Marty Johnson did not panic easily, and he did not like fuzzy systems. He was a CPA who trusted clean rules, clean documentation, and decisions that did not depend on someone guessing. So when his attorney said permanent life insurance could support his estate plan, Marty went online and priced it first because that felt efficient.
At first, the experience looked simple and reassuring. He entered his age, coverage amount, and a few basics, and an estimated premium appeared instantly. Then the health questions started, and the entire tone of the process changed the moment he checked "diabetes" and "insulin."
That shift is common because an online estimate is not the same thing as underwriting. Underwriting is the carrier's process for evaluating risk using verified information, and it can include medical questions, records, and sometimes an exam depending on the situation. The NAIC consumer guide explains that different products and underwriting levels affect both price and certainty, and it is normal for the real decision to come later in the process. NAIC
Marty was not shopping for a gadget, and he was not trying to win a bargain. He and his wife had real assets, but much of their wealth was not instantly liquid, and their attorney wanted them to plan for decision-making under stress. The goal was liquidity that arrives when it is needed, so the surviving spouse has choices instead of pressure.
Marty also cared about the way life insurance typically fits into tax planning. As a baseline rule, federal tax regulations reflect IRC Section 101(a)(1) that life insurance proceeds paid by reason of death are excluded from the recipient's gross income. That general rule is a major reason life insurance is used in planning, but estate inclusion is a separate question. Legal Information Institute+1
Estate treatment can change if the insured retained "incidents of ownership" at death, which is why ownership and control matter in planning. IRC Section 2042 describes inclusion rules for proceeds when the decedent possessed incidents of ownership at death, and the IRS has written guidance applying that framework in real fact patterns. Marty did not need to become a tax attorney, but he did need an advisor who understood how underwriting and planning actually work. Legal Information Institute+2IRS+2
Marty felt the online system stopped listening after one word, and that is what made him mad. His diabetes story was not static, because he had been losing weight and improving his routines. He monitored consistently, showed up to appointments, and his trend line looked better than the "checkbox" impression.
From a medical standpoint, diabetes is a chronic metabolic disease characterized by elevated blood glucose, and over time it can damage blood vessels and organs. That is the core, high-authority framing used by the World Health Organization, and it explains why insurers care about long-term stability and complications. Marty accepted that risk has to be evaluated, but he wanted the evaluation to match the facts of his case. World Health Organization+1
This is where underwriting evidence becomes the difference between "assumption pricing" and accurate pricing. A key marker underwriters often look for is HbA1c (A1c), because it summarizes average blood glucose over roughly two to three months and helps show control over time. The American Diabetes Association describes the A1c test in exactly those terms, and that definition is widely used in clinical practice. American Diabetes Association
Marty expected the advisor to quote companies and try to squeeze a better number. Instead, she asked, "How are you doing now, and what can we prove?" That question signaled a professional approach because underwriting decisions depend on documented evidence, not persuasion.
Good impaired-risk work is often about reducing ambiguity with the right documentation. Carrier materials aimed at advisors describe impaired-risk placement as a process where preparation and the right information help unlock better outcomes, especially when the case is not a clean, standard-risk file. Marty started to see this like a CPA: the outcome improves when the documentation improves. LG America
This is also why pre-qualification tools exist in the real world. Shaw American Financial's impaired risk questionnaire library is built to gather the specific medical and lifestyle details that underwriters use, so the file reflects reality instead of assumptions. Marty liked that approach because it is structured, document-driven, and repeatable. Shaw American
Marty asked the most natural consumer question: "If one company offers better terms, can we just ask another to match it?" The advisor explained that underwriting is not retail pricing, and carriers are not simply negotiating a sticker price. Underwriting is tied to guidelines, claims expectations, and long-term risk discipline.
The practical point was not "carriers are stubborn"; it was that the decision has to be defensible inside the underwriting file. A better offer usually comes from a better evidentiary picture, not from a louder request. Marty immediately understood the logic because he would not trust any financial decision based on loose standards. NAIC
So Marty asked the better question: "What actually works?" The advisor said, "We use the Three Cs, and we earn accuracy." She promised no miracles, but she promised a disciplined process that underwriters can respect. That felt like the kind of professionalism Marty could trust.
Control means the condition is being managed in a way that can be documented, not just claimed. For diabetes cases, that often includes A1c trends, evidence of monitoring, follow-up patterns, and whether complications are present or absent. The clinical importance of HbA1c is supported in peer-reviewed literature that examines relationships between HbA1c levels and cardiovascular outcomes and all-cause mortality risk in observational studies. BMJ Open+1
For Marty, weight trending down was not a cosmetic detail; it was a supporting signal that his habits were improving. He was not claiming he was "cured," and he was not trying to talk his way into a better rate class. He was showing, with evidence, that his trajectory looked stable and responsible. That is what underwriters can evaluate fairly.
Compliance means the record shows the applicant follows medical guidance consistently. Underwriters care because diabetes risk is not only about diagnosis; it is also about the likelihood of stable ongoing management and timely intervention. WHO guidance emphasizes that diabetes can be treated and consequences avoided or delayed with lifestyle measures, medication, and regular screening and treatment for complications. World Health Organization
Marty already had the habits, but the file needed to show them clearly. That meant consistent labs, consistent visits, medication adherence, and the absence of long unexplained gaps. A clean compliance story reduces the underwriter's need to assume worst-case behavior. Marty liked that because it is exactly how risk should be evaluated.
Incomplete records slow underwriting, but they can also hurt outcomes because uncertainty is hard to price generously. When an underwriter cannot verify trends or details, the decision may tilt conservative because the risk picture is incomplete. This is why professional impaired-risk processes emphasize gathering the right documents early and responding quickly, which is also consistent with the NAIC's explanation of how underwriting depth affects pricing and certainty. NAIC+1
Marty built a provider list, pulled visit summaries and labs from patient portals, and mapped out where testing occurred. He did it like an audit trail: names, dates, facilities, and missing items. That approach changed the file from "diabetes plus insulin" into "diabetes plus documented control, documented compliance, and reduced uncertainty." Marty did not ask for mercy; he earned accuracy.
Weeks later, the advisor called with an offer. Marty did not expect Preferred, and he did not need perfection to feel good about the result. He needed the offer to reflect the real facts of his health management and the completeness of the file.
The outcome was meaningfully better than the online experience implied, and that is what stuck with him. It validated a basic underwriting truth: a documented trajectory often prices differently than an assumed trajectory. Marty felt relieved not only about cost, but about integrity. He got a disciplined carrier decision that matched the evidence.
After that, Marty started repeating the same advice to friends. He said buying life insurance online can be fine if you are truly standard risk. He also said that if you have diabetes or anything meaningful in your history, you should not treat underwriting like buying a toaster. Underwriting is a real decision, and the file you build matters.
Impaired Risk Underwriting is the life insurance risk evaluation process used when an applicant has a medical condition, history, or factor that may increase expected mortality risk and therefore affect eligibility, Rate Class, and premium. In diabetes cases, underwriters are pricing a chronic condition in which blood glucose is elevated due to inadequate insulin production or ineffective insulin use, and over time that hyperglycemia can contribute to serious damage to organs and blood vessels. The World Health Organization describes diabetes in these terms, which helps explain why insurers focus on long-term stability and complications. World Health Organization
Underwriting typically relies on verified evidence gathered through the application, health questions, and supporting medical documentation, and the NAIC explains that deeper underwriting commonly changes both certainty and pricing compared to simplified issue approaches. A central marker in diabetes documentation is HbA1c (A1c), because it reflects average blood glucose over about two to three months and helps demonstrate control over time, as described by the American Diabetes Association. Peer-reviewed research also examines how HbA1c levels relate to cardiovascular outcomes and all-cause mortality risk, which is part of why underwriters often request trends rather than a single number. NAIC+2American Diabetes Association+2
Professionals improve outcomes by reducing uncertainty in the underwriting file through documented Control, documented Compliance, and Complete Medical Records. This approach does not "negotiate" risk away; it helps the underwriter evaluate the applicant accurately instead of pricing unknowns conservatively. Done well, it can materially improve offers while keeping the process consistent and defensible. LG America+1
Use these as searchable terms in your LifeInsuranceOpedia glossary and as bolded internal links in the article. They are either commonly included in insurance glossaries or should be included because they come up constantly in impaired-risk work. The recommended anchors are Impaired Risk Underwriting, Rate Class, HbA1c (A1c), Attending Physician Statement (APS), and Incidents of Ownership. Legal Information Institute+1
Often yes, especially when the condition is well-managed and well-documented. WHO describes diabetes as a chronic disease with potential long-term harm, which is why insurers price it carefully, but good management can change the risk picture. In practice, underwriting outcomes are strongly influenced by the quality and completeness of evidence, and NAIC consumer guidance explains why underwriting depth affects cost and certainty. World Health Organization+1
Not automatically, although insulin use can be a significant factor. Underwriters typically weigh broader stability evidence, including A1c trends, follow-up consistency, and whether complications are documented. The A1c test is widely used to summarize average blood glucose over the prior two to three months, and peer-reviewed evidence evaluates how HbA1c levels relate to outcomes, which helps explain why trends matter. American Diabetes Association+1
Underwriting decisions are evidence-based, and missing records can force conservative assumptions. In impaired-risk cases, the absence of trend data or missing physician documentation can make a stable case look uncertain. NAIC guidance explains that simplified underwriting generally costs more than fully underwritten coverage because the carrier is pricing with less verified detail, which is another way of saying uncertainty is priced. NAIC
As a baseline rule, federal tax regulations reflect IRC Section 101(a)(1) that proceeds of life insurance paid by reason of death are excluded from the recipient's gross income. That income-tax rule is a core reason life insurance is used in planning. Estate inclusion is separate, and IRC Section 2042 can include proceeds in the gross estate when the decedent held incidents of ownership at death, which the IRS has discussed in published guidance. Legal Information Institute+2Legal Information Institute+2
FINRA rules and guidance require balanced communications about variable life insurance. In particular, discussions of loans and withdrawals must explain their impact on cash values and death benefits, and any talk about liquidity must be balanced by clear disclosure of potential negatives. This is not optional marketing language; it is a compliance standard for communications with the public. FINRA+1
Yes, and New York is a well-known example. The New York Department of Financial Services promulgated Regulation 187, titled "Suitability and Best Interest in Life Insurance and Annuity Transactions," with life insurance applicability effective February 1, 2020. This is a state-level illustration of how insurance regulation can impose process requirements around recommendations. Department of Financial Services
If you have diabetes or any meaningful medical history, do not let a generic online estimate define what you can qualify for. A better next step is a short pre-qualification conversation that builds a documentation-driven underwriting file based on the Three Cs: Control, Compliance, and Complete Medical Records. That is how you replace assumptions with evidence and earn an accurate decision.
LifeInsuranceOpedia can connect readers with a professional who handles impaired-risk submissions using structured questionnaires and complete documentation. That approach is designed to reduce delays, reduce uncertainty, and improve outcomes while staying consistent with how underwriting actually works. If you want to move from "maybe" pricing to evidence-based pricing, start by building the file the way professionals do. Shaw American+1