In the early 20th century, the rating of higher risk, “substandard” applicants for life insurance was largely the purview of physicians known as medical directors of life insurance companies. Medical directors from the United States and Canada met annually between 1889 and 1991 under the umbrella of the Association of Life Insurance Medical Directors of America to update their knowledge at a time of rapidly evolving medical technologies. The work of this association contributed to a standardized process called automated underwriting, in which paramedical workers gathered key information from insurance applicants over the telephone and then assigned a risk score to each application. This score was constantly refined and tested according to its predictive value. Applications were routinely crosschecked with the Medical Information Bureau, a shared industrial database that had kept track of all life insurance applicants (including those who had been turned down) since 1902. By the 1960s, when combined with carefully crafted exclusion clauses, automated underwriting had become so effective that it often supplanted medical directors.
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