Claim Investigation & User Reported Conditions
Review how User Reported Conditions will play a part in the updated Claim Investigation guidelines.
Start
Handling User Reported Conditions
Click the headphones for an optional audio read along!
User Reported Conditions must be factored into your Claim Investigation. As previously stated, the action you take depends on the type of URC and the time elapsed since the policy effective date: Claimed Condition URCs: If the claimed condition is a URC, obtain full medical records and complete a full MRR regardless of how long the pet has been enrolled. However, there are two exceptions: accident URCs and curable URCs. Accident URCs: If the URC is a true accident, follow the standard accident guidelines (meaning medical records are generally not required). Remember to use your context clues though! If the URC is a fractured leg and the claimed condition is a fractured leg, further investigation may be necessary depending on the claim media and time since the policy effective date. Curable URCs: If the URC is tagged as curable and 18 months have passed since the policy effective date, we can assume the condition is cured. You don’t need to request additional records in this case. However, if we already have medical records on file, you should still review them before officially documenting the condition as cured.
Context Matters!
Next
Claimed Condition URC
Watch the video below for an example on handling a claimed condition URC alongside the new Claim Investigation guidelines.
Next
Accident URC
Watch the video below for an example on handling an accident URC alongside the new Claim Investigation guidelines.
Next
Curable Condition URC
Watch the video below for an example on handling an curable condition URC alongside the new Claim Investigation guidelines.
End
Click the headphones for an optional audio read along!
Context Matters!: Remember to take context into account with URCs. For example, if the policyholder listed "Coughing" as a URC and the claimed condition is "Asthma," further investigation is likely warranted. While coughing can be cured, asthma cannot. And the coughing may have been a symptom of the eventually diagnosed asthma.
Claim Investigation & User Reported Conditions
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Created on April 22, 2026
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Transcript
Claim Investigation & User Reported Conditions
Review how User Reported Conditions will play a part in the updated Claim Investigation guidelines.
Start
Handling User Reported Conditions
Click the headphones for an optional audio read along!
User Reported Conditions must be factored into your Claim Investigation. As previously stated, the action you take depends on the type of URC and the time elapsed since the policy effective date: Claimed Condition URCs: If the claimed condition is a URC, obtain full medical records and complete a full MRR regardless of how long the pet has been enrolled. However, there are two exceptions: accident URCs and curable URCs. Accident URCs: If the URC is a true accident, follow the standard accident guidelines (meaning medical records are generally not required). Remember to use your context clues though! If the URC is a fractured leg and the claimed condition is a fractured leg, further investigation may be necessary depending on the claim media and time since the policy effective date. Curable URCs: If the URC is tagged as curable and 18 months have passed since the policy effective date, we can assume the condition is cured. You don’t need to request additional records in this case. However, if we already have medical records on file, you should still review them before officially documenting the condition as cured.
Context Matters!
Next
Claimed Condition URC
Watch the video below for an example on handling a claimed condition URC alongside the new Claim Investigation guidelines.
Next
Accident URC
Watch the video below for an example on handling an accident URC alongside the new Claim Investigation guidelines.
Next
Curable Condition URC
Watch the video below for an example on handling an curable condition URC alongside the new Claim Investigation guidelines.
End
Click the headphones for an optional audio read along!
Context Matters!: Remember to take context into account with URCs. For example, if the policyholder listed "Coughing" as a URC and the claimed condition is "Asthma," further investigation is likely warranted. While coughing can be cured, asthma cannot. And the coughing may have been a symptom of the eventually diagnosed asthma.