A client came to me last year convinced he was uninsurable. He had been declined by the company his bank referred him to, and reasonably concluded that was that. He had well-controlled type 2 diabetes and had been managing it carefully for a decade.
He was not uninsurable. He was declined by one insurer whose underwriting guidelines happened to be unfavourable for his profile. Another insurer offered him standard coverage at a modest rating.
This is the single most useful thing to understand about life insurance and health: underwriting is not standardised. Insurers set their own guidelines based on their own claims experience, and those guidelines differ dramatically by condition.
Three routes to coverage
1. Fully underwritten
The traditional route: an application, a paramedical exam, bloodwork, and usually a request for records from your doctor. It takes weeks, and it produces the lowest cost per dollar of coverage and the highest available coverage amounts.
Crucially, having a health condition does not disqualify you here. Most conditions result in either standard rates, or a "rating" — a percentage loading on the premium reflecting the additional risk. A rating is not a rejection; it is a price.
2. Simplified issue
No medical exam. You answer a set of health questions — typically a page or two — and a decision often follows within days. Coverage amounts are lower than fully underwritten policies and the cost per dollar is higher, but it is genuine coverage with genuine limits.
This suits people with a manageable condition who would rather not go through full underwriting, or who need coverage in place quickly.
3. Guaranteed issue
No health questions at all. Acceptance is guaranteed within the eligible age range. In exchange, coverage amounts are modest, cost per dollar is highest, and there is almost always a waiting period — commonly two years, during which death from natural causes returns your premiums (often with interest) rather than paying the full benefit. Accidental death is typically covered from day one.
This is the option of last resort, and it is genuinely valuable for final expenses when nothing else is available. It should not be the first thing anyone reaches for.
How common conditions are actually viewed
Broad patterns, not promises — every case turns on its specifics:
- Controlled hypertension — frequently standard rates. Very common and well understood.
- Type 2 diabetes — often insurable, with the rating driven by control (A1C readings), duration, and whether complications exist.
- Cancer history — depends heavily on type, stage and years since treatment. Many cancers become insurable at standard or near-standard rates after a sufficient clear period.
- Mental health conditions — treated far more reasonably than a decade ago. Well-managed depression or anxiety is frequently standard.
- Sleep apnea — usually favourable if treated and compliant with CPAP.
- Elevated BMI — a common cause of ratings, and one of the areas where insurers differ most.
What actually helps your application
Evidence of control. A condition that is well-managed and documented is viewed very differently from one that is untreated or erratic. Recent test results showing stability genuinely move the outcome.
Complete, honest disclosure. This is not just an ethical point, it is a practical one. Material misrepresentation on an application can void the policy, and Canadian policies generally allow the insurer to contest a claim within the first two years. A policy that gets voided at claim time is worse than no policy, because you paid for it and your family planned around it.
Time. If you are recently diagnosed or recently treated, waiting until the condition stabilises can substantially improve the offer. Sometimes the right advice is to secure interim simplified-issue coverage now and reapply for fully underwritten coverage in a year or two.
If you hold a term policy with a conversion privilege, you can usually convert to permanent coverage without new medical evidence. If your health has changed since you bought it, that privilege may be the most valuable thing you own. Check the terms before it expires.
Where the broker actually earns their keep
With a straightforward, healthy applicant, most insurers will offer broadly similar terms and the value of shopping around is mainly price.
With a health condition, the spread between insurers becomes enormous — the difference between a decline and a standard offer, or between a 200% rating and a 50% one. Knowing which insurer is currently favourable for which condition is the substance of the job, and it changes as companies revise their guidelines.
Practically, it also means not submitting applications everywhere at once. Declines are recorded, and a pattern of them makes subsequent applications harder. The right approach is an informal enquiry to the insurers most likely to be favourable, then a formal application to the best fit.
If you have been declined, or have been putting this off because you assume you will be, it is worth a conversation before concluding anything. The answer is often better than people expect.