Welcome to FIG’s Ask the Doctor, where we will pull back the curtain on medical underwriting and show you what really happens behind the scenes.
For our first case study, we are discussing a recent case that highlights just how nuanced disability income insurance underwriting can be—especially when multiple risk factors are in play.
Background – Courtney’s Case Review
I was approached by a 54-year-old executive seeking to supplement his existing Group LTD coverage with an individual disability income policy. On paper, he presented as someone who takes his health seriously: he’s a nonsmoker, physically active, committed to daily walks, and strength trains several times per week.
But when I examined the application more closely, I could see why underwriting wasn’t straightforward. He stands 5’8” and weighs 240 pounds, giving him a BMI of 38, which places him firmly in the moderate obesity range. He had also been diagnosed with hypertension at age 50, although his blood pressure was well controlled at his last primary care visit at 120/78 on Losartan 50 mg.
Even with well-managed blood pressure and excellent lifestyle habits, BMI is one of the most consistent predictors of underwriting outcomes. And for disability coverage—where insurers are projecting the risk of long-term claims—build often plays a central role.
That’s when I looped in our in-house medical director, Dr. Chelsea Alvarado, to help determine whether we had a pathway to approval, and what expectations we should set with the client.
Medical Assessment – Dr. Alvarado’s Review
From a medical underwriting perspective, this client has several factors working in his favor:
- Nonsmoker
- Hypertension, well-controlled on a stable medication dose
- Regular physical activity, including cardio and resistance training
- No other medical diagnoses
These elements help mitigate his overall cardiovascular risk and improve his functional health profile.
However, the primary concern—and the one that holds the most weight in disability underwriting—is his BMI of 38. Obesity is closely associated with the development of hypertension, metabolic syndrome, and increased cardiovascular strain. Even though he maintains a healthy lifestyle, BMI in the obese range is still considered a significant long-term risk factor.
Additionally, he works in a high-stress executive environment, which can contribute to chronic elevations in blood pressure and challenges with weight management. These occupational stressors also influence disability underwriting, especially when insurers consider the future risk of musculoskeletal issues, cardiovascular events, and chronic disease.
Expected Underwriting Outcome
Given all factors, he is most likely to receive a low table rating (approximately 50%), driven almost exclusively by his BMI. Under such a rating:
- Increase options and benefit update riders are typically not available
- Carriers often limit the maximum benefit period to 5 years
Pathway for Improvement
The encouraging news is that many carriers allow for reconsideration after 12–24 months if the client demonstrates meaningful and sustained weight loss. Reducing his BMI into a lower-risk category could open the door to improved rates and potentially expanded coverage options in the future.
At Fortify Insurance Group, we appreciate the trust advisors place in us as we help navigate the complexities of life and disability underwriting. Cases involving build, hypertension, and occupational stress are incredibly common, and each requires a thoughtful, medical-forward approach.
Stay tuned for future “Ask the Doctor” discussions as we continue exploring the conditions and scenarios that shape the insurance industry.
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