Life Insurance Medical Exams: What You Need to Know

Buying life insurance is important to protect loved ones. But consumers purchasing a policy may need to undergo a life insurance medical exam. Here's what's involved in a life insurance exam, as well as some insight into why this is a common requirement.

A life insurance medical exam is a physical that is typically requested by a life insurance company. It's part of the process of buying life insurance in most situations. The purpose is to provide insurance companies with the information they need to set premiums. Life insurers usually pay for it, and there is both a verbal questionnaire and a physical exam.

How do life insurance companies check an applicant's medical background? Generally, by asking questions as part of the life insurance application process. During the life insurance exam, consumers will be asked about their past health status. They'll be asked questions about their lifestyle and social habits, as well as their general health.

A life insurance physical is part of a life insurance application process. During the life insurance physical exam, the medical professional performing the process will check weight, collect a blood and urine sample, and check blood pressure.

Life insurers require an exam because insurance companies want to assess the likelihood of paying out claims. To do this, the insurance company wants to know as much as possible about an applicant's physical health.

The insurer wants to see if the potential policyholder has medical conditions that could make their death during the term of coverage more likely. The insurance company also wants to make sure an applicant isn't hiding any possible health issues.

A life insurance medical exam is required by most life insurance providers -- but not all. A small number of life insurers offer term life insurance with a reasonable amount of coverage without requiring a medical exam. They've harnessed new technologies and algorithms to determine who to cover.

There are also some guaranteed issue life insurance policies that provide coverage without mandating a life insurance medical exam. However, coverage limits are often low with these policies. There may also be restrictions such as a lengthy waiting period before the full death benefit is paid.

When a potential policyholder undergoes a life insurance health exam, the purpose is to identify red flags that could make insuring a policyholder too risky. While there may be slight variations in what different insurers test for when a consumer undergoes a life insurance exam, here are some common things insurers look for.

High blood pressure is a common life insurance test, as high blood pressure can increase the risk of heart attack, stroke, or other cardiac issues.

As part of a life insurance blood test, insurers may look for elevated blood sugar that could be indicative of diabetes. Diabetes also comes with health risks that could result in a higher risk of an insurer paying out a death benefit.

Smoking increases the risk of many medical problems, including various types of cancer. As a result, a life insurance medical exam will involve an exam of current and past nicotine use. Many carriers offer life insurance for smokers, though premiums are significantly higher.

There's a higher risk of a stroke or heart disease when a person has high cholesterol. A life insurance exam will test cholesterol levels.

The use of recreational drugs is a major risk factor that life insurers consider. An exam will look for evidence of recreational drug use. However, some insurers are willing to accept marijuana users, especially as more states have relaxed the laws on cannabis.

Finally, life insurers use blood tests to look for serious diseases. This can include conditions such as HIV or AIDS, as well as hepatitis. While some insurers provide coverage for people with HIV, others don't -- and a serious illness could make it impossible or expensive to get life insurance.

It's important to follow the life insurance company's instructions when preparing for a life insurance medical exam. These may include fasting prior to the exam to avoid skewing blood sugar and cholesterol levels.

Drinking water prior to the exam can help flush toxins from the body and dilate veins, making it easier for the technician to draw blood for the blood test. It's also a good idea to avoid strenuous exercise immediately before the exam to avoid elevated blood pressure.

Also, consumers should review their medical history to ensure they can provide accurate, honest answers when asked about their health status. Failing to provide accurate information could result in an insurance company denying an application, canceling the policy, or refusing to pay death benefits.

During the life insurance physical, a medical professional is typically dispatched to the applicant's home or office. The process will take around 45 minutes or less and will include a nurse or medical technician asking questions, as well as a physical examination. The life insurance exam usually includes:

In addition to a life insurance medical exam, insurers may also employ other techniques to find out information about a potential policyholder's health status. This could include checking your records with the MIB (formerly the Medical Information Bureau), which includes information from past life insurance and health insurance applications. Other potential sources of information include your prescription drug history, driving records, and a criminal background check.

Life insurers generally do not directly ask questions of a person's doctor. Instead, the insurer will ask an applicant for medical information and will arrange for a life insurance medical exam to be conducted by a medical professional of its choosing.

In many cases though, with the permission of the policyholder, an insurer may request medical records from an applicant's doctor's office. It may request an attending physician statement (APS), which is a statement from your provider that gives context about any pre-existing conditions or your general health. However, doctors cannot just disclose patient information to a life insurer without the patient's permission, as doing so would violate federal laws protecting privacy.

Life insurance companies may request medical records during the underwriting process. They do this to determine if a policyholder was honest in their answers to medical questions and to look for red flags that could suggest an increased risk of providing coverage. They must obtain permission from the applicant first.

Life insurers may run a credit check. This is more common with life insurance companies that use algorithms and publicly available information to approve people for policies without a life insurance medical exam.

In most cases, insurers will already be aware of any medical issues based on the information provided by the applicant. However, sometimes abnormalities will be uncovered and an insurer may request additional medical exams. For example, if a life insurance exam shows high blood pressure, the insurer may request a follow-up test to see if it has remained elevated.

Applicants can request a copy of their results after the exam. The information will be sent to the insurer's underwriting department, which will review the results of the life insurance medical exam. Based on this information, the insurer will set premiums. Applicants will then be notified of whether they are approved for coverage and what their premiums will be.

If an applicant isn't happy with the results of a life insurance exam, there are a few options:

If an applicant is denied coverage after a medical exam, they can:

To get a life insurance medical exam, apply for insurance coverage. The insurer will arrange for the exam to occur at its own cost. The medical exam will take place at the applicant's home or workplace.

There are several options for no medical exam life insurance, some of which are better than others. Note that even if you have an underlying health condition, undergoing a medical exam could still help you obtain more coverage at a lower cost.

With simplified issue life insurance, you can typically avoid a medical exam. Instead, life insurance companies base decisions on third-party records and your answers to a health questionnaire. Sometimes this is a good option for people who need coverage to begin right away and can’t wait for a life insurance medical exam and full underwriting.

Guaranteed issue life insurance is life insurance that is available to everyone regardless of medical status. Many insurers offer these policies, although they often have relatively low coverage limits. Many guaranteed issue policies have waiting periods, such as a two-year delay until the full death benefit pays out.

Group life insurance may be available as a workplace benefit. It's often possible to obtain a set amount of coverage through an employer's group life insurance plan without a life insurance medical exam.

Final expense insurance is a small life insurance policy designed to cover funeral costs. Most final expense insurance policies are guaranteed issue policies. That means no life insurance medical exam is required. However, these policies provide limited protection. They only help families cover a small amount of costs after a death.

RELATED: See The Ascent's guide to the best life insurance with no exam.

The Most Important Question About Long COVID

What causes long COVID?

More than three years after the start of the pandemic, this remains the most bedeviling question about a mystifying syndrome estimated to affect some 65 million people globally — an epidemic in its own right with no clear end in sight.

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Long COVID presents with remarkable variation across individuals. It can involve different organs and organ systems and different degrees of severity. One thing is becoming increasingly clear: the condition is likely to have long-lasting physiologic, social, and economic consequences, ripple effects of the initial disaster.

By some accounts, more than 1 million people in the United States alone may be pushed out of the labor force because of long COVID, causing both individual financial devastation and hurting the economy as a whole. This calculus does not factor in the sheer human toll of the disease.

Although infection with SARS-CoV-2 is the known spark plug that ignites long COVID, no one yet knows how this syndrome arises at the cellular and molecular levels. The answer holds the key to solving the long COVID puzzle. It may also help scientists understand syndromes that resemble long COVID and can develop in the wake of other acute infections, such as Lyme disease or herpes zoster.

Without a clear understanding of the driving mechanism — the fuel causing and sustaining the fire — long COVID treatment will remain confined to alleviating symptoms rather than resolving the underlying problem.

To be sure, in the last three years, researchers have gleaned some important insights about long COVID. They have defined the clinical syndrome and the organ systems involved; they have characterized how often it occurs and how widespread it is; and they have identified some of the key risk factors.

But for now, researchers are still circling the periphery of the terra incognita that is the cause of long COVID.

With accumulating evidence, several hypotheses have emerged that are bringing scientists closer the answer.

The range of symptoms is baffling: fatigue, malaise, heart palpitations, blood clots, hair loss, persistent cough, loss of lung function, muscle pain and joint aches, brain fog, headache, depression, anxiety, sleep disturbances, loss of smell, and gastrointestinal problems.

These clinical manifestations point to multiple mechanisms — so much so that researchers are beginning to view long COVID not as a single disease but as multiple disease subtypes, even if instigated by the same virus.

However, symptoms by themselves are unreliable indicators of underlying mechanisms. This underscores the importance of getting deep into the molecular roots of dysfunction. Defining these disease subtypes matters beyond mere classification.

“Physiologic perturbations are often the result of many intersecting pathways,” said Bruce Levy, the Parker B. Francis Professor of Medicine at Harvard Medical School and an investigator at the HMS-led Massachusetts Consortium on Pathogen Readiness.

“These perturbations could be exquisitely defined clinically, but underlying the presentation may be very different mechanisms,” added Levy, who is also interim chair of the Department of Medicine and chief of the Division of Pulmonary and Critical Care Medicine at Brigham and Women’s Hospital.

For example, recurrent blood clots, fatigue, decreased exercise tolerance, and compromised lung function could all arise from ongoing low-grade inflammation. However, this chronic inflammation can be fueled by several distinct pathways — low levels of circulating virus, reactivation of dormant infections, immune dysfunction, and more. Each pathway will demand a different treatment.

“I think that we’re going to find that there are these sub-phenotypes with distinct driving mechanisms, and they’re just so pivotal to understand because they’ll impact their treatment in really important ways,” Levy said. “Let’s say one of these phenotypes relates to viral persistence and another relates to autoimmunity. You might not want to suppress the immune system in somebody who has viral persistence, but in somebody who’s got an autoimmune mechanism, you may want to do this.”

Here are the hypotheses about long COVID mechanisms that scientists are converging upon:

Understanding the basic mechanisms — what is happening at the levels of cells and molecules — can shed light on what patients are experiencing and, more importantly, why they are experiencing specific symptoms.

Understanding the why can inform the how. How to design reliable diagnostic tools and treatments that alleviate and even prevent the condition. Understanding the underlying mechanisms can also help researchers define the most reliable biomarkers —biological signals or footprints — to help track how the disease is progressing and responding to treatment. For example, in people whose symptoms are caused by microclots, certain blood tests could help determine who is responding to treatment with anticlotting medications.

Defining the basic biology of long COVID can also help scientists understand better other conditions like it that affect millions of individuals globally.

SARS-CoV-2, the viral instigator of long COVID, is a novel pathogen, but long COVID shares characteristics with other conditions that develop after an acute infection. These include postinfectious syndromes following infections with the viruses that cause Ebola, dengue, polio, chikungunya, influenza, and certain herpes viruses, as well as nonviral pathogens such as Borrelia, one of the organisms that causes Lyme disease.

This resemblance was one of the first things that caught the attention of many researchers studying long COVID.

“I was surprised by the strikingly common cluster of distinct symptoms present in some of the most severe forms of long COVID and other postinfectious disease syndromes,” said immunologist Snyder-Cappione, assistant professor in the Department of Virology, Immunology, and Microbiology at Boston University and a researcher with MassCPR.

Snyder-Cappione was particularly intrigued by long COVID’s overlap with the symptoms reported in a condition called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is marked by profound fatigue, exhaustion, neurologic problems, sleep disturbances, headache, joint pain, shortness of breath, and palpitations. Like long COVID, ME/CFS tends to develop following certain viral and bacterial infections.

Studying those syndromes in parallel may bring insights about shared or similar mechanisms underlying these disorders. Even though many talented scientists have dedicated efforts to understanding postinfectious syndromes over the years, these efforts have been sporadic, Levy said, mainly because conditions like EBV, CMV, or Lyme disease, for example, have lacked the numbers and urgency of long COVID. This has led to less sustained funding to define their basic biology.

“Because of this new momentum, I am hopeful that research with long COVID patients presenting with these symptoms will result in novel treatments to help those afflicted with chronic conditions caused by other pathogens and insults,” Snyder-Cappione said.

This is why MassCPR is expanding the mandate of its long COVID research group, co-led by Snyder-Cappione and Levy, to incorporate the study of other postinfectious disease syndromes. To reflect the new direction, the group will be renamed Post-Infectious Clinical Syndromes.

“We will start with that common ground,” Levy said. “But then, as they excavate underneath the clinical surface, it’ll be very interesting to see how shared or how discrete some of the molecular mechanisms are.”

Understanding Medical Assistant Practice Liability Issues

The issues discussed in this column are not meant to be considered legal advice. For personal advice, readers are urged to contact a qualified health care attorney.

A nurse practitioner wrote: "I'm worried about the way the medical assistant in my office gives out telephone advice. I heard him tell a patient not to worry about the symptom the patient was calling about. It seems to me that this would be a form of diagnosing, which is the practice of medicine. Boards of nursing come down hard on registered nurses who exceed their scope of practice, but it seems that medical assistants do it all the time. Am I at risk for getting sued if I work with a medical assistant who goes out on a limb and a patient is harmed?"

There are two legal issues here. Liability for malpractice and exceeding scope of practice. If a medical assistant negligently or incompetently advises a patient and the patient suffers an injury because he or she relied on the advice, the medical assistant and his employer probably will be sued. It is unlikely that a nurse or nurse practitioner working at the practice would be sued, but if a nurse or nurse practitioner had supervisory responsibilities, then it is possible that the nurse would be named. It is the medical assistant's employer/supervisor's responsibility to monitor the medical assistant and make sure he or she is acting within the standard of care.

Dermatology Nursing. 2008;20(4):327-329. © 2008  Jannetti Publications, Inc.

Cite this: Understanding Medical Assistant Practice Liability Issues - Medscape - Aug 01, 2008.