Underwriting
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  • March 2025

Group Underwriting: Identifying red flags in a request for proposal

By
  • Carole Bellm
  • Yinnie Chung
  • Mari-Anne Ramson
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Red flags
In Brief

By swiftly identifying and addressing red flags in a request for proposal, group underwriters can avoid negative outcomes later in the insurance process, such as inaccurate pricing, profitability issues, and more. This article highlights some of the key concerns to be watchful of.

Key takeaways

  • Group underwriters need to be alert and identify the presence of potential red flags when reviewing a request for proposal (RFP).
  • Potential sources for red flags can include information provided in the RFP and the advisor’s relationship with the insurer.
  • Communicating and frequently reinforcing expectations with advisors to eliminate aggravation during the quote process are keys to building trust and strong relationships.

 

Red flags may not be cause for a complete halt at the RFP stage, but they do signal that something should be investigated or at least considered further before proceeding. Red flags take many forms, whether written or verbal, and range from missing information to incomplete or questionable data.

This is not to say the absence of essential data is intentional. Rather, it is often simply an opportunity for the group underwriter to gather additional details through a deeper dive.

The importance of identifying red flags

Identifying red flags enables insurers to:

  • Mitigate risk by ensuring all relevant information is available to alleviate potential concerns.
  • Prevent misrepresentation due to incomplete or imprecise information.
  • Detect possible anti-selection and potential attempts to enroll ineligible employees into a plan.
  • Note omitted information with the potential to impact pricing or profitability.

After reviewing any red flags, the underwriter must then determine if a group quote is warranted and how aggressive it should be, or if it should simply be declined. Having all available information can minimize adverse effects, such as faulty assumptions, conservative or inaccurate pricing, messy onboarding of a new group, challenging first renewals, and profitability issues.

What are common warning signs about which a group underwriter should be vigilant?

Groups with no prior coverage

Groups who have not had prior coverage can present an opportunity for insurers, even while the lack of historical experience can make quoting on the group more challenging. Factors to consider when looking for red flags include:

Type of company

  • Startup company: Industry practices suggest a company should be in business a minimum of two years before offering coverage, as many new businesses fail within one to three years.
  • Established business: Look for the reason or any potential underlying issues behind seeking coverage now but not previously.

Group profile

  • Has the group ever had benefits? Due to affordability issues, some groups may have had benefits in the past that were terminated.
  • Are the benefits requested reasonable? A red flag for first-time coverage could be the request for a very generous benefit package.
  • Does the class or division structure make sense? The request for benefits for only one class or division in the group could indicate affordability issues or anti-selection.

Duration with current insurer

How long a group has remained with previous insurers may display concerning patterns.

Frequent changes in insurer

This could indicate that the group’s priority is finding the most competitive rates and terms. If the group changes insurers following the rate guarantee, the insurer may not be able to recoup the investment they made from when they acquired the group, such as the cost of setting up a new group and the ability to move the group’s rates to the required rates.

Out to market frequently but does not change insurer

This may signal that the group is shopping for competitive rates to negotiate with their current insurer and has no intention of replacing them.

Premium, claims experience, and rate history

The current insurer’s experience can be revealing, and group underwriters should scrutinize historical data for inconsistencies or potential errors. Information that may warrant investigation includes:

  • Premium increases or decreases not explained by a rate change
  • A change in the number of employees, such as from a hiring blitz or layoffs, which could alter a group’s composition and impact the claims patterns and pricing of the group
  • Older experience omitted by the advisor, who thinks it does not reflect the current group’s experience
    • It should be the underwriter’s decision to determine how many years of experience will be used for pricing purposes.
  • Lack of full disability claims history information
    • The RFP may be out for bid at a time when the group has fewer or no disability claims; however, that may not reflect the group’s true claims pattern from the past.
    • With manually rated groups, an advisor might not think it is important to provide disability information, even though the information can be used to determine incidence.
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Census data

Census data can provide key information for an insurer to build an understanding of a group. Only with precise information can an insurer deliver an accurate, customized quote with the most competitive rates. Red flags in census data can include several things.

Occupations

Job titles that do not correspond with the employee’s earnings or the group’s industry, along with occupations that are missing or vague, can make it difficult to assess a group’s risk. This ambiguity can impact not only the rates quoted but also future renewal rates and profitability.

Earnings

Missing or low earnings in the census data could indicate:

  • That an employee is working part time and under the minimum number of hours required to be eligible for group benefits.
  • That a group consists mostly of low earners, which could result in high turnover, group instability, and poor experience, if short-term employees claim and dash.
  • The possibility of poor LTD experience, as there is a correlation between low earnings and disability claims.

Dates of hire

This information can lend insight into hiring trends, which can signal growth or high turnover.

Advisors and brokers

It is imperative for an insurer to build strong relationships with advisors by fostering open communication and amplifying trust. This does not mean inundating advisors with questions; rather, it means proactively ensuring they understand the requirements and the advantages good data will bring to the quote process. If responses are not provided or tend to be defensive in nature, this can signal a red flag. Patterns to look for include:

Sporadic relationship

When advisors rarely send quotes to an insurer or send only low-quality opportunities, it can signal that other insurers have declined to quote the unfavorable groups or that the advisor is compiling competitive rate information to negotiate with a group’s current insurer.

Subpar information

An area of concern can be the presence of frequent errors or omissions.

Incomplete specifications

Having to repeatedly request information that should automatically be provided by the advisor is a red flag.

Changing information

When information provided in the RFP is frequently modified it can signal an issue.

New information after sale

Altering information at the time of sale can trigger a red flag because, at that point, the insurer may be more agreeable to secure the sale or to support the advisor if they made an error during the RFP.

Repeated occurrences from the same advisor likely suggest it is time to discuss expectations around the process and the data required during an RFP so that the insurer can provide a complete, competitive quote.

Conclusion

It is important to weigh the pros and cons of requesting additional information, which can vary based on the group size. Following best practices can help insurers recognize and proactively address red flags.

  • Identify. A thorough review of the information provided in an RFP will enable better recognition of red flags.
  • Request and review. There should be no hesitation to request missing/additional information or to seek clarification when the information is important to risk assessment and could impact pricing.
  • Set appropriate expectations. Advisors are more apt to provide an accurate RFP when they understand the advantages of including more detail.
  • Check-in. Periodically reviewing requirements with advisors can ensure an understanding of the information must-haves vs. nice-to-haves.

Red flags are a reality in the RFP process. By recognizing and addressing these potential issues, underwriters can make sound decisions, safeguard their organization, and ensure long-term success.

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Meet the Authors & Experts

Carole Bellm
Author
Carole Bellm
Assistant Vice President, Group Underwriting, RGA Canada
Yinnie Chung
Author
Yinnie Chung
Senior Group Underwriting Consultant, RGA Canada
Mari-Anne Ramson
Author
Mari-Anne Ramson
Senior Manager, Marketing and Communications, RGA Canada