Amber Stitt [00:00:00]:
Welcome to the Responsible Resident. I'm Amber Stitt. This podcast takes a common sense approach to financial decisions for physicians, breaking down complex topics into something clear, practical, and usable. Because you shouldn't have to have a finance degree to build financial freedom. Today we're covering a key part of the disability insurance process that many physicians hear about, but don't fully understand until we meet to discuss their own personal health history. So, what is medical underwriting and why does timing matter so much? Before we define underwriting, let's talk about what this actually looks like in real life. Applying when you are at your healthiest allows for a more comprehensive and flexible plan. When I'm pre-screening cases, there are a few patterns I see over and over again.
Amber Stitt [00:00:48]:
I've worked with physicians who feel completely healthy but are taking medication for anxiety, depression, or ADHD. In many cases, that history can lead to a psychiatric exclusion on the contract. Others have a history of physical therapy for back pain, or are recovering from a sports injury. That can result in exclusions tied to the area of treatment, sometimes even broader limitations, depending on the case. In recent years we've also seen more cases involving weight fluctuations, or the use of GLP1 medications. If there hasn't been a stable normal weight maintained for at least 12 months, that can lead to a rate increase rather than an exclusion. And in situations where someone has recently started, or stopped a treatment plan without consistent follow up, we often need to wait several months to properly document stability before applying.
Amber Stitt [00:01:41]:
Now, it's important to clarify, most of these situations do not mean you can't get coverage, but they do influence how an underwriter evaluates your application and whether that results in a clean offer, an exclusion, or a modified policy. This is where timing becomes strategic, because in some cases, waiting even a short period can lead to a better outcome, and in other cases, applying sooner allows you to lock-in options before something changes. That's why pre-screening matters. An experienced advisor isn't guessing. They're working behind the scenes with underwriting teams to understand how a case is likely to be viewed before you ever submit an application. So, if someone tells you to just apply and see what happens, I would pause. I would rethink the relationship between you and that advisor. Advisors should always have options to pre-screen you before you apply.
Amber Stitt [00:02:38]:
Our approach always involves a pre-screen. Through pre-screening, we can often identify potential outcomes in advance, including whether an exclusion might be applied. And in some cases those exclusions aren't permanent. There may be opportunities to revisit and remove them after a period of stability, often within a year, or so, if your medical history improves and is well documented. The key takeaway is: "Underwriting isn't just a process, it's something you can prepare for. And when you approach it strategically, you're not just applying for coverage, you're shaping the outcome at a high level."
Amber Stitt [00:03:14]:
This comes back to one simple idea, your options are based on your health today, not your health later, and underwriting is the process that determines those options. Medical underwriting is how the insurance company evaluates your risk. They're trying to understand your current health, your medical history, and any factors that could affect your ability to work in the future. Based on that, they determine whether to offer coverage, how much coverage to offer, and at what rate. Not all disability insurance is underwritten the same way. There are 3 primary types of coverage physicians typically encounter, and each interacts with underwriting differently. First, we have individual private disability insurance, which is the most customizable type of coverage. You can tailor the policy structure, riders, and benefits to your specific needs.
Amber Stitt [00:04:06]:
However, it requires full traditional medical underwriting. This means your health history is reviewed in detail, often going back 2 to 5 years, and sometimes longer in many cases. Today, a medical exam is not required, but your pricing exclusions, or eligibility, are still determined based on that review. This is why it's important to review your health history with an advisor before applying. Second, we have group disability insurance, which is often provided through your employer. While premiums may be lower, and sometimes employer paid, you have less control over the contract and these benefits may change, or end, with employment. If these policies are portable, they may require underwriting later to maintain or increase coverage. Underwriting is often simplified upfront, but restrictions may show up later in how claims are evaluated and paid.
Amber Stitt [00:04:58]:
Third, are guaranteed standard issue disability insurance contracts, often referred to as GSI contracts. This allows eligible physicians, typically through a residency or employer program, to obtain coverage without full medical underwriting. This means there is no medical exam, limited or no health history review, and access to coverage even with pre-existing conditions. On the surface, this can be a very attractive option. However, it's important to understand how it fits into a broader strategy. GSI plans can be offered in pre-built packages and may come with limitations in contract design, benefit structure, or long-term flexibility. Although, they have become more flexible in recent years. For some physicians, GSI can serve as a strong starting point.
Amber Stitt [00:05:45]:
For others, this can be a very expensive trade-off when looking at savings over time when you are healthy. The key is understanding that not all paths to coverage are the same and some could come with trade-offs Please note that we screen for which process is best for you. I'd like to take a second to tell you about a Free Medical Professional's Blueprint that I created with you in mind. At some point in your career, you realize it's not just about making more money, it's about making decisions that actually support your life. That's exactly why I created "The Pathways Perspective for Physicians". It's a simple, non-technical framework to help you think through your career, your money, your risk, and how everything connects as your life evolves. You shouldn't have to have a finance degree to build financial freedom. You don't need to have everything figured out, you just need a place to start.
Amber Stitt [00:06:39]:
You can download the Free Medical Professionals Blueprint at: StittStrategies.com/Blueprint. Some good news is that the underwriting process itself is often more straightforward than most physicians expect if working with an experienced advisory team. First, you complete a client questionnaire that includes your basic personal information, occupational details, and initial health history. You review the application before signing. Second, there is a medical history review. This may involve a phone interview, or a detailed written questionnaire. Carriers typically review your medical history over the past 2 to 5 years and analyze treatment patterns, diagnoses, and CPT codes. Third, there may be medical requirements such as blood work, or a paramedical exam. However, many applications today are completed without lab work.
Amber Stitt [00:07:32]:
Fourth, there may be a financial review for attending physicians. Income verification may be required for residents and fellows. This step is often simplified, or waived, with carriers allowing coverage based on training status. Finally, an underwriting decision is made. The insurance company reviews everything and provides an offer. Some offers are standard, meaning a perfect offer and no modifications. Others may include exclusions, or ratings based on your history. From there, you decide whether to accept the policy and finalize your coverage.
Amber Stitt [00:08:06]:
Many physicians assume underwriting is something to avoid or delay today. But the reality is that underwriting is what allows you to lock-in your options, and those options are based on your health at the time you apply. This is where the "Responsible Resident Mindset" comes in. Your health today is likely simpler, more predictable, and easier to ensure than it may be in the future. Even small changes like new diagnoses, ongoing treatments, or changes in medication can impact pricing, exclusions, or eligibility altogether. When you go through underwriting earlier in your career, you may qualify for better rates. You can secure coverage before health changes, and you can often increase coverage later without going through medical underwriting, again. That last point is key.
Amber Stitt [00:08:52]:
Many policies allow you to grow your coverage as your income grows as long as you are healthy enough to qualify for those increase options early on. One of the goals of our team is to make this process as efficient and clear as possible. We use technology to provide quotes quickly, facilitate HIPAA compliant pre-screening, and deliver underwriting feedback as soon as possible. In most cases, quotes are available within hours and underwriting decisions are often completed within about a week. We also work directly with underwriting teams to help identify the best fit for each physician before moving forward. You should never wing it and see what happens in underwriting. It's something to approach strategically. Instead of asking, "Should I wait until I'm further along?" A better question is, "What can I lock-in today that protects my future options?" You don't have to complete everything immediately, but understanding how underwriting works and how timing affects your options can make a meaningful difference over time.
Amber Stitt [00:09:50]:
Because protecting your income isn't just about today, it's about maintaining flexibility for the future. Like our story with Claire in an earlier episode. If you'd like help reviewing your disability insurance options, you're welcome to schedule a consultation with our team. My partner, Scott Nelson-Archer, and I work with physicians nationwide through MD Disability Quotes, helping residents, fellows, and attendings design coverage that fits their careers. Our goal is to give you a clear, independent perspective so you can make informed, responsible decisions about protecting your future income. If you found this episode helpful, share it with a colleague and be sure to "Follow" so you don't miss the next episode on how much disability insurance physicians should have. If this episode helped you think a little more clearly about your next step, that's the goal. You don't need to have everything figured out, but you do need to take ownership and take a meaningful step forward today.
Amber Stitt [00:10:48]:
Thanks for listening to the Responsible Resident. As a reminder, this podcast is for general educational purposes only. It is not legal, tax, or individualized financial advice and coverage options will vary based on your personal situation.
