Group disability medical underwriting continues to evolve as carriers invest in digital Evidence of Insurability (EOI) capabilities, automated underwriting solutions, and additional sources of underwriting information. Findings from Munich Re's 2026 Group Disability Medical Underwriting Survey suggest that, while technology is playing an increasingly important role in underwriting operations, medical underwriters remain central to evaluating complex risks and making informed underwriting decisions. 

Survey results indicate that carriers continue to invest in digital EOI capabilities, online application processes, and automated underwriting technologies. Company portals and websites remain the dominant channels for application intake, while electronic signatures, enrollment platform integrations, simplified questionnaires, and automated communications have become common across participating carriers. 

Automated underwriting is also an established component of many group disability underwriting operations. Most participating carriers reported using automated underwriting solutions for both long-term disability (LTD) and short-term disability (STD) business. Survey results further indicate that online adjudication supports meaningful levels of straight-through processing, particularly for STD applications. 

While digital capabilities continue to expand, all participating carriers reported utilizing medical underwriters in some capacity. Applications are commonly referred for medical underwriter review based on factors such as specific diagnoses, applicant characteristics, appeals, or other underwriting considerations.  

These findings suggest that carriers continue to view automation as a tool that supports underwriting workflows rather than a replacement for underwriting expertise. Participating carriers continue to invest in technologies intended to improve efficiency and consistency while maintaining medical underwriter involvement in more complex underwriting situations. 

While carriers continue to evaluate additional sources of underwriting information, traditional medical evidence remains the foundation of group disability underwriting. Prescription drug reports have achieved meaningful adoption, particularly for LTD underwriting, while use of electronic health records (EHRs), medical claims data, and other sources remains more limited.  

Medical records and MIB data continue to be among the most utilized sources of underwriting information in addition to prescription drug reports. Rather than replacing established underwriting evidence, these data sources are being incorporated into selected underwriting workflows and risk assessment processes. 

Artificial intelligence remains one of the most discussed topics in insurance, but survey results indicate that adoption within group disability medical underwriting remains limited. Large language models (LLMs) used to summarize medical information represented the only AI application reported as currently in use. Ninety percent of participating carriers reported that AI currently plays no role in underwriting decisions.  

While some carriers reported plans to explore AI-related technologies, current implementations remain limited and primarily focus on supporting information review and operational efficiency rather than on making underwriting decisions.  

One of the survey's notable findings involved the medical conditions most frequently associated with underwriting declines. Psychiatric and musculoskeletal conditions emerged as the leading reasons for decline among participating carriers, ranking ahead of cardiac conditions and cancer. Several carriers also identified diabetes and BMI-related concerns as meaningful contributors to adverse underwriting outcomes.  

These findings highlight the complexity of disability risk assessment and underscore the continued role of medical underwriters in evaluating applications. The relatively low volume of appeals and modest appeal approval rates reported by participating carriers further suggest that decline decisions are generally supported by established underwriting criteria and are infrequently overturned.  

The survey findings suggest that carriers are continuing to balance technological innovation with underwriting oversight as digital capabilities evolve. Digital workflows, automated underwriting solutions, and additional sources of underwriting information are increasingly incorporated into underwriting operations, while medical underwriters continue to play an important role in evaluating more complex risks and decisions.  

Munich Re intends to continue this research as group disability medical underwriting evolves. As the first industry study dedicated exclusively to this discipline, the survey reflects the experience of many leading carriers and establishes a benchmark for tracking underwriting practices, technologies, and industry trends. Carriers interested in learning more about future participation opportunities are encouraged to contact Munich Re.