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moderate difficulty~45% typical win rate

Hereditary / congenital condition exclusion

The insurer says the condition is hereditary or congenital and excluded from coverage.

The full picture

Most modern policies cover hereditary and congenital conditions (hip dysplasia, heart defects, etc.) unless explicitly excluded. The appeal usually requires showing your policy doesn't exclude this specific condition, or that it manifested as an acquired (not congenital) issue.

The winning argument

Check your policy. Most reputable insurers cover hereditary/congenital conditions by default. If yours does, cite the inclusion. If condition is genuinely degenerative/acquired (e.g., adult-onset), document that.

What evidence wins this appeal

  • Policy showing hereditary/congenital coverage is included
  • Vet statement that condition is acquired, not congenital
  • Diagnosis date well after birth

Step-by-step checklist

  1. 1Find hereditary coverage language in policy
  2. 2Get vet to specify classification
  3. 3Note diagnosis age vs birth date

What to ask your vet for

Please clarify whether [CONDITION] in [PET NAME] is best classified as hereditary, congenital, or acquired, with supporting diagnostic evidence.

If the first appeal fails

Supervisor review → DOI complaint.