Filing a reconsideration request with new medical evidence

If an insurer has declined you, postponed you or offered a rated price, and something has changed since the file was built, you can ask it to look again. The request is called reconsideration. It is not a right in most places and it is not a formality: it works when you send specific new evidence that answers the specific reason for the decision, and it fails when it amounts to "please look again." This walkthrough follows one request from the first question to the final answer.

The general rules are in the guide on asking for a better rate class later, which covers rate classes on policies already in force. This post is narrower: a request tied to a particular decision, with new medical evidence.

The eight steps

Step 1: confirm that reconsideration is the right tool

Reconsideration fits some situations and not others. It is usually worth it when:

• The decision rested on incomplete information, such as a test with no follow-up on file.
• The finding has changed, for example a repeat test is normal or a treatment has stabilized the condition.
• The record contained an error that has been corrected.
• The offer was a rated price, and new evidence suggests a lower class.

It is less likely to work when nothing is different. If the decision came from a stable condition and no new information exists, a second look at the same file tends to reach the same result. In that case a different insurer, or a different product, is usually the better path, and the 90-day plan in the 90 days after a decline: a step-by-step plan covers the alternatives.

Also check the timing. Some insurers have a window in which they will accept new information on an application, and others want a fresh application after a period. Ask which applies before you invest in gathering evidence.

Step 2: get the reason in writing

You cannot answer what you cannot name. Ask the insurer, through your agent or directly, for the specific reason for the decision and the information it relied on. Many states have privacy laws that let an applicant request the reasons for an adverse underwriting decision, and rules vary, so if the insurer does not respond, the state insurance department can say what applies in your state. The guide to state insurance departments: what they do for you explains how to reach yours.

Write down the reason in one sentence. Everything you send should answer it. For example:

• "The insurer cited an abnormal lab value with no repeat test."
• "The insurer cited a hospital stay seven weeks before the application, with records incomplete."
• "The insurer rated the policy because of blood pressure readings at the exam."

Step 3: decide what evidence would change the decision

Think like the underwriter. They are asking whether the risk is now clear and acceptable. Evidence that helps is specific, dated, from a qualified source and directly relevant.

Evidence that does not help includes general statements, such as "I feel fine," reports without dates, and documents unrelated to the reason. An underwriter reads many files and needs the answer to be easy to find.

Step 4: collect the documents

Plan on getting records from the provider directly. Federal rules give you access to your own medical records, with a deadline for providers to respond that you can confirm with each office. Ask for:

1. The records covering the event or condition, including test results.
2. Follow-up notes that show the outcome.
3. A short letter from your physician, if one can honestly be written, giving the diagnosis, treatment, current status and dates.

An attending physician statement is the formal version in which the insurer itself requests records from your doctor. In a reconsideration, it is often easier for you to supply the documents through your agent, with your authorization, so the insurer can verify them if it chooses. Ask what format the insurer prefers.

Two cautions apply. Do not ask a physician to write anything that is not accurate or to predict the outcome of an application. And check each document for errors before sending, because a wrong date or name creates a new question.

Step 5: write the cover letter

The letter is short and factual. It should have five parts:

1. Identifying details. Your name, the application or policy number, the date of the decision and the insurer's reference if it gave one.
2. The request. One sentence asking for reconsideration of the specific decision.
3. The reason you understand it to be. Quote the insurer's reason as you have it.
4. What has changed. A dated list: what was done, when and what the results were.
5. The attachments. A numbered list of each document.

An example of the middle section, with invented details: "The decision cited an elevated liver enzyme value on the October exam with no follow-up. On January 14, my physician repeated the test, and the value was within the normal range. On January 28, an ultrasound was normal. Both reports and my physician's letter dated January 30 are attached as items 1 to 3."

Keep your tone neutral. The aim is to make the underwriter's job easy, not to argue.

Step 6: send it the right way

Submit through your agent if you have one, because the agent knows the insurer's process and where underwriting accepts new material. If you applied online without an agent, ask the insurer how to file a request: a portal, a mailing address or a phone number for underwriting. Send it in a way that creates a record, and keep a copy of everything.

Before you send, ask two questions.

• Can the review only improve the outcome? Insurers usually say yes for a decision not yet accepted, but get the answer in writing. If new information could change an existing offer in either direction, you want to know first.
• Will it count as a new application? Some insurers treat a reconsideration as a continuation of the old file, while others require a new application. This affects records, fees such as a new exam, and the contestability clock if a policy is issued.

Step 7: the wait

Insurers vary in how long reviews take, and nothing here is a deadline you can rely on. The wait commonly runs from days to a few weeks and can be longer if the underwriter asks for more material. A reasonable approach is to:

• Ask at the time you send the request how long a review usually takes.
• Note the date and follow up through your agent if that time passes.
• Keep your other plans in place. Do not cancel existing coverage, and keep any stopgap policy.

If the insurer asks for more, such as a new exam, a specialist's report or an attending physician's statement, treat the request as a sign the file is being taken seriously. Supply it promptly.

Step 8: read the outcome

There are five usual outcomes.

1. The original decision is reversed and a policy is offered as applied. Review the offer, confirm the price and terms, and compare against alternatives.
2. An offer at a different price or class. This may be a rated policy; the guide to table ratings and flat extras explained explains how ratings work. Ask what evidence could lower it later.
3. A postponement. The insurer wants more time or a specific event. Ask for the date or milestone, in writing.
4. The decision stands. Ask why the new evidence did not change it and whether anything would.
5. A request for more information. Answer it and keep the plan on track.

Whatever the outcome, ask for the explanation in writing. It will guide your next move.

An example with invented numbers

Say Marcus, 46, applies for $750,000 of 20-year term coverage and is offered a rated price of an illustrative $96 a month, about 40 percent above the standard price of $68. The cited reason is blood pressure readings at the exam, taken on a day he had come straight from a busy shift.

• Evidence he collects. Six months of home and clinic blood pressure readings, a note from his doctor and a record of the medication he started three months ago that brought his readings down.
• His request. Marcus asks, through his agent, whether the insurer will reconsider with the readings, and whether the review can only lower the rate.
• The result. Suppose the insurer agrees to offer a better class at an illustrative $78 a month.

The arithmetic: the original offer is $96 x 12 = $1,152 a year. The revised offer is $78 x 12 = $936 a year. The difference is $216 a year, or $4,320 over 20 years. The standard price of $68 would be $816 a year, so the revised offer still costs $120 more per year than standard. Whether the exercise is worth it is a judgment call, and in this case the saving is meaningful. These prices are made up to show the arithmetic and are not typical or promised.

Why requests fail

Most unsuccessful requests fail for avoidable reasons.

• The evidence does not match the reason. Sending a clean cholesterol report to answer a question about a heart rhythm test leaves the original concern untouched.
• The records are old. An underwriter looking at a recent event wants records showing what has happened since. A year-old note adds little.
• The package is hard to read. Forty unlabeled pages with the key result on page 31 get less attention than five pages with a cover letter that points to it.
• There is no stable trend. One good reading after a run of poor ones rarely settles a question about control. The underwriter looks for a pattern over time, which is why a series of dated readings beats a single value.
• The timing is early. If the insurer wants a condition to be stable for a period and you ask before it has been, the answer will probably be to come back later. Asking what period applies saves effort.
• The request raised new questions. An inaccurate date, a name that does not match or a statement that contradicts the application can undo the benefit of the evidence.

Questions to put to the insurer or agent before you send anything

Having a list keeps the conversation short and the answers on record.

1. Does the insurer accept new information on this application, or does it require a new one?
2. What period of stability does it generally want for this type of finding, if any?
3. Which documents does it prefer, and in what form?
4. Can the review change the decision only in my favor?
5. Will I need a new exam, and who pays for it?
6. How long does a review usually take, and who will contact me?
7. If the answer is still no, can I ask again later, and what would it take?

An independent agent can often get a straighter answer to these than you can, because the agent deals with the underwriting department regularly. If you have no agent, ask the same questions in writing and keep the replies.

A second example: a specialist's report

Say Nina, 38, is postponed on a $400,000 policy because a scan found a small abnormality and a specialist referral was pending when she applied. The insurer's note says it will not decide until the workup is complete.

• She completes the referral. The specialist finds nothing that needs treatment and recommends a follow-up scan in six months.
• She asks the specialist's office for the written report, and for a short letter on the findings and the plan.
• She sends the report and letter with a cover letter through her agent and asks whether the insurer will decide now, or wait for the follow-up scan.

Two reasonable outcomes follow. The insurer may say the report is enough and make an offer, perhaps at a price that reflects the remaining uncertainty. Or it may say it wants the follow-up scan, and give her a date. In the second case her request was not wasted: she now knows exactly what milestone ends the postponement. The first lesson from this example is that a reconsideration can turn a vague wait into a defined one. The second is that the insurer asked for the follow-up not to be difficult but because the risk it was weighing was a change over time.

If the answer is still no

The decision may stand even when your request was good. Your options then include a different insurer, a different product, waiting for a longer record and asking again, or a complaint if you believe a decision was unfair or the process was not followed. The guide to state insurance departments: what they do for you describes where complaints go. A complaint does not usually force an insurer to change its underwriting judgment, but it can require it to explain and follow the rules.

The companion post myths about how a decline follows you to the next application explains what a first decision does and does not mean for your next application.

Key takeaways

• Reconsideration works when the evidence answers the insurer's specific reason; it rarely works when nothing has changed.
• Get the reason in writing first, then collect dated records and, where honest, a physician's letter.
• Send a short factual cover letter through your agent, and ask in advance whether the review can only help and whether it counts as a new application.
• Expect one of five outcomes, from a reversal to a standing decision, and ask for the explanation in writing.
• Keep existing and stopgap coverage in force while you wait.