The bilateral exclusion in pet insurance
If one knee was a problem before the policy, many insurers won't cover the other one either. Here is who does what.
Updated October 2, 2026. Plan facts come from each insurer's published documents; each insurer's policy documents control.
The short answer
Most insurers apply a bilateral exclusion: if a condition that can affect both sides of the body, like a cruciate ligament tear, showed on one side before coverage, the other side is excluded too. Embrace, Fetch, Lemonade, Odie and Spot say so, and Healthy Paws applies it to the cruciate ligament.
We found no such clause in the Pets Best sample policy, and couldn't check Trupanion.
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Bilateral exclusion, by insurer
| Insurer | Bilateral exclusion | Notes |
|---|---|---|
| Embrace | Yes, bilateral exclusion[1] | If one side shows signs before coverage or in first 180 days, the other side is excluded. |
| Fetch | Yes, bilateral orthopedic exclusion[2] | If one side showed signs before coverage or during waiting period, the other side is excluded (e.g. cruciate tears). |
| Healthy Paws | Yes, cruciate ligament only[3] | If either knee showed cruciate lameness or tear before enrollment or in waiting period, the other side is excluded too. |
| Lemonade | Yes, bilateral exclusion[4] | If one side shows signs of a bilateral condition before the policy starts, the other side is not covered. |
| Odie | Yes, bilateral conditions excluded[5] | Bilateral condition (e.g. cruciate, luxating patella, hip dysplasia) pre-existing on either side at any time is excluded. |
| Pets Best | Not stated publicly | We found no answer in Pets Best's published policy, terms or FAQ. |
| Spot | Yes; knee/ligament treated as bilateral[6] | Bilateral conditions of pre-existing conditions are excluded; a knee/ligament issue on one side counts for both sides. |
| Trupanion | Not verified yet | Trupanion's website blocks automated requests, so we could not check this against its policy yet. Ask Trupanion directly. |
From each insurer's own sample policy, terms or FAQ, checked October 2, 2026. Terms vary by state and plan, and the policy you buy controls.
Check how this applies to your breed
What this means for your dog
Under a bilateral exclusion, the insurer treats the left and right side as one condition. It matters most for breeds with cruciate ligament disease on their list, such as the Labrador Retriever, Rottweiler, Newfoundland, Bernese Mountain Dog and Mastiff. Depending on the policy, the same rule can apply to hips, elbows and kneecaps.
The exclusion only bites when the first side is pre-existing. Enroll before any limp, stiffness or knee note appears in the vet record, and let the orthopedic waiting period pass before strenuous exercise if you can. A cruciate tear that happens after coverage starts is a covered claim, and so is the second knee later.
If your dog already had a knee problem, read the bilateral clause before switching insurers: a new policy will look at that history.
Before you buy
- Search the policy for the word bilateral and read which conditions it lists.
- Check whether any limp, stiffness or knee note is already in your dog's vet record.
- Read the orthopedic waiting period together with the bilateral clause.
- If your dog had a knee problem before, ask the insurer in writing how the other knee will be treated.
Questions owners ask
What is a bilateral condition in pet insurance?
A condition that can affect both sides of the body, like cruciate ligament disease, hip or elbow dysplasia, or a luxating patella. Insurers often treat both sides as one condition.
If my dog tore one cruciate ligament, will insurance cover the other knee?
Not if the first tear was before coverage. Embrace, Fetch, Lemonade, Odie, Spot and, for cruciate ligaments, Healthy Paws exclude the other side when one side was pre-existing.
Is a cruciate tear covered if it happens after enrollment?
Yes, once the waiting periods have passed. The bilateral exclusion only applies when the condition showed on one side before coverage started or during the waiting period.
Which conditions count as bilateral?
It depends on the policy. Spot, for example, treats ligament and knee conditions as bilateral; others list cruciate ligament disease, hip dysplasia and patellar luxation.
Sources
- Embrace Pet Insurance Sample Policy Terms & Conditions (v6, most states). Embrace Pet Insurance.
- Pet Health Insurance Policy Terms and Conditions (sample, GPTM 050 0326 A). Fetch, 2026.
- Frequently Asked Questions | Healthy Paws. Healthy Paws.
- How Does Pet Insurance Work? (Lemonade coverage guide). Lemonade.
- Sample Illness & Injury Insurance Policy (Trisura Insurance Company, TRSA-OPI-PC101-ILL). Odie Pet Insurance, 2026.
- Accident & Illness Sample Policy (Arizona, form PET-P-20000-1024, Independence American Insurance Company). Spot Pet Insurance.
How we choose and check sources: Sources we use.
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