Medical impairment underwriting is the process by which life and health insurers evaluate applicants who have existing medical conditions or significant health histories. Unlike simplified or preferred underwriting, which focuses on healthy risks, medical impairment underwriting deals with applicants who present elevated mortality or morbidity risk due to issues such as heart disease, diabetes, cancer history, chronic lung disease, kidney impairment, or mental health disorders. Underwriters analyze attending physician statements, lab work, imaging, prescription histories, and lifestyle factors in light of company guidelines and medical impairment guides. The goal is to classify risk appropriately-whether standard, table rated, subject to a flat extra, postponed, or declined-while honoring regulatory requirements and ensuring fair, consistent treatment. Medical impairment underwriting allows carriers to offer coverage to a broader segment of the population while pricing policies according to the additional risk they assume.

In the field, advisors refer to medical impairment underwriting when they send challenging cases to specialty impaired-risk brokerage firms or carrier underwriters who focus on complex medical histories. A producer might say, "This is an impaired-risk case due to prior myocardial infarction and diabetes," signaling that expectations should be set for potential ratings or coverage limitations. Agencies often gather detailed questionnaires, physician letters, and preliminary underwriting opinions before submitting formal applications to multiple carriers. Medical impairment underwriting can involve shopping the case, obtaining tentative offers, and negotiating based on additional evidence or favorable trends in lab values. Successful navigation of this process requires strong communication between the advisor, client, carrier underwriters, and sometimes the client's physicians. For many agencies, expertise in medical impairment underwriting is a key differentiator that helps them place difficult cases and provide meaningful coverage for clients who might otherwise be declined.