Impaired risk underwriting is the specialty practice of assessing elevated-risk applicants and translating clinical, lifestyle, and financial data into a defensible mortality expectation. It emphasizes detailed medical chronology, stability since last treatment, comparative outcomes (e.g., ejection fraction, A1C trend), and interaction with other risk drivers such as obesity or tobacco. Tools include build charts, impairment manuals, reinsurer guidelines, and predictive analytics from Rx, MVR, labs, and medical records. Outcomes range from preferred through table ratings to postponements; some risks warrant temporary flat extras that expire after stability periods. Effective impaired-risk underwriting balances prudence and market competitiveness so coverage remains attainable and sustainable.

Field underwriting collects timelines, labs, and imaging. The team highlights stability, control, and physician follow-up, then shops carriers with niches for the condition. When appropriate, they request facultative reviews to secure better than standard manuals might indicate.