Got a Tough Case?

Unless you are an underwriter – don’t assume a case is decline or lost opportunity because they have impairments.
Start our Preliminary Case Review Process below! You can always call us: 866-639-0443 Or, e-mail at: info@brookfieldpartners.com
We handle Impaired Risk Life, Disability and Long Term Care Insurance.
You can: Schedule a Call with an Underwriter
More often than not we can secure a better rating class after our underwriting process!
If a case is a true decline – there are other options! Accidental Insurance Coverage is a great solution to secure coverage for your declined life and disability insurance clients. For decline Long Term Care Insurance there are a variety of strategies that help protect assets.

Advisor Information
Advisor Name:*
First Last
Advisor E-Mail:*
Advisor Phone Number:*
Client Information
Name:*
First Last
You may also enter client initials. We don’t share client information with carriers on risk assessments.
Date of Birth:*
MM slash DD slash YYYY
Gender:*
Height:*
Weight:*
Smoker?:*
If No, Date Last Used if ever.
MM slash DD slash YYYY
Medical Impairments (please be as detailed as possible)
Non-Medical Concerns (Scuba Diving, Pilot, etc.)
Medications (Reason for Rx, dosages)
Actions from other Carriers:
Case Concerns:
Health Issues, Tobacco Usage, Family History, Driving Record, Marijuana Usage, etc.
Desired Product Type and Face Amount:*
File Upload
Drop files here or

Max. file size: 512 MB.
Upload any documentation that might help us with risk assessment. Medical Records, Lab Slips, etc.

*Cases under $5,000 in premium may require an agency case split. Contact your Brokerage Manager to learn more.

Advisor Information