Large case review is a collaborative underwriting and case design process reserved for significant life insurance placements, typically involving high face amounts, complex financial situations, or advanced planning strategies. During large case review, underwriters, medical directors, advanced markets attorneys, and sometimes reinsurers examine the client's financials, medical history, and planning objectives in depth. They evaluate insurable interest, financial justification, premium affordability, and product suitability. Large case review aims to produce consistent, defensible decisions on high impact cases while supporting advisors with creative structuring ideas, such as layering policies, using different entities, or coordinating with estate and business documents.

In real practice, advisors initiate large case review when presenting major estate liquidity plans, buy sell funding for sizable companies, or high premium accumulation strategies. BGAs and carrier wholesalers often request detailed fact finders, financial statements, business valuations, and legal documents before scheduling a review call. During the meeting, advisors can explain the client's goals, clarify planning structures, and discuss potential underwriting concerns such as foreign travel, complex income patterns, or aggressive premium financing. Carriers may propose alternative products, benefit levels, or underwriting programs to improve placement odds. Once decisions are made, they are communicated clearly to help advisors manage client expectations. By engaging in large case review, producers gain access to carrier expertise and support, increasing the likelihood of successfully placing sophisticated, high face amount arrangements that are both compliant and tailored to client needs.