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What is a Medical Underwriter?

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  • Written By: Mitch Morgan
  • Edited By: Andrew Jones
  • Last Modified Date: 08 November 2016
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    Conjecture Corporation
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A medical underwriter determines whether or not an applicant should be granted medical coverage based on the patient's current or pre-existing medical conditions. Having evaluated the health of an applicant, a medical underwriter may then either accept or deny insurance coverage for the individual and, if the applicant is accepted, may then determine what premium rate to set for that particular client, based on the financial risk that entails accepting the applicant. Although it was created for the purpose of lowering insurance premiums for individuals, the practice of medical underwriting may be considered a harsh practice by some who are denied coverage based on a minor condition. Insurers, however, may argue that the practice prohibits individuals from seeking coverage strictly when surgery or other expensive medical procedures are needed.

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Some insurers may claim that by making some applicants ineligible, the return investment of insurance premiums is leveraged, helping make these premiums more affordable for the masses, and helping ensure some monetary return for the insurer. Due to the negative reception of medical underwriting by some individuals in the United States, the practice has been restricted by law in certain states, and within some insurance companies. In turn, these states generally maintain the highest average premiums in the country. While it may be argued that outlawing medical underwriting allows otherwise uninsurable applicants to receive some coverage, insurers often claim that dismissing the practice would raise premiums even further, and prevent even those healthy individuals with no pre-existing conditions from being able to afford insurance or medical coverage.

Some medical conditions that may result in a medical underwriter denying coverage to an individual may include more serious illnesses such as heart disease, arthritis, and most cancers. Less-serious and often curable conditions such as obesity, anorexia, and old injuries may likewise prevent certain individuals from being accepted by an insurer. The set of criteria taken into account by a medical underwriter may vary depending on the insurance provider, or the state or region in which the applicant resides. Millions of individuals living in the U.S. are currently considered uninsurable due to some pre-existing condition that may or may not be severe enough to warrant the denial of a premium. This concern continues to spark debate across the country.

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