A guide to life insurance underwriting

When you apply for life insurance, the provider will make a risk assessment using a process called underwriting. This is to help them decide whether they can offer you cover and how much you should pay. All life insurance providers have a slightly different underwriting criteria and process.

The application process generally starts with a questionnaire asking for details about things like your lifestyle, medical history and current health. It can be really straightforward and most people are accepted immediately on standard terms – with no need for extra medical checks, reports or tests.

It’s important to give an honest and accurate picture during underwriting. If you don’t, it could mean that your policy won’t pay out and your family will miss out on vital support at a very difficult time. It also makes sure you don’t pay too little or too much for your cover.

If your health or your circumstances are more complicated, it can be a good idea to go through a broker or adviser as they could be able to help you get suitable cover.

It can vary between providers but, as a general rule, these are the types of questions you’ll need to answer during the life insurance underwriting process: 

• Medical history: You’ll be asked to share details of your past and present medical history, including any ongoing tests or dates of treatment. If you have a pre-existing condition like diabetes, the insurer will take it into account when assessing your risk. 
• Height, weight, waist size and BMI: Providers will want to know about your body mass index (BMI). If you’re outside their particular limits, you’ll probably need to pay more. But a high BMI certainly doesn’t mean you won’t be able to get life cover.  
• Family history: If you have a family history of illnesses like cancer or heart disease, this will be taken into account. 
• Smoking: This is a big one. Smoker life insurance premiums will be higher. You’ll usually be asked how much you smoke, and whether you use e-cigarettes or any other types of tobacco products. 
• Alcohol consumption: Providers will usually want to know if you drink alcohol, how much and how regularly. Drinking a ‘moderate’ amount of alcohol isn’t likely to be considered to increase your risk.   
• Recreational drug use: It’s important to be honest if you partake in illegal drugs so the underwriters can accurately assess the risk. 
• Occupation: Most occupations don’t affect your risk level or premiums. But some may, for example if you work in the armed forces, at height, in mining or in the offshore oil and gas industry. 
• Recreational activities: Some hobbies, like skydiving, motorsports, rock-climbing  or caving, come with extra risk, so your premium might be higher. 
• Overseas travel: Don’t worry, your yearly fortnight in Italy or Greece won’t affect your premiums. But some providers will want to know if you visit places that have a high risk of infectious diseases, or if they’re considered unsafe regions to visit. You should also tell them if you go abroad for extended stays. 

Most people are accepted for life insurance at standard rates without having to give any more evidence. According to Legal & General only around 7% of people who apply for life insurance are requested to attend a medical.

But depending on what information you’ve given during underwriting, or if you want a particularly high level of cover, the provider might want to dig a bit deeper. This could mean asking you to answer some more questions, provide extra evidence or have some tests carried out.

For example, you might be asked for one or more of the following:

General Practitioner’s Report (GPR): Your GP compiles this report from your medical records and history. You’d need to give permission for this first. 

Nurse telemedical interview: This is a telephone call with a nurse to get more details about something that you’ve mentioned on your application form. It doesn’t take long.

‍Nurse screening examination (NSE): You’d be asked to make an appointment with a nurse at a place that’s handy for you, like your home or workplace. During the appointment, the nurse might take your height, weight and blood pressure, and they could ask for more details about your medical and family medical history. They might also carry out a urine test and a peak flow reading. 

Medical examination report (MER)/medical examination (MED): This examination and report is usually carried out and compiled by an independent doctor, arranged by the insurer. It’s likely to involve a detailed questionnaire about your medical history, family medical history and lifestyle habits. You then have some physical health checks like heart and chest function, blood pressure, urinalysis and a cotinine test, which measures nicotine levels. 

Other medical tests: Depending on what’s required, these could include an electrocardiogram (ECG) to check your heart health. You could also be asked to have saliva, blood or urine tests to check for things like HIV, whether you’re a smoker or to measure your cholesterol.  

Lifestyle/Hobby questionnaire: If you have a hobby that can be a bit risky, like jumping out of planes or conquering the world’s highest peaks, the insurer might want a bit more information from you about it. They’d ask you to fill out a questionnaire to help them understand the risks better before offering you cover. 

Financial evidence: If you’re asking for an unusually large amount of cover, the provider might ask you for more details on your finances or to fill in a financial questionnaire. This is to make sure the amount of life cover is in line with your financial circumstances.

Can insurers ask you to undergo genetic testing?

The short answer is no, they can’t. The government and the Association of British Insurers (ABI) have agreed a code around genetic testing that insurers have to follow. This code states that insurers are not allowed to ask or pressure people into taking a predictive or diagnostic genetic test. 

There’s one exception to the rule: insurers can ask for the results of a predictive genetic test for Huntington’s disease if the life insurance cover you’re requesting is over £500,000. 

When is it a good idea to disclose a genetic test result?

If you’ve had predictive genetic testing that proves you haven’t inherited a condition that’s in your family, it’s worth telling your insurer during the underwriting process. This could help you get cover with lower premiums.

Generally, once your life insurance underwriting is complete, you’ll receive one of these decisions: 

• ‍Accepted on standard rates: Most people have their application for life insurance accepted at standard rates and terms. You won’t need to answer any more questions, have any tests or provide medical reports. ‍
• Accepted with an increased premium: If there are any risk factors that mean you’re more likely to make a claim, such as being a smoker or morbidly obese, you’ll pay a higher premium. This is called extra mortality loading and it’s normally given as a percentage. So if the extra mortality loading is 20%, you’ll pay an extra 20% for your premiums. ‍
• Accepted with exclusions applied: This means that the provider has excluded some things from your policy, so they won’t pay your claim if a particular event happens. It doesn’t apply to life insurance, but can be applied to add-ons like critical illness cover. ‍
• Deferred application: The provider might choose to put off a decision if you’re considered too high risk at the moment, but things might improve or you’re waiting for results, for example. They would review the decision after a certain amount of time or when you get your results back. ‍
• Decline: If you’re considered too high risk because of any of the risk factors, the insurer might not be able to offer cover and your application would be declined. If this is the case, all is not lost. You could seek out specialist insurers or go through a broker or adviser who might be able to help you find cover.

This depends. Most people apply for life insurance online, or by phone if you prefer. If everything’s straightforward, you’re likely to get a decision right away. The recent Protection Platform Pulse Report showed that 85% of life insurance applicants received an instant decision. 

If you have any risk factors and you need to have a medical exam or provide extra evidence, for example, the life insurance underwriting process could take around six weeks.