The frequency ranking of pet insurance claims has been stable enough across the published industry data that it now functions as a buying-decision input rather than trivia. Nationwide's analysis of its 2025 US claims puts skin allergies at the top of the dog list for the 15th year running and digestive issues at the top of the cat list, and finds most of the top conditions for both species are chronic [Nationwide: Chronic Conditions Dominate this Year's List of Most Common (and Expensive) Pet Health Problems, 2026]. The categories below recur across insurer claim lists: gastrointestinal disorders, skin and ear conditions, dental disease, orthopedic injuries, and cancer. The order shifts between species and between carriers' policyholder mixes.
Two things make the ranking useful at the buying stage. First, the top five are all conditions a buyer can underwrite on the policy terms (waiting period, pre-existing rule, dental-illness clause) rather than the headline premium. Second, the bottom of the ranking (the rare, high-cost cancer or neurological claims) is where the upper end of an annual payout cap matters, which flips the conventional advice on "cap size."
The ranking from cited claims data
These are the claim categories that recur on US dog policies; on Nationwide's 2025 list, skin allergies rank first [Nationwide: Chronic Conditions Dominate this Year's List of Most Common (and Expensive) Pet Health Problems, 2026]:
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Gastrointestinal disorders. Vomiting, diarrhea, and foreign-body cases are a frequent claim category on dog policies. The cost per case runs from a consultation up to the $3,471-to-$7,976 range CareCredit gives for intestinal-blockage surgery on a dog [CareCredit: Intestinal Blockage Surgery Cost for Dogs and Cats, 2025].
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Skin and ear conditions. Allergic skin disease, otitis, hot spots, and chronic dermatology cases. These are the highest-frequency, lowest-per-case claims on most insurer books, and the category where the curable-vs-incurable pre-existing distinction matters most.
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Dental disease. Periodontal disease and gingivitis sit near the top because the prevalence in adult dogs and cats is high. Whether the claim pays depends entirely on the carrier's dental-illness clause; Embrace covers it to $1,000 a year on the base policy, Trupanion excludes it [Embrace: Dental illness coverage, 2026-05].
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Orthopedic injuries. Cruciate ligament tears, luxating patella, hip dysplasia. Lower frequency than GI or skin but materially higher cost per case: cruciate repair runs $2,793 to $6,417 on cited 2025 cost data [CareCredit: How Much Does CCL (ACL) Surgery for Dogs Cost?, 2025]. The category drives a disproportionate share of total payout.
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Cancer. The highest per-case cost category. Chemotherapy runs $3,000 to $10,000 for a full protocol on cited cost data; radiation $4,500 to $6,000 for a curative course on the same source [CareCredit: How Much Does Chemotherapy for Dogs Cost?, 2025]. Lower frequency on the under-7 dog population, much higher frequency past 7.
For cats, digestive issues hold the top spot on Nationwide's list for the third consecutive year, and 7 of the top 10 cat conditions are chronic [Nationwide: Chronic Conditions Dominate this Year's List of Most Common (and Expensive) Pet Health Problems, 2026].
Why the top claims are what they are
The ranking is not arbitrary. Each of the top five categories shares a structural feature: it is high-prevalence in the general pet population, and it tends to recur once it has started. That recurrence is what makes the curable-vs-incurable pre-existing distinction the most expensive sentence in most policy contracts.
A first ear infection, GI episode, UTI, or skin flare-up can be classed as curable at the named reviewed carriers and re-qualify for coverage after 12 consecutive months symptom-free at Embrace [Embrace: What are pre-existing conditions and does Embrace cover them?, 2026-09]. The same conditions, if they recur within that window, become incurable in the policy's eyes and stay excluded for the life of the policy. The top five claim categories are exactly the ones where this distinction bites most often. The full mechanic is on pre-existing conditions.
The orthopedic and cancer categories account for a disproportionate share of total claim payout because the per-case cost is so much higher than the top three. A buyer reading the ranking as "GI and skin are what insurance is for" is missing the math: the policy's economic value comes mostly from the rarer orthopedic and cancer claims, not the frequent GI and skin ones.
The most-frequent claim categories are not the same as the highest-payout categories. Consumer Reports surveyed 3,583 people who insured their pets and found that only 44% received full reimbursement at their chosen policy level after the copay [Brian Vines, Consumer Reports Pet Insurance Buying Guide, 2026]. FurVerdict's reading, not part of the survey finding: that shortfall is likely to fall hardest on small claims, where the deductible and copay take the largest share.
What the ranking implies for a buyer
Three structural implications fall out of the top-five ranking once a buyer reads it as a buying input.
First, on a frequency basis, dental cover is one of the most-used clauses in the contract. A buyer for whom dental is a likely claim category should treat the dental-illness clause as a load-bearing buying term, not a marginal one. Embrace and Pets Best clear that bar; Trupanion does not.
Second, on a per-case-cost basis, orthopedic and cancer are where the policy's annual payout cap matters. A buyer choosing a tunable annual limit at the lower tunable tiers (Lemonade's lower tiers, for example) is trading the right-tail upside for cost savings, exactly the trade a buyer of a cancer-prone or orthopedic-prone breed should think twice about. Trupanion's no-cap structure pays a premium specifically to keep the right tail open.
Third, the top three categories (GI, skin, ear) are recurrence-prone, which means the curable-condition window is the single most valuable concession a carrier makes to a buyer of a typical dog. Embrace's named 12-month symptom-free reclassification is the cleanest version of this in the reviewed set [Embrace: What are pre-existing conditions and does Embrace cover them?, 2026-09].
The full "is pet insurance worth it" math, run against this ranking, is at is pet insurance worth it. The five terms that decide three-year cost across this ranking are at how to choose pet insurance. The review method is at /methodology/.