Ever had a client with a heart condition ghost you after you told them their IPMI options were “limited”?
Or watched a family with a child who has diabetes walk across the street to your competitor?
If you’re nodding your head, you’re not alone.
Most brokers lose high-risk clients because they don’t know how to find REAL solutions.
Instead, they offer the same cookie-cutter policies that these clients have already been rejected for.
But what if I told you that the “unsellable” client with three pre-existing conditions could actually be your most profitable client this year?
The High-Risk Client Opportunity Most Brokers Miss
Let’s talk numbers.
The average IPMI broker converts about 15% of their high-risk prospects.
Top performers? They close 50%.
The difference isn’t luck. It’s not even connections.
It’s system.
Here’s why this matters more than ever:
- Global mobility is skyrocketing post-pandemic
- The expat workforce is aging (average age up 7 years since 2010)
- More people with chronic conditions are working internationally
- High-risk clients are willing to pay premium prices for proper coverage
Yet most brokers treat these clients as dead ends rather than golden opportunities.
What Exactly Makes a Client “High-Risk”?
Before we can solve the problem, we need to define it clearly.
In IPMI underwriting, high-risk typically means:
Medical Risk Factors:
- Pre-existing chronic conditions
- Recent major surgery or treatment
- Family history of serious illness
- Age (typically 65+)
Lifestyle/Location Risk Factors:
- Residence in areas with poor healthcare infrastructure
- Frequent travel to multiple countries
- Adventure sports or high-risk hobbies
- Career in hazardous industries
Administrative Risk Factors:
- Previous claims history
- Gaps in coverage
- Insurance application rejections
- History of late payments
Most brokers only consider the first category. The best brokers consider all three.
The “Triple-A Method” for High-Risk Client Success
After working with thousands of high-risk clients, I’ve developed what I call the Triple-A Method:
1. Assessment (Beyond the Application)
Standard applications don’t tell the full story.
I once had a client rejected by five insurers because his application simply stated “heart condition.”
What the application didn’t show:
- His condition was fully controlled
- He hadn’t needed intervention in 7 years
- His cardiologist considered him lower risk than many “healthy” individuals
- He was willing to accept exclusions for his specific condition
The solution? Create a “Pre-Application Profile” that includes:
- Detailed medical reports (not just diagnoses)
- Treatment success metrics
- Specialist statements on prognosis
- Client’s coverage priorities and acceptable exclusions
This profile gives underwriters what standard forms don’t – context.
2. Alignment (Matching Risk to Risk Appetite)
Not all insurers evaluate risk the same way.
Insurer A might reject all diabetes cases outright.
Insurer B might accept them with a 50% premium loading.
Insurer C might fully cover them if they meet certain criteria.
The key is knowing which conditions each insurer is actually willing to underwrite favorably – not what their public guidelines suggest.
I maintain a “Risk Appetite Matrix” for major insurers that looks like this:
For each condition/risk factor, I track:
- Which insurers consider it standard risk
- Which apply modest loadings (10-30%)
- Which require exclusions but accept the client
- Which have specialized programs for specific conditions
This matrix changes quarterly as insurers adjust their risk models.
3. Advocacy (Making the Underwriter’s Job Easy)
Underwriters aren’t looking for reasons to reject clients.
They’re looking for reasons to justify accepting them.
Your job? Give them those reasons.
For a high-risk client, don’t just submit an application. Submit a case.
This includes:
- A cover letter explaining why this client is a better risk than they appear
- Documentation that answers objections before they arise
- Comparison to similar cases the insurer has accepted
- Clear explanations of risk mitigation (medical compliance, lifestyle changes)
One broker told me: “I used to dread high-risk clients. Now for complex cases, I charge an advisory fee that clients are willing to pay given the complexity and time invested in building a proper submission. The value I provide in securing coverage when others can’t justify this approach.”
The Negotiation Playbook for High-Risk IPMI
Once you’ve built your case, it’s time to negotiate.
But effective negotiation isn’t about haggling – it’s about options.
Here are 3 proven tactics:
- The “Modified Coverage Structure”
Instead of standard exclusions for pre-existing conditions, work with insurers who offer modified coverage approaches.
Example: Some specialized insurers may offer full coverage with a waiting period for pre-existing conditions (Moratorium type cover) rather than permanent exclusions, or provide coverage with particular medical requirements and follow-ups.
- The “Staged Review Process”
Work with insurers who offer policy reviews after certain periods of time, allowing for reassessment of conditions based on updated medical information.
Example: An insurer might agree to review coverage terms after 12 months of claims history with them, potentially removing certain exclusions if the client’s health remains stable.
- The “Group Coverage Approach”
Utilize Medical History Disregarded (MHD) group policies when possible for high-risk individuals.
Example: For clients who are part of a company or organization, MHD policies can be an excellent solution as insurers accept all members without medical questions, providing coverage for pre-existing and chronic conditions.
The 4 Critical Mistakes Most Brokers Make
Mistake #1: Only Trying the “Big Three” Insurers
There are over 30 reputable IPMI providers globally. Each has different risk appetites.
Some smaller insurers specialize in specific conditions and offer better terms than the market leaders.
Mistake #2: Taking the First Rejection at Face Value
Initial rejections are often based on incomplete information.
In my experience, 40% of high-risk rejections can be overturned with additional information and advocacy.
Mistake #3: Not Understanding Medical Context
The difference between “diabetes” and “well-controlled diabetes with excellent HbA1c levels” is enormous to an underwriter.
Medical context transforms a decline into an accept.
Mistake #4: Failing to Present Alternative Options
When full coverage isn’t possible, brokers often give up rather than exploring:
- Local plus international plans
- Partial coverage options
- Condition-specific policies
- Health-triggered upgrade paths
Your 7-Day Action Plan for High-Risk Success
Here’s how to transform your approach to high-risk clients in just one week:
Day 1: Build Your Specialist Network
- Identify three medical professionals who can help interpret complex medical records
- Exchange contact information and establish a referral relationship
Day 2: Create Your Insurer Risk Matrix
- List all IPMI providers you have access to
- For each, note which conditions they handle well (based on past experience)
- Highlight any specialized programs they offer
Day 3: Develop Your Pre-Assessment Questionnaire
- Create detailed questions that go beyond standard applications
- Focus on stability, compliance, and context for each condition
Day 4: Prepare Your Underwriter Relationships
- Identify key underwriters at each insurer
- Reach out to establish direct communication channels
- Explain your new approach to high-risk clients
Day 5: Build Your Negotiation Templates
- Create standard language for each of the five negotiation tactics
- Develop a cover letter template for high-risk submissions
Day 6: Review Your Current “No” Pile
- Look at high-risk clients you’ve been unable to help
- Select three to approach with your new methodology
Day 7: Set Your Premium Structure
- Decide on your commission model for high-risk placements
- Consider a success fee structure for particularly difficult cases
FAQs About Placing High-Risk IPMI Clients
Q: How much extra time should I budget for high-risk clients?
A: Initially, about 3-4x your standard case time. Once you have systems in place, this drops to about 2x. For complex cases, consider implementing an advisory fee structure, as clients are often willing to pay for specialized expertise that can secure them coverage when others can’t.
Q: What if my client isn’t fully transparent about their medical history?
A: This is the biggest risk to successful placement. Make it clear that undisclosed conditions can void the entire policy. Better to address issues upfront than have a denied claim later.
Q: How do I justify higher premiums to clients?
A: Compare to the alternative: no coverage or significantly limited coverage. Also, demonstrate the value of having an advocate during the claims process for their specific conditions.
Q: Which conditions are actually easiest to place despite their reputation?
A: Stabilized diabetes, controlled hypertension, and historical (not current) mental health conditions often seem difficult but can be placed with minimal loadings when properly presented.
Q: What if an insurer offers terms with exclusions my client won’t accept?
A: Use this as a starting point, not an endpoint. Go back with specific counter-proposals based on medical evidence. About 30% of initial offers can be improved.
Your Next Step: From Rejection to Revenue
Every broker has “the one that got away” – the high-risk client they couldn’t help.
That client is still out there, still needs coverage, and is likely still getting rejected.
Be the broker who calls them back with a solution.
Here’s what to do today:
- Identify your three most recent high-risk rejections
- Apply the Triple-A Method to just one of them
- Prepare a new submission using the advocacy techniques above
- Submit to an insurer you haven’t tried before
- Track your results
Even if you only convert one in three, you’ll have a client who sees you as their hero – and a system for tackling cases other brokers avoid.
At Health Compass, we’re building tools specifically designed to help brokers place complex risks more effectively.
Our platform now includes a High-Risk Placement Module that uses data from thousands of successful placements to match client profiles with the insurers most likely to offer favorable terms.
If you’re dealing with high-risk clients and want to see how technology can transform your success rate, join us at one of our upcoming roadshow events.
The one-on-one sessions are particularly valuable for discussing specific challenging cases you’re working on.
Because in today’s IPMI market, the ability to place high-risk clients isn’t just a nice-to-have skill.
It’s the difference between a growing book and a stagnant one.