Welcome back to FIG’s Ask the Doctor, where we pull back the
curtain on medical underwriting and show you what really happens behind the
scenes.
Background – Courtney’s Case Review
This particular case had my full attention from the moment it crossed my desk. I was working with a 30-year-old dentist—young, diligent, and proactive about her health. Yet despite her otherwise healthy profile, she had recently received a permanent decline from a major carrier due to concerns about her cardiovascular risk.
A permanent decline at her age is unusual. More importantly, the carrier’s reasoning left us in a bind:
- They were unwilling to insure her
with a cardiovascular exclusion, because such an exclusion is
considered too broad to protect the carrier. - They also weren’t willing to
reconsider the case based on the information originally reviewed.
At first, it looked like our only path forward was to pivot to a carrier that specializes in substandard risks. But something felt off. The client had undergone updated cardiology evaluations, and once I reviewed the notes, I knew the picture might be very different from what the original underwriter saw.
So I brought the updated file straight to our in-house medical director, Dr. Chelsea Alvarado, and asked her to take a closer look. What she uncovered would ultimately change the entire trajectory of the case.
Medical Assessment – Dr. Alvarado’s Review
Dr. Chelsea Alvarado, FIG Medical Consultant
Let’s walk through the medical profile and underwriting considerations that ultimately helped reopen this case.
Clinical Snapshot
- 30-year-old female, nonsmoker
- 5’5″, 140 lb (BMI 23) — normal, healthy build
- Diagnosed with hypertension at
age 28 - Treated with amlodipine 10 mg
daily - Most recent blood pressure: 125/75
at cardiology follow-up - Cardiologist recommended kidney
ultrasound + bloodwork to evaluate for secondary causes - All testing was completed last
month — normal results
Build and Lifestyle Analysis
Her BMI of 23 is ideal from an underwriting standpoint. A normal build significantly reduces the risk of complications from hypertension such as stroke and coronary artery disease. Her nonsmoking status is another major protective factor. Smoking and hypertension together create a disproportionately high cardiovascular risk, so the fact that she is a lifelong nonsmoker works in her favor.
Blood Pressure Control
Her blood pressure is well controlled on her current regimen. That is often the single most important indicator when assessing functional cardiovascular risk.
Early-Onset Hypertension Concerns
What initially alarmed the carrier—and rightfully required further evaluation—was her age at diagnosis. Hypertension that appears before age 30 falls into a category we consider early-onset hypertension. In young adults, this raises the question of whether the elevated blood pressure is primary (essential hypertension) or secondary to another medical condition.
This is precisely why her cardiologist ordered additional imaging and lab testing. Secondary causes might include renal artery stenosis, endocrine abnormalities, or structural kidney issues. In her case, all follow-up testing was normal, which is a highly reassuring finding.
Final Medical Impression
Although early-onset hypertension is associated with a modestly increased long-term mortality risk, this client demonstrates:
- Excellent blood pressure control
- Normal secondary workup
- Healthy body composition
- No smoking history
Based on these findings, she should qualify for standard coverage with most traditional life insurance carriers, despite the original decline.
This illustrates why updated medical data and a fresh clinical perspective can dramatically change underwriting outcomes. Cases involving early hypertension require nuance, and this is a prime example of how collaboration between advisors and medical underwriters can produce the best result.
Hypertension is just one of the many medical conditions we encounter in life and disability insurance underwriting. Stay tuned for more Ask the Doctor conversations with the FIG team, where we continue to demystify the process and share real-world case insights.
We appreciate you spending time with us today, and as always, the Fortify Insurance Group is grateful for the trust you place in us as we help your clients secure their income protection.
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