A medical impairment guide is an internal underwriting reference tool used by life and health insurance carriers to classify and price risks associated with specific medical conditions. The guide summarizes current medical knowledge, actuarial data, and company experience for a wide range of impairments such as diabetes, coronary artery disease, cancer histories, mental health disorders, and kidney disease. For each condition, it typically outlines required underwriting evidence, acceptable ranges for lab values, time since diagnosis or treatment, and recommended underwriting actions-standard, table rating, flat extra, postpone, or decline. A medical impairment guide helps underwriters apply consistent decisions across cases while still allowing flexibility for individual judgment and medical director input. Because medicine and treatment outcomes evolve, these guides are regularly updated to reflect new therapies, survival statistics, and best practices, making them a core component of modern risk selection and pricing.

In practice, underwriters consult the medical impairment guide whenever they see an impairment that could affect mortality or morbidity. For example, when reviewing an application for a client with controlled type 2 diabetes, the underwriter will reference the guide to see how A1C levels, duration of disease, body mass index, and presence of complications should influence the risk class. Brokerage case managers and producers often receive feedback based on this guide, such as "our impairment guide calls for Table 4 on this cardiac history" or "we can consider standard if the next liver function test is normal." Advanced underwriting and impaired-risk centers may request excerpts or guidance drawn from the carrier's impairment guide to help position cases with multiple carriers. While the full guide is proprietary, the principles behind it help advisors set realistic expectations with clients about likely underwriting outcomes and pricing.