Difficult to Place Life Insurance | BUI Impaired Risk Experts

Key Takeaways

What BUI Brings to Difficult to Place Life Insurance Cases

BUI places difficult to place life insurance cases through in-house, classically trained, former carrier underwriters who review medical records and negotiate with carriers
Every Other Than Applied For (OTA) case is reviewed carefully with BUI's in-house underwriters seeking to negotiate the rate class back toward the originally anticipated level
When cases are fully underwritten, BUI maintains the underwriting file, enabling carrier moves in weeks rather than restarting the process.
The Pre-Underwriting Questionnaire helps advisors identify potential issues before quoting, producing more realistic initial rate estimates
BUI handles a wide range of impaired risk cases. Examples range from medical complications (e.g. cancer, heart disease, diabetes, etc.), to behavioral (e.g. nicotine, tobacco, marijuana, etc.), to hazardous avocations and hobbies (e.g. piloting, rock climbing, racing, etc.)
Large case experience and joint presentation assistance are available for complex, client-facing scenarios

The Challenge

When a Life Insurance Case Becomes Difficult to Place

When a client's history indicates a potential increased risk factor, standard carrier underwriting often returns a rate class worse than applied for, or a decline. For advisors, the challenge is twofold: finding a carrier that may accept the risk, and seeking to secure the most favorable rate class available.

BUI takes a refined approach to improving the outcome by leveraging industry knowledge, relationships, and volume. Advisors who partner with BUI access top shelf resources to advocate for their clients' best interests.

Common Scenarios That Create Placement Challenges

Case is approved as Other Than Applied For and the advisor has no context to explain the new premium
Client has a complex medical history that falls outside standard underwriting guidelines
Hazardous avocation or behavioral risk triggers ratings or declines at multiple carriers
High face amount case requires facultative reinsurance and complex financial underwriting

Medical Impairments

Medical Impairments We Regularly Evaluate

Each carrier evaluates medical conditions differently. BUI's underwriters review the client's specific history to identify which carrier may view a given impairment most favorably. The following are helpful hints for perspective on conditions we encounter frequently. BUI's underwriters evaluate many impairments beyond those listed here.

01

Cancer History

Underwriters assess cancer type, stage at diagnosis, treatment history, and time since last treatment. Many carriers consider policies after a cancer-free waiting period, which varies by cancer type and carrier. Some carriers may offer coverage sooner for certain diagnoses, while others require longer remission periods before offering standard rates.

02

Diabetes

Type 1 and Type 2 diabetes are evaluated based on age of onset, A1C levels, current treatment regimen, and presence of complications. Well-controlled diabetes with no comorbidities may qualify for standard or preferred rates at some carriers, while insulin-dependent diabetes with cardiovascular complications may face table ratings or declines depending on severity.

03

Cardiovascular Disease

Coronary artery disease, prior heart attacks, stent placement, valve replacement, and arrhythmias each carry distinct underwriting considerations. Carriers evaluate severity, treatment, time since intervention, current cardiac function, and overall health profile. Some carriers view certain cardiovascular histories more favorably than others, which is where carrier-specific expertise may make a difference.

04

Arthritis

Osteoarthritis is rarely disabling and extra mortality is rare; it can usually be taken at standard rates. Rheumatoid arthritis, however, is associated with disability and can affect longevity. Underwriters evaluate severity of attacks, steroid use, presence of nodules, disability status, associated impairments, and sedimentation rate. Mild rheumatoid arthritis treated with non-steroidal drugs may qualify for standard rates, while moderate cases with steroid use may fall into Table 2-4. Severe rheumatoid arthritis with significant disability, nodules, or organ involvement may be rated Table 6 or declined.

05

Asthma

Many asthmatics will qualify for standard or preferred rates, while some may be rated depending on severity. Underwriters evaluate frequency and severity of attacks, type of medications, steroid use, hospitalization history, age, smoking status, and number of inhalers used. Mild asthma with infrequent or seasonal attacks treated with a single medication or bronchodilator may qualify for preferred rates. Moderate asthma requiring an oral inhaler may fall at standard. Severe asthma with episodes requiring hospitalization may be rated Table 6 or higher.

06

Hepatitis

There are at least six known types of hepatitis, and underwriting outcomes vary significantly by type. Hepatitis A is self-limiting and does not progress to chronic liver disease, so a history may qualify for preferred or standard rates. Hepatitis B can be standard if there is no liver damage, but may be rated if minimal liver damage is present. Hepatitis C typically results in moderate table ratings due to the higher likelihood of liver damage. Underwriters evaluate the type of hepatitis, liver test results, alcohol use, treatment history, and biopsy reports.

07

Multiple Sclerosis

MS is a complex disease of the central nervous system and underwriting classification can range from standard to decline. Underwriters evaluate age at onset, number of attacks per year, extent of disability, and how quickly the disease progresses. Mild MS with onset before age 35, multiple years of infrequent attacks with recovery between, and no disability may qualify for standard or Table 2. Moderate MS that is slowly progressive with moderate disability may fall into Table 4-6. Severe MS with significant disability may be rated Table 8 or declined.

08

Sleep Apnea

Most clients with sleep apnea will qualify for standard rates, some may qualify for standard better, and some will be rated. Preferred is rarely available. Underwriters evaluate the frequency and severity of episodes, type of treatment, sleep study results, and associated impairments. Mild or moderate sleep apnea with CPAP compliance for at least two years may qualify for standard better. Moderate or severe sleep apnea with treatment compliance may fall at standard or Table 2-4. Very severe sleep apnea with non-compliance with CPAP may result in a decline.

09

Ulcerative Colitis

Ulcerative colitis presents field underwriting challenges and preferred classifications are seldom available. Underwriters evaluate age at diagnosis, medications used, and any surgical history. Mild colitis with a single episode, recovery, and good follow-up, or surgical removal of the affected area, may qualify for standard to Table 2. Moderate colitis with longer duration and steroid or immunosuppressant drug use may fall into Table 2-4. Severe colitis with long duration and ongoing drug use may be rated Table 6 or higher.

Avocations and Hobbies

Hazardous Avocations and Hobbies

Hazardous avocations can trigger flat extras, table ratings, or declines depending on the carrier. BUI's underwriters evaluate the specific activity, experience level, and frequency to identify carriers that view each avocation most favorably.

Carrier treatment of the same avocation can vary significantly. A private pilot with 500 hours and an instrument rating may receive preferred rates at one carrier and a flat extra at another. Identifying the right carrier before submission can save weeks of underwriting time and help avoid unnecessary ratings.

Aviation

Private pilots, student pilots, and commercial pilots face varying underwriting treatment depending on flight hours, certification level, aircraft type, and whether flying is for business or pleasure. Some carriers rate aviation at flat extras, others include it in the base rate, and some may decline depending on the pilot's experience profile.

Racing

Motorsports participants, including amateur and professional racing drivers, may face avocation ratings. Underwriters consider the type of racing, frequency, competitive level, and safety equipment.

Other Hazardous Avocations

Scuba diving, rock climbing, hang gliding, and other hazardous avocations are evaluated based on depth, frequency, certification, and location. BUI's underwriters can identify carriers that view specific avocations more favorably.

Behavioral Risks

Behavioral Underwriting Risks

Behavioral factors, including substance use and alcohol history, are evaluated differently across carriers. BUI's underwriters track carrier-specific guidelines to identify the most favorable path for each client profile.

01

Marijuana Use

Carrier treatment of marijuana use varies significantly. Some carriers may offer non-tobacco rates for occasional users, while others apply tobacco rates or table ratings depending on frequency, method of consumption, and whether use is medical or recreational.

02

Nicotine and Tobacco

Nicotine use, including cigarettes, cigars, chewing tobacco, vaping, and nicotine replacement products, generally triggers tobacco rates at most carriers. However, certain carriers may offer competitive non-smoking rates for alternative tobacco users or those who have been nicotine-free for a specified period.

03

Alcohol History

Alcohol consumption history is evaluated based on frequency, quantity, and any history of abuse or treatment. Carriers review liver function tests, driving records, and medical history for indicators of alcohol-related risk. Those with documented history of substance abuse must generally refrain from all alcohol and drug consumption to be eligible for coverage.

The BUI Difference

OTA (Other Than Applied For): Where BUI's Underwriters Earn Their Keep

When a case comes back Other Than Applied For (OTA), advisors typically receives a brief note from the carrier with the approval. It might say "Table 2: Diabetes" with an inflated "approved" premium when the application was submitted at Standard. At many BGAs, that is the end of the conversation. The advisor is left to explain the new premium to the client with no additional context, no negotiation, and no alternative options.

BUI handles OTA cases differently. This is where a boutique underwriting relationship separates itself from a self-service transaction.

1

Medical Record Review

When a case returns OTA on a fully underwritten plan, BUI's underwriters review the medical records that were built during the underwriting process. They examine the underwriting evidence and identify whether the carrier's rating is supported by the medical file.

2

Carrier Negotiation

BUI's underwriters go back to the carrier to seek to negotiate the rate class back up toward the originally anticipated class. This is not a request for reconsideration based on hope; it is a reasoned argument grounded in the medical evidence and carrier guidelines.

3

Underwriting File Portability

If negotiation with the current carrier does not produce a satisfactory result, BUI's underwriters evaluate whether another carrier may offer better terms or work with the advisor and client to create a game plan for improvement. Because BUI maintains the underwriting file, the case can be moved to a more favorable carrier in a matter of weeks rather than starting the entire process over again from scratch.

4

Evidence-Based Carrier Selection

When BUI recommends a carrier move, it is based on evidence that the new carrier is likely to accept the risk at a more favorable rate, not a blind submission. BUI's underwriters know which carriers evaluate specific impairments more favorably, and they direct the case accordingly.

"In a supermarket model, the advisor submits and waits. In a boutique model, the advisor has an underwriter on their side who advocates for the client's most favorable outcome."

BUI Underwriting Philosophy

Our Team

Classically Trained Underwriters, Not Case Managers

Many BGAs will label an employee an "underwriter" who has no formal experience or education as an actual carrier underwriter.

BUI's underwriting team is different. Led by Chris Hooper, CLU, FALU, FLMI, Chief Underwriter, BUI's underwriters are classically trained, senior-level professionals who built their careers at the carrier level. They hold industry designations including FALU (Fellow, Academy of Life Underwriting) and FLMI (Fellow, Life Management Institute), which represent formal education in risk assessment and insurance management.

Their role at BUI is not to process paperwork. Given any underwriting risk, their job is to identify the carrier that may look most favorably on that specific client profile.

"I've got a guy..."

Many of our underwriters' conversations with advisors begin this way, followed by a brief description of the client's medical history or avocation. That is an appropriate and welcome way to engage BUI's underwriting team. No formal submission is required to start the conversation.

First Step Intake Tool

Start with the Pre-Underwriting Questionnaire

Before submitting a formal application, BUI offers a Pre-Underwriting Questionnaire that helps identify potential underwriting issues up front. This tool allows BUI's underwriters to review the client's health history, medications, family history, and avocations before a carrier ever sees the case.

The result is a more realistic initial quote that reflects the client's actual health profile, rather than a preferred-plus quote that comes back several table ratings higher after full underwriting. Many advisors who work with BUI start every case with this tool.

Complete the Pre-Underwriting Questionnaire

No formal application required. BUI's underwriters review the details and respond with a realistic assessment.

Beyond Underwriting

Additional Capabilities for Complex Cases

01

Large Case Experience

BUI has experience with high-face-amount cases that may require facultative reinsurance and complex financial underwriting. Large cases often involve additional scrutiny of medical history, financial justification, and carrier retention limits, all of which BUI's underwriters navigate regularly.

02

Joint Presentation Assistance

For complex cases that require client-facing explanation, BUI's team can participate in joint presentations alongside the advisor. This may include explaining underwriting outcomes, reviewing policy illustrations, or discussing advanced planning structures.

03

Advanced Planning Support

Brian Seigel, J.D., AEP, Director of Advanced Planning, provides support for cases involving estate planning, business succession, and tax-advantaged strategies. Complex life insurance structures often intersect with trust planning, and BUI's advanced planning team coordinates with the underwriting team to help address both the medical and structural elements of the case. Explore BUI's turn-key evaluation processes for additional planning support.

FAQ

Frequently Asked Questions

What medical conditions disqualify my client from life insurance?

Few medical conditions automatically disqualify an applicant from all life insurance coverage. Conditions such as cancer, diabetes, cardiovascular disease, sleep apnea, and other impairments may result in table ratings, flat extras, or declines at some carriers. However, depending on the time since the incident, treatment response, and overall prognosis, some applicants with these same conditions may qualify at Standard or better rates. The key is identifying which carrier evaluates a given condition most favorably, which is where experienced underwriting support may help.

What does impaired risk insurance mean?

Impaired risk life insurance refers to coverage for applicants with medical conditions, hazardous avocations, or behavioral factors that place them outside standard underwriting guidelines. These cases require carriers that evaluate the specific impairment more favorably, and often involve negotiation to seek to secure the most favorable rate class available.

How hard is it to get a life insurance policy for my client?

The difficulty of obtaining life insurance depends on the applicant's health profile, age, financial profile, and the carrier's underwriting guidelines. Young, healthy applicants may qualify quickly through accelerated underwriting programs. Applicants with medical impairments or hazardous avocations may face a more robust process, but coverage is often available through the right carrier with proper underwriting support.

How can I get BUI to review my client's profile?

There are two easy ways to engage BUI's underwriting team. Advisors can complete the Pre-Underwriting Questionnaire, which allows BUI's underwriters to review the client's health history, medications, family history, and avocations before you even quote the case. That is the best first step for a smooth path in underwriting. Alternatively, advisors can schedule a consultation to discuss the case directly. No formal application is required to start the conversation.

How many carriers does BUI work with?

BUI works with dozens of highly rated life insurance carriers. This carrier breadth allows BUI's underwriters to identify the carrier most likely to view a given impairment favorably, rather than being limited to a small panel of options.

Get Started

Submit Your Difficult to Place Case

Whether you have a client with a complex medical history, a hazardous avocation, or a case that came back Other Than Applied For, BUI's underwriting team is available to review the details and identify the most promising carrier path.

Complete the Pre-Underwriting Questionnaire Schedule a Consultation

Call: 314-392-2841

Email: marketing@buiusa.com