Denial database
Every appeal outcome reported by PetClaim users, grouped by denial reason. Use it to predict your odds before you file.
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Reports
0
Wins
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Win rate
| Denial reason | Difficulty | Estimated win rate | Reported outcomes | Reported win rate | Avg claim | |
|---|---|---|---|---|---|---|
| Pre-existing condition exclusion | high | 35% | 0 | — | — | Playbook → |
| Condition arose during waiting period | high | 30% | 0 | — | — | Playbook → |
| Bilateral condition exclusion | moderate | 50% | 0 | — | — | Playbook → |
| Hereditary / congenital condition exclusion | moderate | 45% | 0 | — | — | Playbook → |
| Dental illness / dental exclusion | moderate | 45% | 0 | — | — | Playbook → |
| Routine / preventive / wellness not covered | low | 20% | 0 | — | — | Playbook → |
| Curable pre-existing not waited out | moderate | 55% | 0 | — | — | Playbook → |
| Lapsed / inactive policy at time of treatment | moderate | 60% | 0 | — | — | Playbook → |
| Insufficient documentation | low | 75% | 0 | — | — | Playbook → |
| Annual or per-condition limit reached | high | 15% | 0 | — | — | Playbook → |
| Specific policy exclusion | moderate | 40% | 0 | — | — | Playbook → |
| Late claim submission | high | 25% | 0 | — | — | Playbook → |
| Not medically necessary / experimental | moderate | 45% | 0 | — | — | Playbook → |
| Pre-authorization not obtained | high | 35% | 0 | — | — | Playbook → |
| Behavioral treatment exclusion | moderate | 40% | 0 | — | — | Playbook → |
| Prescription food / supplements exclusion | moderate | 35% | 0 | — | — | Playbook → |
| Misrepresentation / non-disclosure on application | high | 30% | 0 | — | — | Playbook → |
| Boarding / advertising / death-benefit exclusions | low | 30% | 0 | — | — | Playbook → |
| Out-of-network / non-licensed provider | moderate | 45% | 0 | — | — | Playbook → |
| Coverage not yet effective / enrollment gap | moderate | 55% | 0 | — | — | Playbook → |
Reported win rates draw from user-submitted outcomes; estimated rates reflect editorial research where reports are sparse. Submit an outcome after your appeal to keep this current.