Training In A Box Series: Determining Cured Conditions
In this micro-learning course, you will gain a comprehensive understanding of when and how to determine if a condition can be considered cured. This discussion will include topics include: - What makes a condition cured
- When and how to review if a condition can be considered cured
- What counts as an occurrence
Click start to begin!
Training
Trip to the vet
start
What Makes A Condition Cured?
Whether a condition can be considered cured or not is dependent on two things: - If it's been a minimum of 12 months (365 days) since the last documented occurrence or treatment.
- If our internal guidelines have deemed the condition curable and is tagged as such within Blender.
If the condition does not meet both of the above requirements, then the condition cannot be considered cured. Important: Please note that there are no shortcuts or grace periods for the timeline to consider a condition cured. If it's only been 364 days since the last documented occurrence, it cannot be considered cured.
Next Page
Reviewing If A Condition Is Cured
We will only investigate whether a condition can be deemed cured if a claim is filed for that same curable condition or may be related to a curable condition. It must also have been at least 365 days since the last documented occurrence and the condition is tagged as curable in Blender. Keep three things in mind with curable conditions: - We will not preemptively investigate if a condition is cured just because it's been twelve months since the last documented occurrence.
- We must NEVER assume that a condition was cured simply because of the length of time since the last documented occurrence in the Medical Timeline.
- We cannot determine whether a condition is cured based on the claim history.
Ultimately, we always need updated medical records to determine if a condition can be considered cured.
Next Page
What Counts As An Occurrence?
To determine if a condition can be cured, we need 12 months' worth of medical records prior to the date of loss of the condition we're investigating. Once those records are received, we will review them for the last documented "occurrence." An occurrence is: - An actual sick visit where the condition in question was a concern and/or treated.
- This includes recheck exams for the specific condition, even if the exam showed that all had returned to normal.
- A medication refill for the condition in question.
- The occurrence date is based on the date the medication was filled and do not guess the day the last medication was administered.
- A supplement or food being purchased or used to treat the condition in question (preventatively or otherwise).
- This includes prescription diets and over-the-counter diets and prescription medications and over-the-counter supplements.
- Phone or email correspondence regarding the condition in question.
Important: Please do not send these requests to the MRR team - they only review records through the 14-day illness waiting period. The Claim Advocate will be responsible for reviewing the updated records.
Next Page
What About?....
What if I call the vet clinic? We cannot in good conscience rely on asking the vet clinic over the phone whether or not a pet has been treated for a curable condition. Those who works in vet clinics aren't looking at records through the same lens as us in insurance. As such, we should always get the medical records. What about if it's been a REALLY long time? Can we just go based on the claim history in that situation? Short answer: no. Insurance claims require consistency and "a really long time" can be subjective from person to person. That could mean a year to one Claim Advocate and ten years to another Claim Advocate. To ensure consistency and that we're staying in compliance with our policy, we must investigate to consider a pre-existing condition cured. Also, some policyholders actually read their policy and understand the cured condition requirement. So they may not submit claims they know aren't eligible until they think they're eligible. Any additional questions?
Next Page
Group Discussion
Click on the images below to discuss two different curable condition scenarios. Discuss as a group on what should be done before revealing the answer!
Answer Reveal!
Answer Reveal!
End
Cornbread the cat was enrolled on 6/6/2024. An MRR showed that Cornbread had a URI on 5/20/2024. Symptoms were nasal discharge, sneezing, and conjunctvitis. No additional documentation was made regarding the URI prior to the end of the IWP. A claim for conjunctivitis was filed on 8/28/2025. There have been no other claims filed that would be related to conjunctivitis or a URI. Based on the information provided, how would we proceed with the 8/28/2025 claim?
Cornbread the cat: We should collect updated medical records (from 12 months prior to 8/28/2025) and review them to determine if URI can be considered cured. Since the conjunctivitis was related to the URI prior to the PED, we should do our due diligence to ensure that the URI or conjunctivitis was not documented as treated or ongoing.
Vader the dog was enrolled on 5/1/2024. An MRR had previously revealed that he had pre-existing vomiting from 1/13/2024, 2/16/2024, and 4/15/2024. Rule outs previously included dietary indiscretion and gastroenteritis. He had an annual visit on 4/30/2024 where it was documented that he had had no issues of vomiting and was doing great. A claim was submitted on 4/13/2025 for gastroenteritis. No other GI claims had been filed since enrollment. With the information provided, how would we proceed with the claim?
Vader the dog: We would not collect medical records in this instance. We know that it hasn't been more than 365 days since the last occurrence, so we would not be able to lift the pre-existing vomiting at that time. The claim should be denied as pre-existing. Disclaimer: If the claim media suggested that there might be a specific reason for this bout of GI upset (e.g., ate something, switched food, etc.), gathering medical records to determine coverage would be necessary as we may be able to apply coverage if the GI distress was due to an accident.
Training In A Box Series: Cured Conditions
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Created on October 8, 2025
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Transcript
Training In A Box Series: Determining Cured Conditions
In this micro-learning course, you will gain a comprehensive understanding of when and how to determine if a condition can be considered cured. This discussion will include topics include:
- What makes a condition cured
- When and how to review if a condition can be considered cured
- What counts as an occurrence
Click start to begin!Training
Trip to the vet
start
What Makes A Condition Cured?
Whether a condition can be considered cured or not is dependent on two things:
- If it's been a minimum of 12 months (365 days) since the last documented occurrence or treatment.
- If our internal guidelines have deemed the condition curable and is tagged as such within Blender.
If the condition does not meet both of the above requirements, then the condition cannot be considered cured. Important: Please note that there are no shortcuts or grace periods for the timeline to consider a condition cured. If it's only been 364 days since the last documented occurrence, it cannot be considered cured.Next Page
Reviewing If A Condition Is Cured
We will only investigate whether a condition can be deemed cured if a claim is filed for that same curable condition or may be related to a curable condition. It must also have been at least 365 days since the last documented occurrence and the condition is tagged as curable in Blender. Keep three things in mind with curable conditions:
- We will not preemptively investigate if a condition is cured just because it's been twelve months since the last documented occurrence.
- We must NEVER assume that a condition was cured simply because of the length of time since the last documented occurrence in the Medical Timeline.
- We cannot determine whether a condition is cured based on the claim history.
Ultimately, we always need updated medical records to determine if a condition can be considered cured.Next Page
What Counts As An Occurrence?
To determine if a condition can be cured, we need 12 months' worth of medical records prior to the date of loss of the condition we're investigating. Once those records are received, we will review them for the last documented "occurrence." An occurrence is:
- An actual sick visit where the condition in question was a concern and/or treated.
- This includes recheck exams for the specific condition, even if the exam showed that all had returned to normal.
- A medication refill for the condition in question.
- The occurrence date is based on the date the medication was filled and do not guess the day the last medication was administered.
- A supplement or food being purchased or used to treat the condition in question (preventatively or otherwise).
- This includes prescription diets and over-the-counter diets and prescription medications and over-the-counter supplements.
- Phone or email correspondence regarding the condition in question.
Important: Please do not send these requests to the MRR team - they only review records through the 14-day illness waiting period. The Claim Advocate will be responsible for reviewing the updated records.Next Page
What About?....
What if I call the vet clinic? We cannot in good conscience rely on asking the vet clinic over the phone whether or not a pet has been treated for a curable condition. Those who works in vet clinics aren't looking at records through the same lens as us in insurance. As such, we should always get the medical records. What about if it's been a REALLY long time? Can we just go based on the claim history in that situation? Short answer: no. Insurance claims require consistency and "a really long time" can be subjective from person to person. That could mean a year to one Claim Advocate and ten years to another Claim Advocate. To ensure consistency and that we're staying in compliance with our policy, we must investigate to consider a pre-existing condition cured. Also, some policyholders actually read their policy and understand the cured condition requirement. So they may not submit claims they know aren't eligible until they think they're eligible. Any additional questions?
Next Page
Group Discussion
Click on the images below to discuss two different curable condition scenarios. Discuss as a group on what should be done before revealing the answer!
Answer Reveal!
Answer Reveal!
End
Cornbread the cat was enrolled on 6/6/2024. An MRR showed that Cornbread had a URI on 5/20/2024. Symptoms were nasal discharge, sneezing, and conjunctvitis. No additional documentation was made regarding the URI prior to the end of the IWP. A claim for conjunctivitis was filed on 8/28/2025. There have been no other claims filed that would be related to conjunctivitis or a URI. Based on the information provided, how would we proceed with the 8/28/2025 claim?
Cornbread the cat: We should collect updated medical records (from 12 months prior to 8/28/2025) and review them to determine if URI can be considered cured. Since the conjunctivitis was related to the URI prior to the PED, we should do our due diligence to ensure that the URI or conjunctivitis was not documented as treated or ongoing.
Vader the dog was enrolled on 5/1/2024. An MRR had previously revealed that he had pre-existing vomiting from 1/13/2024, 2/16/2024, and 4/15/2024. Rule outs previously included dietary indiscretion and gastroenteritis. He had an annual visit on 4/30/2024 where it was documented that he had had no issues of vomiting and was doing great. A claim was submitted on 4/13/2025 for gastroenteritis. No other GI claims had been filed since enrollment. With the information provided, how would we proceed with the claim?
Vader the dog: We would not collect medical records in this instance. We know that it hasn't been more than 365 days since the last occurrence, so we would not be able to lift the pre-existing vomiting at that time. The claim should be denied as pre-existing. Disclaimer: If the claim media suggested that there might be a specific reason for this bout of GI upset (e.g., ate something, switched food, etc.), gathering medical records to determine coverage would be necessary as we may be able to apply coverage if the GI distress was due to an accident.