The State of Disability Underwriting

How often do disability policies carry exclusions?

Across the individual disability policies Disability Insurance Agency has placed, about 28% carry an exclusion or a rating. An exclusion removes a specific condition or body system from coverage; a rating raises the premium to reflect added risk. Either one changes what the policy pays at claim time, which is why the agency tracks them at the book level rather than treating each as a one-off.

The conditions behind those exclusions cluster tightly. Mental and nervous conditions are the most common by a wide margin, behind roughly 43% of all exclusions in the book. Musculoskeletal and spine conditions come second, near a quarter. Pregnancy and reproductive conditions are third, around one in six. Every other category, cardiovascular, neurological, and lifestyle or avocation exclusions among them, sits in the single digits.

How does exclusion risk differ by profession?

The book-wide rate hides a wide spread, and the profession is one of the strongest signals of where an applicant lands. CRNAs carry exclusions most often, about four in ten policies. Other professionals, a group that includes physician assistants, nurse practitioners, and podiatrists, come next near a third. Physicians and dentists sit lower, both close to a quarter. The sections below take each group in turn.

Physicians

Physicians are the largest group in the book by a wide margin, so their figures rest on the deepest sample and move the least year to year. About a quarter of physician policies carry an exclusion or rating, with mental and nervous conditions behind roughly 40% of them. That tracks with how widely burnout is reported in medicine; the American Medical Association reports that "For 2025, 41.9% of physicians reported experiencing at least one symptom of burnout, down from 43.2% in 2024 and 48.2% in 2023." Physician policies are issued at a median age of 36, the point in a career where income is established but the health record is usually still clean.

Specialty is the variable that most changes coverage. For proceduralists and surgeons, the own-occupation definition has to protect the specific procedural work, the provision that decides whether a claim pays when a hand or back condition ends operating while other medical work remains possible. Principal, Guardian, and The Standard carry the most physician placements in the book.

CRNAs

CRNAs draw exclusions more often than any profession in the book, about 40% of policies. Mental and nervous conditions account for half of those exclusions, the highest share of any group, and the back and neck history common to operating-room work is the recurring second flag. The pattern matches the occupational-health literature, where burnout among CRNAs is widely reported (AANA Journal review). CRNA policies are issued at a median age of 38, the oldest of the major groups in the book.

Carrier positioning has moved. Principal has historically been the most-placed carrier across the book, CRNAs included, but MassMutual took the lead for new CRNA placements after upgrading the occupation from 3A to 4A in 2025 and pricing most competitively at that class. Principal sits at 2M+ and remains among the most flexible at underwriting. True own-occupation language, written around anesthesia delivery, is standard in CRNA placements. The detail lives in the CRNA hub and the carrier comparison.

Dentists

Dentists draw exclusions least often of the major groups, just under a quarter of policies, and they are the youngest at issue, a median age of 34. Mental and nervous conditions still lead, though at a lower share of dentist exclusions, around a third, than in other groups, with hand, wrist, and musculoskeletal conditions close behind. Dentistry is among the most hand-dependent professions in medicine, and musculoskeletal disorders are its most common occupational injury (PLOS One), which is why own-occupation language built around procedural dental work carries so much weight.

Classification rewards credentials. MassMutual will upgrade a dentist from a 3D to a 4D own-occupation class when the applicant has completed an AEGD or GPR residency, which can change both the definition and the price for the same coverage. Principal and Guardian carry the most dentist placements in the book.

Other professionals

Beyond the three large groups, Disability Insurance Agency places coverage for technology professionals, engineers, physician assistants, nurse practitioners, optometrists, podiatrists, pharmacists, veterinarians, attorneys, and other high earners, with the technology field a growing focus. As a group these professionals carry exclusions more often than physicians or dentists, about a third of policies, driven partly by the clinical roles among them. They span a wider income range than the medical specialties, so coverage is sized to each professional's documented income rather than a single profile. True own-occupation language is available across these professions and is worth the same contract-by-contract check.

How professionals structure their policies

The same book review captured how policies are built, not just how underwriting treated them, and three structural patterns stand out.

Waiting period. The 90-day elimination period dominates: 82% of placed policies carry it. The 180-day period is the clear second structure and has grown into a regular part of the practice, appearing on roughly a third of recent placements. The two serve different profiles: 90 days fits the professional bridging the gap with savings or employer salary continuation, while 180 days fits a client whose reserves comfortably cover six months and who puts the premium difference toward a higher benefit or stronger riders. Neither is the better policy in the abstract.

Benefit period. Coverage to age 65 is close to universal, on 87% of placed policies. A meaningful share of the remainder reflects underwriting offers rather than buyer preference: some applicants are offered only a 5-year benefit period, most often on health or occupational grounds, and accept it as the strongest coverage available to them.

Inflation protection. Cost-of-living riders have shifted from optional to usual: more than 70% of policies placed in the last two years include a COLA rider, a substantially higher share than the historical book, reflecting a deliberate change in how the agency builds coverage for younger buyers with decades of claim horizon ahead.

Reproductive exclusions and family planning

About 9% of the women in the book carry a pregnancy or reproductive exclusion, covering pregnancy, complications of childbirth, fertility treatment, and related conditions. These exclusions become more likely once a reproductive history is on the medical record, so for anyone planning a family, the timing of an application matters. Securing coverage before starting a family is often the difference between a clean policy and one that carves these conditions out.

What this means for high-income professionals

Two patterns carry across every field in the book. First, because exclusions and ratings are common, the carrier comparison is about which underwriter will issue the cleanest contract for a given health history, not only which one is cheapest. An exclusion on a first offer is frequently negotiable. When a rating does not fit the medical record, Disability Insurance Agency's practice is to challenge it, supply supporting case history, and re-shop the file to a carrier whose underwriter reaches a different conclusion.

Second, underwriting positions move year to year, so the favorable carrier this year may not hold next year. That is why this page is dated and updated as carriers move rather than offered as a fixed answer.

What we see across the carriers

Running every case across the five major carriers (Guardian, Principal, MassMutual, Ameritas, and The Standard) surfaces differences that rarely show up in a rate quote but matter at claim time and at application. A few that hold consistently in our experience:

• True own-occupation is delivered differently. Guardian and Ameritas build it into the base contract; MassMutual and The Standard deliver it through a rider (The Standard's is limited to occupation classes 3A/3P/3D and higher). All five can be written true own-occupation for most professions, but how, and whether your class qualifies, varies.
• Mental-health coverage is the widest gap, except for the high-risk specialties. For most occupations, Guardian does not cap mental and nervous claims by default while the other four limit them to 24 months, and MassMutual can remove its cap by endorsement everywhere except California. The exception is consistent across carriers: the higher-risk specialty cluster, anesthesiology, emergency medicine, pain management, nurse anesthetists, and general dentistry, is required to take the 24-month limitation regardless of carrier.
• Underwriting flexibility is not uniform. In our experience the order from most flexible to most conservative is Principal, The Standard, MassMutual, Ameritas, then Guardian, so Principal most often salvages a complicated file and Guardian is the strictest. On the same health history, the offers can differ enough to change the outcome.
• Ameritas carries the highest business-overhead-expense limit of the majors, $100,000 a month, where the others generally cap near $50,000, which matters for practice owners with high fixed costs.
• MassMutual is the outlier on eligibility and discounts. To our knowledge it is the only major that will write a policy for someone on active military duty, and it offers a 25% military discount, a 25% government-employee discount, and resident discounts (20% medical, 10% dental).

None of these is a reason to default to one carrier. They are reasons to compare the contracts, not just the premiums, for the specific profession and health history in front of us. The full breakdown lives on the carrier comparison hub.

Methodology and limitations

This report draws on a complete review of the individual disability policies Disability Insurance Agency has placed since the agency was founded in 2011, refreshed in a full client-by-client audit in 2026 that verified occupation, carrier, exclusion, and own-occupation fields. The figures describe the agency's own placements rather than a market-wide survey. Occupations are grouped into physicians, dentists, CRNAs, and other professionals. Every figure is rounded and dated, because both carrier behavior and the book itself change over time.

Sources

• U.S. Bureau of Labor Statistics: Nurse Anesthetists
• U.S. Bureau of Labor Statistics: Physicians and Surgeons
• U.S. Bureau of Labor Statistics: Dentists
• AANA Journal: Burnout Among CRNAs (integrative review)
• AMA: Physician burnout rate continues to decline (2025)
• PLOS One: Musculoskeletal disorders of the hand among dentists
• Disability Insurance Agency book of placed individual disability policies, reviewed 2026 (proprietary)

Last reviewed June 2026. This page is updated as carrier positions and the book change, rather than republished on a fixed schedule.