Medical director review is the internal process in which a life or health insurance company's medical director-a physician employed or retained by the carrier-evaluates complex or borderline underwriting cases. When standard underwriting guidelines do not clearly address a particular impairment, combination of conditions, or unusual medical history, the underwriter can escalate the file for expert review. The medical director examines attending physician statements, lab results, imaging studies, EKGs, treadmill tests, and other clinical data to assess mortality or morbidity risk more precisely. Their written opinion may support a standard approval, a rated offer, postponement, or decline, and frequently includes guidance on future reconsideration. Medical director review helps carriers maintain consistent, evidence-based underwriting decisions while adapting to evolving medical research and treatment protocols. It is especially important for high-face-amount cases, impaired risks, or situations where conflicting medical opinions require a higher level of professional judgment and documentation.

In everyday brokerage and agency work, medical director review is requested when an underwriter is unsure how to classify a client's risk using the standard underwriting manual alone. A producer might hear that a case has been "sent to the medical director" after an APS shows complex cardiac history, recent cancer treatment, or multiple comorbidities. This often extends processing time but can lead to more nuanced and favorable decisions compared to a strict guideline approach. Brokerage agencies may proactively ask underwriters whether a file can be reviewed by the medical director when they suspect additional context or physician letters could improve the offer. The outcome is typically communicated back to the producer as a formal decision, sometimes with an explanation of the risk factors considered. Over time, feedback from medical director reviews helps shape carrier underwriting philosophies, preferred criteria, and impairment guides, improving quote accuracy for similar cases in the future.