Life insurance underwriting: what to expect
Life insurance underwriting is the part most people don’t see—and the part that creates the most confusion. Two people can apply for the same coverage amount, on the same day, and receive very different pricing or outcomes. That’s not arbitrary. It’s underwriting.
This article explains why approvals and pricing vary, what the underwriting process actually evaluates, what steps you can expect along the way, and—most importantly—how to avoid unpleasant surprises after you apply.
What underwriting is—and what it isn’t
Underwriting is the insurer’s process for evaluating risk so policies are priced fairly and sustainably.
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What it is:
A structured review of health, lifestyle, financials, and history to estimate mortality risk.
The goal is accuracy—not punishment.
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What it isn’t:
A moral judgment, a personal assessment, or a “gotcha” exercise.
Underwriters don’t care why something happened—only whether it affects risk.
- Why it matters: Underwriting determines approval, pricing class, and available riders.
Life insurance pricing isn’t subjective—it’s actuarial.
Why two people get two different outcomes
Even small differences can move an applicant between rate classes.
- Age: Every birthday matters. Premiums increase as statistical life expectancy shortens.
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Health history:
Blood pressure, cholesterol, A1C, medications, diagnoses, and treatment compliance.
Well-controlled conditions are often rated very differently than untreated ones.
- Build: Height-to-weight ratios are measured against carrier-specific tables.
- Lifestyle factors: Tobacco/nicotine use, alcohol history, recreational drugs, aviation, motorsports, scuba, and travel.
- Family history: Early heart disease, cancer, or genetic conditions in parents or siblings can affect class.
Underwriting isn’t about perfection—it’s about patterns.
What actually happens after you apply
Most underwriting follows a predictable sequence, even if timelines vary.
- Application review: Personal info, coverage amount, beneficiaries, and initial health disclosures.
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Medical exam (if required):
Height/weight, blood pressure, blood draw, urine sample.
Many policies waive exams for lower amounts or healthier profiles.
- Record collection: Paramed exam results, prescription database checks, motor vehicle reports, and medical records (APS).
- Underwriter review: All data is evaluated together to assign a rate class or request clarification.
The longest delays usually come from waiting on medical records—not decisions.
Common requests applicants don’t expect
These aren’t red flags—they’re standard parts of due diligence.
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Attending Physician Statements (APS):
Records requested from your doctor to clarify diagnoses or treatment.
APS requests are the #1 cause of underwriting delays.
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Financial justification:
For larger policies, insurers may verify income or net worth.
Coverage must make financial sense relative to the applicant’s profile.
- Follow-up questions: Clarifications on medications, travel plans, hobbies, or past conditions.
More questions usually mean the insurer is trying to approve—not decline—the policy.
Understanding rate classes and decisions
Approval isn’t binary. Most outcomes fall on a spectrum.
- Preferred / Preferred Plus: Excellent health metrics, clean history, favorable build.
- Standard: Average risk—still fully insurable, just priced accordingly.
- Rated (Table ratings): Higher risk results in increased premiums, not denial.
- Declined or postponed: Usually tied to unresolved medical issues, recent diagnoses, or incomplete records.
“Standard” is not bad—it’s normal.
How to improve outcomes before you apply
The best underwriting strategy starts before paperwork is submitted.
- Be honest and precise: Inaccurate disclosures cause delays, re-rates, or rescissions later.
- Time matters: Waiting a few months after a diagnosis or medication change can materially improve pricing.
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Shop carriers intelligently:
Different insurers treat the same risk differently.
This is where experienced agents add the most value.
- Prepare records: Knowing your doctors, dates, and medications speeds everything up.
Good underwriting results are engineered, not hoped for.
Common underwriting questions
Will a medical exam hurt my chances?
No. Exams provide objective data and often help applicants qualify for better rates.
Can I be approved without an exam?
Yes. Many policies offer accelerated or no-exam underwriting based on age, amount, and health profile.
What happens if I’m declined?
Declines are carrier-specific. Another insurer—or a different policy type—may still be viable.
Underwriting is predictable—if you know what’s being measured
Life insurance underwriting isn’t mysterious, but it is detailed. Approvals and pricing reflect measurable risk, documented history, and timing. When you understand the process—and prepare for it—you reduce delays, avoid surprises, and position yourself for the best outcome available to you.