Forty percent of life insurance applications fail to issue. That's not a typo.

Nearly half of all life insurance applications never become policies. Some get declined for health reasons. Some get rated at premiums higher than applicants will accept. And many abandon the process because it takes too long, requires too much effort, or communication breaks down.

This is why underwriting management is critical to your production. You can have perfect prospecting, brilliant needs analysis, and masterful illustration presentation. But if you can't get applications through underwriting and issued at acceptable rates? You don't get paid.

Top producers understand this. They prepare clients for underwriting, manage the process proactively, advocate effectively with underwriters, and keep applications moving toward issue. That's the difference between 40% issued rate and 75% issued rate.

Underwriting Process Overview

Understanding the process helps you manage it effectively.

Application submission to carrier kicks off underwriting. You submit the application (usually electronically), initial premium, and any supplemental questionnaires. Carrier assigns the case to an underwriter and orders requirements.

Medical exam scheduling and completion happens next for most policies. Paramedical exam companies schedule exams at applicant's home or office, collect blood and urine samples, record vitals, and send results to the carrier. This typically happens within 1-2 weeks of application.

Medical records ordering (Attending Physician Statements or APS) occurs if application reveals health conditions requiring documentation. Carriers request records from doctors, hospitals, or specialists. This is where delays often happen because medical offices are slow responding.

Prescription database checks happen automatically. Carriers check MIB (Medical Information Bureau) and prescription databases (Rx) to verify disclosed medications and identify undisclosed conditions. Discrepancies trigger questions or additional requirements.

Motor vehicle reports check driving records for DUIs, accidents, or patterns indicating risk. Multiple DUIs or reckless driving can result in declined applications or rated premiums, especially for larger policies.

Financial underwriting applies to high face amount policies (typically $1 million+). Carriers verify income, net worth, and financial need for coverage to prevent over-insurance. Tax returns, financial statements, or CPA letters may be required.

Underwriter review and decision synthesizes all information. Underwriters evaluate risk, determine rate class (preferred plus, preferred, standard, table ratings), and issue decision: approved as applied, approved with modifications, or declined.

Pre-Underwriting Preparation

The work you do before application dramatically affects success rates.

Health questionnaire accuracy sets proper expectations. Pre-qualify health conditions before submitting applications during your discovery meeting process. If client has diabetes, high blood pressure, or other conditions, understand severity and treatment. This lets you set realistic rate class expectations.

Setting client expectations prevents disappointment. If health history suggests standard rates at best, don't let clients expect preferred rates. "Based on your health history, I expect standard or possibly standard plus rates. If we get preferred, that's bonus." This conversation should happen during your insurance illustration process.

Explaining the medical exam process reduces anxiety and no-shows. Tell clients what to expect: blood draw, urine sample, blood pressure, height/weight, medical history questions. Schedule when convenient and emphasize it takes 30-45 minutes.

Disclosing known health issues completely is essential. Undisclosed conditions discovered during underwriting destroy trust and can result in declined applications. Better to disclose everything upfront and deal with it than get surprised later.

Medication list preparation helps applicants remember everything. Many people forget medications during application. Have them bring pill bottles or medication list to application meeting. Missed medications discovered via prescription check create underwriting delays.

Optimal timing avoids unnecessary delays. Don't submit applications week before Thanksgiving or Christmas when underwriters are backed up. Avoid submitting Friday afternoon (sits over weekend before assignment). Tuesday-Thursday submissions get fastest attention.

Health Risk Classifications

Understanding rate classes helps set expectations and choose carriers strategically.

Preferred Plus or Elite is best available rate class. Requires excellent health, normal weight, no smoking, good cholesterol and blood pressure, no family history of early heart disease or cancer, and no medications. Only 10-20% of applicants qualify.

Preferred is still excellent rate class. Slightly less restrictive than Preferred Plus. Maybe one minor condition well-controlled, slightly elevated cholesterol on medication, or family history without other risks. 30-40% of applicants get this or better.

Standard Plus is between preferred and standard. Some carriers have this class, others don't. Typical for people with controlled hypertension, elevated cholesterol, borderline BMI, or combination of minor issues.

Standard is average rate class. Most Americans would qualify as standard if they applied. Controlled health conditions, normal medications, average height/weight, non-smoker. This is not bad rating, it's normal.

Table ratings (A through H or J) add cost above standard. Each table is typically 25% increase. Table B is standard plus 50%, Table D is standard plus 100% (double). Assigned for significant health issues that increase mortality risk but don't justify decline.

Flat extras are per $1,000 surcharges added for specific risks. Common for aviation, hazardous occupations, or recent serious conditions. "$5 per thousand flat extra" means $5 extra per $1,000 of coverage ($5,000 extra annually on $1M policy).

Declines and postponements happen when risk is too high. Declines are permanent decisions (can try different carrier). Postponements suggest reapplying after health improves or time passes since serious condition.

Common Underwriting Issues

These conditions frequently cause rated or declined offers. Understand how carriers evaluate them.

Elevated blood pressure or cholesterol are manageable if controlled. Carriers want to see consistent medication compliance, regular doctor visits, and stable readings. Uncontrolled or recently diagnosed hypertension creates issues.

BMI and weight concerns affect most applications. Carriers have height/weight charts. Being 10-20 pounds over preferred weights usually means standard rating. Being 50+ pounds overweight can mean table ratings. Weight loss before applying can save thousands in premiums.

Diabetes management varies by type and control. Type 1 diabetes usually means standard to table ratings. Type 2 controlled with oral medication might get preferred. A1C levels, medication compliance, and complications all factor in. The American Diabetes Association provides resources on diabetes management that can help clients improve their health status before applying.

Cardiac history is serious for underwriting. Recent heart attack, bypass surgery, or stent placement typically means postponement or table ratings. Time since event matters. Five years post-stent with no complications is much better than one year.

Cancer history and survival periods determine insurability. Most carriers require 5-10 years cancer-free before offering standard rates. Recent cancer means postponement. Type of cancer and stage affect waiting periods.

Mental health history is more accepted than previously but still affects underwriting. Well-controlled depression on single medication might not affect rates. Multiple medications, hospitalizations, or suicide attempts create challenges.

Tobacco and marijuana use trigger smoker rates (50-100% higher premiums). Tobacco includes cigarettes, cigars, chewing tobacco, and nicotine vaping. Some carriers treat occasional cigar use differently than cigarettes. Marijuana use is increasingly accepted but policies vary.

DUI and driving records matter especially for large policies. Single DUI 5+ years ago might be overlooked. Multiple DUIs or recent DUI means decline or substantial ratings. Pattern of reckless driving creates concerns.

Aviation and hazardous occupations require special underwriting. Private pilots, commercial fishermen, roofers, loggers, and other dangerous occupations face flat extras or table ratings. Carriers evaluate hours flown, type of aircraft, and training for pilots.

Managing Underwriting Delays

The longer underwriting takes, the more applications abandon. Minimize delays.

Medical exam scheduling obstacles occur when applicants don't answer exam company calls or delay scheduling. Follow up immediately. "The exam company will call you today or tomorrow. Please schedule immediately so we keep moving."

APS procurement delays are common because doctor offices are slow. If underwriter orders APS, call the medical office yourself to expedite. Explain urgency. Offer to cover rush charges (your client pays but worth it to prevent abandonment).

Incomplete medical records require additional requests and time. If underwriter requests APS and receives incomplete records, they'll re-request. Stay on top of this. Ask underwriter exactly what's needed and help get it.

Additional requirements like stress tests, specialist reports, or updated lab work extend timelines. Explain why needed, help schedule tests promptly, and stay in communication with underwriter and client.

Client communication during process prevents abandonment. Weekly updates even if there's no news keeps clients engaged. "Still waiting on medical records from your doctor. I'm following up daily." This shows you're on it.

Preventing application abandonment requires proactive communication and expectation management. If medical exam is taking longer than expected, explain why and reassure client you're pushing it forward. Don't let clients feel forgotten.

Advocating for Clients

Underwriters review applications based on rules and data. Your job is providing context.

Underwriter communication strategies build relationships that help clients. Be professional, responsive, and reasonable. Underwriters remember agents who are easy to work with. Return calls promptly, provide requested information quickly, and don't argue irrationally.

Providing additional context and documentation can change outcomes. If client got table rating for elevated cholesterol but has been working with doctor to reduce it, send recent lab results showing improvement. Context matters.

Attending physician letters from doctors explaining conditions, treatment, and prognosis can overcome adverse underwriting. If underwriter sees diabetes on APS without context, they might rate heavily. Doctor's letter explaining well-controlled type 2 diabetes with excellent A1C might get better rating.

Requesting reconsideration works when you have new information or can explain circumstances. "I know you offered Table B based on blood pressure reading during exam. Client was anxious. Here are three recent readings from his doctor showing normal blood pressure." Underwriters will reconsider with good documentation.

Appealing adverse decisions through formal appeals process can overturn declines or improve ratings. Most carriers have appeal processes. Provide medical evidence, doctor letters, or new test results supporting better rating.

Shopping declined cases to other carriers often finds coverage. Carriers have different underwriting guidelines and risk appetites. Case declined by one carrier might be approved by another. Use brokerage general agents who know which carriers to try for specific conditions.

Alternative Underwriting Solutions

When traditional fully underwritten coverage won't work, alternatives exist.

Simplified issue policies require no medical exam. Answer health questions, instant decision based on prescription and MIB checks. Faster (2-3 days) but more expensive than fully underwritten. Good for people who can't take time for medical exam or have minor health issues.

Guaranteed issue products accept everyone regardless of health. No medical questions, no exam, immediate approval. Very expensive and limited coverage (typically $25,000-50,000 maximum). Often have graded death benefits (limited death benefit first 2-3 years).

Graded death benefit plans pay limited benefits if death occurs in first 2-3 years (return of premiums plus interest) but full death benefit thereafter. Used for guaranteed issue products and people with serious health conditions.

Accelerated underwriting programs use predictive analytics to offer instant approvals for healthy applicants. Answer health questions online, carriers check data sources, and some applications get instant approval without medical exam. According to LIMRA, accelerated underwriting is transforming the industry by making coverage more accessible. Much faster but only for applicants meeting healthy criteria.

Final expense insurance is simplified or guaranteed issue coverage designed for funeral and burial costs. Smaller face amounts ($5,000-25,000), easier underwriting, and higher premiums per thousand. Appropriate for seniors or people with health issues needing some coverage.

Rate Class Optimization

Strategic decisions can improve rate classes and save clients thousands.

Strategic carrier selection by health profile leverages carrier specialization. Some carriers are friendlier to diabetes, others to cardiac history, others to weight issues. Knowing which carriers have best underwriting for specific conditions improves outcomes.

Timing applications around health improvements can dramatically improve ratings. If client is losing weight, working on cholesterol, or getting blood pressure under control, waiting 3-6 months to apply might save 25-50% on premiums for life.

Weight loss before applying has biggest impact for overweight applicants. Losing 20-30 pounds might be difference between standard and preferred rates, saving thousands annually. If client is motivated to lose weight, suggest they do so before applying.

Blood pressure management before exam improves results. Reduce caffeine and salt week before exam, get adequate sleep, stay hydrated. These won't fix hypertension but might avoid one-time elevated reading that affects underwriting.

Nicotine testing timing matters for recent quitters. Most carriers require 12 months nicotine-free for non-smoker rates. If client quit 9 months ago, better to wait 3 more months than apply as smoker (which doubles premiums).

Post-Decision Process

Underwriting decision isn't the final step. You still need to close the sale.

Rate class negotiation involves accepting offer, requesting reconsideration, or declining and trying different carrier. If client expected preferred and got standard plus, evaluate whether the premium is still acceptable or whether to appeal.

Accepting offers vs re-applying depends on offer quality and alternatives. If only option is Table D rating and client really needs coverage, accepting might be right choice. If offer is terrible and other carriers might do better, decline and shop.

Policy delivery after approval is when you get paid. Move quickly to deliver policy, collect first premium if not already paid, and complete the sale through your policy delivery service process. Don't delay once approval comes.

Explaining ratings to clients requires honesty and perspective. "You got standard rating instead of preferred because of your cholesterol and blood pressure. This adds $30/month to premium. That's not ideal but you're still getting the $1 million coverage you need to protect your family."

Planning for future re-rating opportunities applies to table ratings for improving conditions. Some carriers allow re-evaluation after time period. If client gets table rating for recent diabetes diagnosis, let them know they might qualify for better rating in 2-3 years with good control. Keep door open for future re-application.

Why Underwriting Management Matters

This is where production lives or dies.

Advisors who don't manage underwriting lose 40-50% of applications. Advisors who actively manage underwriting, communicate proactively, advocate effectively, and keep cases moving issue 70-80% of applications. That difference is massive.

If you write $500,000 in annual premium at 40% issued rate, you place $200,000. If you improve issued rate to 70%, you place $350,000. That's $150,000 more annual premium for the same prospecting and sales effort. Just by managing underwriting better.

Treat underwriting as active sales process, not passive waiting. Follow up on requirements daily. Communicate with clients weekly. Provide context to underwriters. Advocate for better ratings when justified. Get cases across the finish line.

That's how you maximize your sales effort and build a sustainable insurance practice.

Learn More

Master the complete life insurance sales process: