Making a pet insurance claim works one of two ways. You can pay your vet, send the invoice to your insurer and get the eligible portion back into your bank account. Or with participating pet insurers at participating vet clinics, you can use GapOnly® to have the claim assessed while you're still there, so that you only pay the difference between the vet's bill and your eligible claim benefit. That difference is called the gap.
And if you're reading this with a poorly pup on your lap, or a kitty glaring at you from inside a carrier, take a breath. Claiming isn't a maze once you can see the whole path. So let's walk it together, in plain English, one step at a time.
This is how most claims have always worked, and it's simpler than it sounds.
Handy to know: many vet clinics can lodge the claim for you, which means no photographing invoices at the kitchen bench. Just ask at reception.
One more thing worth knowing upfront. Your first claim will probably take a little longer than the rest, because the assessor needs your pet's full vet history to confirm nothing relates to a condition that existed before your cover began. Once that history is on file, it stays there, and future claims tend to move along faster.
Insurance has a habit of dressing simple ideas in complicated outfits. Here's what the jargon actually means for you and your fur child.
Benefit percentage: The share of eligible vet costs your policy pays back. Many Australian policies let you pick your benefit percentage when you sign up. A higher benefit rate means more back on each claim, and usually a slightly higher premium.
Annual limit: The most your policy will pay out across a policy year. Reach it, and any further costs that year are yours until the policy renews. Think of it as the size of the pool you're drawing from.
Excess: A set amount you chip in when you claim, if your policy includes one. Some policies apply it once per condition per year, so it's worth checking your Product Disclosure Statement (the PDS — the document that spells out exactly how your policy works) to see how yours behaves.
Waiting periods: The stretch of time between starting your policy and being able to claim for certain things. If a condition first appears during a waiting period, claims for it generally aren't covered.
Pre-existing conditions: Health issues that showed signs before your cover started, or during a waiting period. These are typically excluded, though some policies will review certain temporary conditions after your pet has been symptom-free for a while.
None of this is designed to catch you out. These are simply the settings that shape your premium, and knowing yours before you claim means no surprises after.
Two quick stories. The numbers are examples only. Your own figures depend on your policy.
Luna the kelpie spends a glorious Saturday at the dog park and comes home limping, courtesy of a grass seed buried deep in her paw. Sedation, removal and antibiotics come to $600. Luna's policy has an 80% benefit percentage and no excess. If the whole invoice is eligible, her pet parent gets $480 back and covers the remaining $120.
Milo the tabby loses an argument over fence-line territory and needs an abscess drained. The bill is $900. Let’s say Milo's policy has a 90% benefit rate and a $100 excess that applies to this claim. Of the $900, 90% is $810; take away the $100 excess and the reimbursement is $710, leaving $190 to pay.
Same process, different settings, different results. Which is exactly why two mates with the "same" insurer can tell very different claim stories at the park.
Ask pet parents what they like least about claiming, and you'll hear the same answer: fronting the full bill, then waiting to be paid back. GapOnly® was built to take that sting out at participating vet clinics.
So, in Milo's story above, instead of paying $900 and waiting on $710, his pet parent pays only the $190 gap at reception. Milo, naturally, takes zero interest in any of this.
Remember: GapOnly® works for eligible claims at participating clinics with participating insurers, so check that your vet and your policy are both on board before your appointment. And it's a claims and payment service, not insurance itself — your cover, limits and exclusions still come from your policy.
It happens, and it's usually for one of a handful of reasons: the condition was pre-existing, the treatment fell inside a waiting period, the item is excluded under the policy (routine care like vaccinations often is, unless you've added extra cover), or a piece of paperwork went missing.
That last one is the easiest to fix. If your claim is declined or partially paid and the reason isn't clear, ask. Insurers must explain their decisions, and you're entitled to request a review or make a complaint if you believe an assessment is wrong. Sometimes a single missing vet record is all that stands between a decline and a payout.
Claiming isn't a test, and it isn't a fight. It's a process with known steps, and every one of them gets easier once you know your policy's settings and keep decent records. Claiming is also completely normal. Pet insurance exists to be used — that's the whole reason you pay for it.
So, if your fur baby needs the vet this week, give them a scratch behind the ears and take a breath. Pay-and-claim or pay the gap with GapOnly® at a participating clinic. Either way, you now know exactly what happens next.
Cover is subject to policy terms, conditions, waiting periods and exclusions. Always read the relevant Product Disclosure Statement (PDS) to understand what your policy covers.
How do I make a pet insurance claim? Pay your vet, then submit the itemised invoice (and your pet's vet history for a first claim) to your insurer online, via an app or through your vet clinic. If the claim is eligible, you're reimbursed to your nominated bank account. At participating clinics, GapOnly® lets your vet lodge the claim on the spot so you only pay the gap.
Do I have to pay the vet before claiming? Under the traditional claims process, yes: you pay the full invoice and are reimbursed later. At participating vet clinics, GapOnly® changes this for eligible claims, assessing the claim in around 5 minutes so you only pay the difference between the invoice and your claim benefit.
How is a pet insurance payout calculated? Your payout is the eligible vet costs multiplied by your benefit percentage, minus any excess that applies, subject to your annual limit. For example, an $800 eligible bill at an 80% benefit rate with no excess would return $640.
What is the gap in pet insurance? The gap is the difference between your vet's invoice and the benefit your insurer pays under your policy. With GapOnly®, eligible claims at participating clinics are assessed on the spot so you pay only the gap, rather than the full bill upfront.
How long does a pet insurance claim take? It varies by insurer and claim type. First claims usually take longer because the assessor needs your pet's full vet history. GapOnly® claims at participating clinics are assessed in around 5 minutes while you're still at the vet.
Why would a pet insurance claim be declined? The most common reasons are pre-existing conditions, treatment during a waiting period, items excluded under the policy, or incomplete paperwork such as a missing vet history. If you disagree with a decision, you can ask your insurer for an explanation and request a review.
Can my vet submit the claim for me? Many clinics can lodge claims on your behalf, and participating GapOnly® clinics can process eligible claims while you wait. Ask your clinic which options they support before your appointment.
What documents do I need to claim? Typically the itemised vet invoice and, for your first claim, your pet's consultation history. Keeping records with one regular clinic makes this much easier to gather.