Underwriting Mental Health: Depression, Anxiety, and Bipolar Cases Explained

By David Beas, Cavalier Associates & Ken Turscak, Chief Underwriter AIN

Mental health is one of the most frequent—and often most misunderstood—factors in life insurance underwriting. Depression, anxiety, and bipolar syndrome come across our desks daily. Yet while these conditions are common, each case has unique factors that can mean the difference between a decline, a rated offer, or even a preferred class approval.

To shed light on how carriers approach these cases, I sat down with our Chief Underwriter, Ken Turscak, for another episode of Underwriting Shorts.

Treated & Stable: What Underwriters Look For

Ken explained that when evaluating depression or anxiety, underwriters are looking for stability over time. That includes:

• Age at diagnosis (younger onset often viewed more cautiously)
• Medication type and dosage (low, consistent doses are a positive)
• Follow-up care (routine check-ins show stability)
• Work history (no missed time due to the condition is favorable)
• Hospitalizations or acute episodes (these add risk)

In short, underwriters want to see a steady trajectory—not frequent med changes, inconsistent care, or gaps in documentation.

Avoiding Over-Penalization

With depression affecting anywhere from 13% to 20% of Americans in a given period, Ken emphasized the need to underwrite context. Was the depression triggered by a situational event, such as a divorce or loss of a loved one? Has the client been stable for years on a mild medication? Those nuances matter.

For mild, well-controlled cases, a short cover memo from the advisor can make a big difference. A couple of sentences describing long-term stability may allow the case to move through without medical records—sometimes even via accelerated underwriting.

Red Flags: Self-Medication

Ken drew a clear line when it comes to alcohol, marijuana, or benzodiazepines used outside of medical guidance. Occasional social drinking or prescribed marijuana use might pass. But daily self-medication—especially with depression or anxiety in play—will almost always draw a conservative rating or decline.

Bipolar Syndrome: Bipolar I vs. II

While bipolar I and II have distinct clinical differences, many carriers treat them the same in their underwriting manuals. Still, factors that can improve an offer include:

• Time since last episode or hospitalization
• Medication adherence with good labs
• Stable lifestyle and employment

Ken stressed the importance of shopping these cases, as different carriers have different thresholds. One might come back with a two-to-four table rating, while another could offer Standard.

Field Underwriting Fix: The Killer Cover Letter

Ken’s advice to advisors: if you want the best shot at a favorable offer, your cover letter should include five key points:

1. Stability of the condition over several years
2. Minimal or no medication changes
3. Long-term low-dose treatment
4. Age at diagnosis (older is better)
5. Stable lifestyle—employment, family, activities

And what not to do? Don’t include unnecessary negatives that the underwriter will uncover anyway. Position the client in their most favorable light without omitting material facts.

Lightning Cases: On-the-Spot Decisions

To close, we put Ken through a quick “lightning round” of hypothetical cases:

Case 1 – Mild Depression
35-year-old female, mild depression, on 10mg Lexapro, runs marathons, stable career.
➡️ Ken’s Take: Likely Preferred, possibly Best Class with some carriers.

Case 2 – Depression + Cannabis
29-year-old male, stable on Zoloft, nightly recreational marijuana use for sleep.
➡️ Ken’s Take: If prescribed, possible options. If recreational, most carriers will decline or rate heavily.

Case 3 – Bipolar I with Stability
46-year-old female, one hospitalization 12 years ago, compliant on lithium, successful executive, no episodes since.
➡️ Ken’s Take: Offerable, but expect Table 2–4 with most carriers.

Takeaway for Advisors

Mental health cases don’t need to be automatic declines. With the right context, careful documentation, and a well-written cover letter, many clients can secure favorable offers. And when in doubt—bring the case to us early. The difference between a decline and a standard offer often comes down to how the story is told.

👉 If you’d like to discuss a case with Ken or our team, reach out to me directly via email or phone. We’ll help position your client in the best possible light.

David Beas

Life Marketing Consultant

800.350.2019

Dbeas@cavalierassociates.com