Over the past decade, accelerated underwriting (AUW) has transformed the life insurance industry by removing traditional lab and exam requirements for many applicants. While this has improved speed and accessibility, it has also allowed some risks, previously declined due to adverse lab results, to slip into the pool undetected. Since such cases have been excluded from in-force business for more than 30 years, the industry has struggled to quantify their impact.
To address this gap, our US Life underwriting and actuarial teams partnered to analyze historical lab and exam data from ExamOne, dating back to 2001. This collaboration produced a durational mortality study focused on lab results commonly associated with declines, bringing new clarity and consistency to underwriting decisions. The findings were presented at the 2025 AHOU Conference.
In this interview, Joshua Herzog, Actuary-Accelerated Underwriting and Analytics, and Gretchen Juneau, Chief Underwriting Solutions Officer, share how their collaboration not only quantified risk where data was scarce, but highlighted how integrating underwriting and actuarial skill sets drive better results in the evolving AUW landscape.
Life Underwriting (Gretchen): Laboratory results play a key role in underwriting. They provide objective, quantifiable insights into an applicant’s current health status, many times revealing conditions that may not be disclosed or diagnosed. Underwriting guidelines provide detailed instructions on how to interpret these lab values—either in conjunction with known medical conditions (such as using A1c levels to evaluate diabetes) or as standalone indicators (like elevated liver enzymes in the absence of other medical concerns). The guidelines outline acceptable ranges, identify values that may require a rating adjustment, and flag results that are considered unacceptable for coverage.
Up until 35 years ago, life insurers rarely ordered laboratory tests, but that changed with the emergence of HIV and AIDS in the 1980s. By the early 1990s, nearly all carriers began routinely screening applicants for HIV, using either urine or blood samples. The introduction of blood testing soon expanded into broader health assessments, with insurers adding tests for cholesterol, glucose, and liver and kidney functions—enhancing their ability to evaluate overall health risk more accurately.
Actuarial (Joshua): Lab measurements are important to study because while they have been a fixture in the risk selection process for decades, their removal in favor of automated tools creates a fundamental discrepancy between issued business and the historical experience actuaries use to develop their assumptions.
Without labs and exams, there are lives entering the risk pool with adverse lab measurements on which there is no insurance experience to draw upon because these risks have not entered insured pools for decades. This is why it is so exciting to have access to such a comprehensive dataset from ExamOne, which contains lab results for not just insured lives, but also historically declinable lives. The mortality experience on these previously declinable cases will give us insight beyond just the average impact of removing lab requirements and help us quantify the volatility implications as well.
Without labs and exams, there are lives entering the risk pool with adverse lab measurements on which there is no insurance experience to draw upon because these risks have not entered insured pools for decades.”
Life Underwriting (Gretchen): We selected lab tests based on their relevance and impact on underwriting decisions. Our focus was on tests that are commonly encountered and can significantly influence risk assessment. We prioritized lab values that are not typically captured through third-party data sources, e.g., prescription history or medical claims, and could otherwise be missed in an accelerated underwriting process. For example, an elevated PSA level may not appear in claims or prescription data unless the individual has already been diagnosed with a prostate condition.
Actuarial (Joshua): The first feature I focused on when selecting lab measurements was data quality. We needed to ensure we had credible enough data to support a robust analysis and determine how granular we could get while maintaining a clear and intelligible signal. From there, we emphasized choosing a diverse set of lab tests that reflect a broad range of health conditions, intentionally avoiding analytes that are highly correlated to help us isolate the unique impact of each measurement.
Underwriting expertise played a critical role in refining our selection as we leaned on insights from Gretchen and her team to identify which labs are most valuable when assessing mortality risk. Our underwriters prioritized tests tied to conditions that are least likely to be detected through other data sources, allowing us to accurately project the mortality impact when those labs are excluded.
Life Underwriting (Gretchen): The underwriting team identified ranges for the labs, including everything from preferred and standard to substandard and declinable risks. We provided context related to when labs are requested, such as for age and amount vs. “for cause.” We shared context related to the conditions often associated with abnormal lab values and how we might look at the labs differently if we know that the client already has a medical condition.
Actuarial (Joshua): Since we were presenting this research at an underwriting conference, we focused on framing our findings in terms that were relevant and actionable for underwriters. Typically, we would begin a research project with our domain expertise, consult subject matter experts, and then finalize our work. But in this case, our process became more iterative. We started by building out the base analysis, and once we reached the limits of our direct knowledge, we engaged underwriters for input. Their feedback sparked a cycle of refinement, where we would adjust our methods based on their guidance and return for further insights. This helped us align technical findings with practical underwriting perspective, ultimately producing a stronger, more compelling result.
Life Underwriting (Gretchen): Yes, we saw some values that I’ve never seen in all my 35+ years in underwriting. I recall a GGT that was greater than 9000 and an A1c value that was 26. Both of those values are dangerously elevated.
Actuarial (Joshua): There were quite a few unexpected findings in the data, one of the most striking being just how severe some of the lab values were. The tails of the distributions for certain lab values extended far beyond what is documented in publicly available clinical research. There were applicants presenting lab results which would typically suggest imminent mortality, yet they lived for many more years in some cases.
Another surprise was the sensitivity exhibited by our profit projections to an AUW program’s ability to identify severely unhealthy lives. Even after seeing these extreme lab values that exist among insurance applicants, the degree to which they influence group mortality outcomes if they become part of an in force pool was eye-opening. It underscores the importance of carefully designing AUW programs and pricing them with a clear understanding of the volatile risks which may slip through.
Life Underwriting (Gretchen): Accelerated Underwriting has created a unique opportunity for actuaries and underwriters to collaborate more closely. Great partnerships thrive on mutual respect, and this project gave both teams a chance to better understand how the other side approaches mortality.
Underwriters like to say that our work is more of an art than a science, while actuaries focus on the science—it’s called “actuarial science” for a reason!”
Actuarial (Joshua): For a long time, actuaries and underwriters have worked in silos. As Gretchen pointed out, the sweeping changes in how we assess risk have made collaboration essential. This project created an ideal micro-environment for that kind of teamwork, with frequent discussions to interpret findings and strategize next steps.
Through these conversations, I deepened my understanding of medical concepts – like gamma-glutamyl transferase in the human liver – and gained insight into what truly resonates with underwriters. While I tend to focus on aggregate mortality statistics and Monte Carlo profit simulations, I learned that underwriters connect more with individual case examples – real applicants with real lab results. Understanding these nuances helped us communicate more effectively and ultimately produce results that are both technically sound and broadly impactful, moving us closer to our shared goal of sustainable, secure mortality protection.
Actuarial (Joshua): This research has been an exciting endeavor into unexplored areas of mortality research and has produced insightful, actionable takeaways regarding the volatility of mortality outcomes in AUW cohorts. For example, for the most critical lab measurements, we were able to project the cost of issuing a policy with a declinable lab value at the individual policy level, as well as the cost to a whole block of business given the frequency of the lab value. I am looking forward to sharing more insights into the frequency and severity of lab and exam surprise findings in our upcoming whitepaper.
Life Underwriting (Gretchen): In this research project, we shared a common goal: to accurately assess the mortality impact of labs in the AUW world. Combining our talents led to deeper insights, resulting in research that will be useful for our clients and the life insurance industry as a whole.
As accelerated underwriting evolves, success will depend on blending actuarial rigor with underwriting insight. By grounding our tools in real-world lab data, we give clients practical solutions that strengthen risk assessment, safeguard mortality assumptions, and support sustainable innovation. A full view of this study will be published in a detailed whitepaper to help clients apply these insights directly in their own programs.
Gretchen Juneau, Chief Underwriting Solutions Officer, US Life
Joshua Herzog, Actuary – Accelerated Underwriting & Analytics, US life