Medical Records Request for Life Insurance Underwriting

When applying for life insurance, insurers need detailed medical records to accurately assess risk and determine policy terms. This Medical Records Request for Life Insurance Underwriting template streamlines the process of obtaining complete patient records, health condition disclosures, and attending physician statements in a HIPAA-compliant, professional format.

Designed for insurance agents, underwriters, and healthcare providers, this form captures all essential information required for life insurance medical underwriting—from patient authorization and identification to specific health conditions, examination findings, and treatment history. The conditional logic ensures that only relevant follow-up questions appear based on disclosed conditions, making the process efficient for both patients and providers.

Paperform makes medical records requests simple and secure. The clean, professional design builds patient trust while the built-in conditional logic adapts to each unique situation. Forms can be embedded directly into your insurance agency website or sent as standalone links, with all submissions encrypted and stored securely.

For insurance agencies managing multiple underwriting requests, Stepper can automate the entire workflow after submission—automatically routing requests to the correct medical facilities, sending follow-up reminders, updating your underwriting system, and notifying the relevant team members when records are received. This eliminates manual data entry and ensures no request falls through the cracks.

Whether you're an independent insurance agent, work for a life insurance carrier, or manage medical records releases for a healthcare facility, this template helps you gather accurate, complete information while maintaining compliance and providing a professional experience that reflects well on your organization.