Legal Question in Insurance Law in New York

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.


Asked on 7/15/09, 1:17 am

2 Answers from Attorneys
John W. DeHaan DeHaanBusse LLP

Re: Insurance terms

It is difficult to answer a contract question without reviewing the entire contract -- even if it seems just a single clause is at issue. So, you would really need to have the entire contract reviewed by an attorney. However, insurance contracts are read in New York so that their terms are given their "plain meaning." Ambiguities are read against the party that drafted the policy. In this case, you have an argument to make that only the vet's statement has to be submitted in the first 30 days, but it is no "slam dunk." Pet insurance policies are typically for 1 year terms and get renewed every year. So, the timing of the exam and certification by the vet are important.

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Answered on 7/20/09, 11:41 am
Mark S. Moroknek Kelly & Curtis, PLLC.

Re: Insurance terms

If this has become an issue because the pet had knee surgery, it may be worth fightin in court, and letting a judge decide which interpretation is correct. Otherwise, if possible, allow the exam to take place when the company wants.

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Answered on 7/16/09, 9:05 am


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