be provided within the first 30 days. My insurance company is arguing that the exam must take place within the first 30 days as well. Even though her certificate of health was issued during the first 30 days of the policy, my dog’s last exam was before the policy began. Do I have an argument here that the terms only state that the certificate needs to be provided within the first 30 days and it does not require that the exam actually take place within the first 30 days? This is the only place in the terms and conditions where patella issues are addressed.
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