Medical Underwriting

Medical underwriting evaluates an applicant's health and medical history to assess mortality risk through various collection methods and analysis.

Medical Information Collection Methods

Paramedical Examination

Basic health screening by nurse/technician:

Includes: - Height, weight (BMI calculation) - Blood pressure (multiple readings) - Pulse - Blood sample (venipuncture) - Urine sample - Brief health questionnaire

Location: Applicant's home or office

Time: 30 minutes, fasting preferred (8-12 hours)

Results: Sent to lab, forwarded to insurer (3-5 days)

Laboratory Tests

Blood tests: - Cholesterol: Total, HDL, LDL, triglycerides - Glucose: Diabetes screening - Liver enzymes: ALT, AST, GGT (alcohol abuse, hepatitis) - Kidney function: BUN, creatinine - CBC: Complete blood count - A1C: Long-term glucose control (diabetes) - HIV: Required for large amounts - Nicotine/cotinine: Tobacco verification

Urine tests: - Protein (kidney disease) - Glucose (diabetes) - Blood (kidney/bladder issues) - Drugs (screening) - Nicotine (smoking)

Attending Physician Statement (APS)

Medical records from applicant's physician:

When requested: - Application discloses medical condition - Abnormal exam/lab results - Need detailed information

Includes: - Complete medical records - Diagnosis and ICD codes - Treatment history - Test results (labs, imaging) - Prognosis - Current status

Time: 2-4 weeks typically

Example:

Application: "Heart murmur - monitored"

APS reveals:
- Mild mitral valve prolapse
- No regurgitation
- Echo normal
- No treatment needed
- Excellent prognosis

Decision: Approve standard

Prescription Database

Shows prescriptions filled (5-7 years): - Medication names - Prescribing physician - Fill dates

Reveals conditions:

Metformin → Diabetes
Nitroglycerin → Angina
Zoloft → Depression
Lipitor → High cholesterol

Inspection Report

Third-party investigation (large cases $1M+): - Financial: Income, net worth, debts - Reputation: Character, stability - Lifestyle: Alcohol, hobbies - Driving record: MVR, DUIs - Employment: Job stability

Medical Underwriting Factors

Build (BMI)

Formula:

BMI = (Weight lbs × 703) ÷ (Height inches)²

Example: 5'10" (70"), 220 lbs
BMI = (220 × 703) ÷ 4,900 = 31.6

Classification:

Normal: 18.5-24.9 (standard)
Overweight: 25-29.9 (standard to slight rate)
Obese I: 30-34.9 (rated)
Obese II: 35-39.9 (substantial rating)
Obese III: ≥40 (likely declined)

Blood Pressure

Categories:

Normal: <120/80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2: ≥140/90 (rated)
Crisis: ≥180/120 (postpone/decline)

Cholesterol

Total cholesterol:
<200: Desirable
200-239: Borderline
≥240: High (may rate)

LDL (bad):
<100: Optimal
≥160: High (rating likely)

Glucose

Fasting:
<100: Normal
100-125: Pre-diabetes (may rate)
≥126: Diabetes (rated/declined)

A1C:
<5.7%: Normal
5.7-6.4%: Pre-diabetes
≥6.5%: Diabetes

Diabetes Underwriting

Type 2 (adult-onset):

Well-controlled (A1C<7), no complications:
Standard to Table B

Moderate control (A1C 7-8):
Table B-D (+50-100%)

Poor control (A1C>8.5) or complications:
Table F-H (+150-200%) or declined

Type 1 (juvenile):

Well-controlled: Table D-F (+100-150%)
Complications: Substantial rating or declined

Cardiovascular Disease

Heart attack:

Recent (<1 year): Declined/postponed
1-3 years, recovery: Table D-H (+100-200%)
5+ years, no issues: Table B-D (+50-100%)

Stroke: Recent declined; past TIA with recovery rated

Cancer

General approach:

Active: Declined
Recent (<1 year): Postponed  
1-3 years remission: Substantial rating
5+ years remission: Moderate rating
10+ years (type dependent): Standard

Varies by: Type, stage, treatment, prognosis

Mental Health

Depression:

Mild, controlled: Standard to slight rating
Moderate, stable: Table B-C
Severe, recent hospitalization: Postpone
Suicide attempt: Substantial rating or declined

Substance Use

Tobacco:

Cigarettes: Smoker rates (2-3x)
Quit <1 year: Smoker rates
Quit 1-3 years: Moderate rating
Quit 3-5 years: Slight rating
Quit 5+ years: Non-smoker rates

Alcohol:

Social (1-2/day): Standard
Heavy: Rated or declined
DUI: Rating
Multiple DUIs: Substantial rating/declined
Alcoholism: Declined or postpone 2-3 years sober

Privacy Laws

HIPAA

Privacy rule: - Written authorization required - Specific purposes listed - Time limit (24-30 months) - Right to revoke

FCRA

Fair Credit Reporting Act: - Disclosure required - Authorization needed - Adverse action notice if declined - Right to see report - Can dispute errors

Key Exam Concepts

• Paramedical exam: Basic screening by nurse (vitals, blood, urine)
• APS: Attending Physician Statement - detailed records from doctor
• When APS ordered: Medical condition disclosed or abnormal results
• Blood tests: Cholesterol, glucose, liver enzymes, kidney function
• Prescription database: Shows medications past 5-7 years
• BMI ≥30: Obese - rated
• BP ≥140/90: Stage 2 hypertension - rated
• A1C: Hemoglobin A1C shows long-term glucose control
• Diabetes A1C <7: Well-controlled
• Tobacco: Must quit 12 months for non-smoker rates
• Cancer: Type, stage, time since treatment determine rating
• HIPAA: Privacy law; authorization required for medical records
• FCRA: Governs consumer reports; adverse action notice required
• Accelerated underwriting: No exam, uses data analytics