Part of our guide: Impaired Risk Life Insurance Underwriting by Condition →
Three carriers turned this case down before the fourth one said yes — and offered better than expected. Here’s how a client with thyroid nodules and carotid stenosis went from three straight declines to a Standard Non-Tobacco offer.
Key takeaways
- Multiple overlapping findings on paper often get declined by carriers that underwrite off diagnosis codes alone.
- A specialist’s follow-up findings — clinically insignificant nodules, stable carotid stenosis — can change the outcome entirely.
- Matching a case to the right carrier can turn a decline into a Standard offer.
Three carriers declined or rated this case at Table D and Table 3 before a fourth carrier evaluated the full clinical picture and offered Standard Non-Tobacco.
The situation
The client was a 58-year-old male, non-smoker, seeking $1 million of universal life coverage. A comprehensive routine physical a year earlier had turned up mild carotid stenosis and a single thyroid nodule on ultrasound. His other medical history included neuropathy, mild osteoarthritis, and acid reflux. A follow-up thyroid ultrasound six months later found new nodules — too small to biopsy. A specialist ordered additional imaging and determined the nodules were clinically insignificant; no biopsies were ultimately needed.
Why this case was hard to place
On paper, this is exactly the kind of file that gets declined by carriers unwilling to dig past the surface-level diagnosis codes: multiple overlapping findings (carotid stenosis, evolving thyroid nodules, neuropathy) without a single carrier fully underwriting the clinical picture as a whole. That’s exactly what happened. Carrier #1 declined to offer at all. Carrier #2 came back at a Table D. Carrier #3 offered a Table 3 — still a meaningful flat extra and a hard sell to the client.
The solution
Rather than accepting the Table 3 as the ceiling, we took the case to a fourth carrier with underwriters willing to evaluate the specialist’s follow-up findings on their own terms — a clinically insignificant thyroid nodule with no biopsy required, and mild, stable carotid stenosis, not a progressive or high-risk presentation.
The result
Carrier #4 offered Standard Non-Tobacco — the best possible outcome for this profile, and a dramatic swing from the Table 3 the client would have settled for elsewhere. The difference wasn’t the medical file; it was which carrier’s underwriters actually read it.
If you have a client sitting on a decline or a heavy table rating because of overlapping or ambiguous findings, that’s exactly the kind of case our underwriting team is built to re-shop. Send us the file — we’ll find the carrier that reads it the way it deserves to be read.
Frequently asked questions
Why would four carriers give four different offers on the same file?
Carriers vary widely in how they underwrite overlapping or ambiguous findings, especially when a diagnosis code alone doesn’t capture the full clinical picture. A specialist’s follow-up notes and imaging results can change the offer dramatically — but only if the carrier’s underwriters actually weigh them.
Is it worth re-shopping a case after a decline or a heavy table rating?
Often, yes. A decline or a high table from one carrier doesn’t mean the case is uninsurable at a reasonable rate — it may just mean that carrier didn’t fully evaluate the clinical detail. Cases like this one, which moved from a Table 3 offer to Standard Non-Tobacco, show how much the outcome can depend on where the case is placed.
Reviewed by Tim Fuller on 2026-09-23
Tim Fuller
President, SRS Inc.
Tim leads SRS Inc., a full-service IMO (Independent Marketing Organization) and BGA (Brokerage General Agency) connecting independent financial professionals with life, annuity, disability income, and long-term care solutions from 60+ carrier partners — with the impaired-risk and complex-case expertise to place business other IMOs and BGAs turn away.
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