The Medical Expertise Behind Verisk Risk Assessment

11 November 2026 / 8 min read

A diagnosis is only part of the picture. Understanding what it means for insured risk requires clinical knowledge, careful interpretation and an understanding of how medical evidence translates into insurance decisions. We look at the people and thinking behind Verisk’s risk rating solutions.

Medical risk is rarely straightforward

For insurers, understanding an applicant’s medical history is an important part of assessing risk. But a diagnosis alone does not always tell the full story.

The severity of a condition, how it is treated, the presence of complications and the course of recovery can all influence how risk should be understood. Medical knowledge also evolves, changing how conditions are treated and what that can mean for people living with them.

In insurance, there is another important distinction: understanding a person’s medical condition is not the same as assessing the potential insured costs associated with it. The relevant considerations depend on the insurance product and the risks it is designed to cover.

The challenge is to interpret medical information in context and translate it into a practical, consistent approach to risk assessment.

At Verisk, our Medical Team brings clinical and specialist knowledge to the development and ongoing management of risk rating solutions across Travel, Health, Life, Critical Illness and Pet insurance. Their expertise helps inform the medical content underpinning these solutions, connecting an understanding of medicine with the practical requirements of insurance underwriting.

And this work doesn't stop when a product is developed. Medical evidence, treatment approaches and claims experience can all raise questions about whether an assessment captures the distinctions that matter. Knowing how to investigate those questions, and when a change may be warranted, is an important part of the process.

Looking beyond the diagnosis

A condition can mean different things for different people. Recognising those differences requires more than identifying a diagnosis; it requires an understanding of the clinical details that put it into context.

For Inma Ceres, Medical Product Specialist, those details are central to understanding risk. In pet insurance, for example, the severity and recurrence of symptoms, response to treatment and breed predispositions can all be relevant to how a condition is interpreted.

As Inma puts it, “The small details can completely change the risk picture.”

The same principle applies to travel insurance. Melisa Laurence, Senior Medical Product Manager, brings more than 15 years of clinical experience as a nurse in the UK and US to her work on Travel Risk Rating. Her background in acute medicine, surgery and emergency care informs her understanding of how medical conditions present and how their circumstances can differ.

Two people may share the same diagnosis but have very different experiences of that condition. Their symptom control, treatment history, recent complications and wider medical circumstances may all matter.

For insurers, recognising this complexity is important. A meaningful assessment needs to consider the relevant medical context, rather than treating a diagnosis as the whole story.

From a real-world claim to a product review

The importance of clinical context becomes particularly clear when real-world claims experience raises questions about how a condition is assessed.

One example involved a substantial claim relating to a young traveller who sustained a complex open fracture. The injury required external fixation and presented a very different risk from an uncomplicated fracture that had healed normally.

Rather than prompting an immediate change to the score, the claim initiated a deeper investigation by the team.

The review considered the anatomical site of the injury, the type of fracture, the treatment required, any complications and the recovery process. The team then examined how the assessment’s questions and the relationships between them could capture those distinctions. The revised assessment was subsequently tested against claims experience from the relevant portfolio.

This process illustrates an important principle: a claim can raise a question, but the answer requires investigation.

A single case does not automatically justify changing a risk assessment. The team needs to understand the medical circumstances, consider the evidence and evaluate whether the assessment adequately reflects the relevant differences in risk. Testing against the appropriate portfolio's claims experience provides a further check before changes are adopted.

There is also a distinction between clinical fitness and insured risk. A clinician may determine that someone is fit to travel, but that judgement does not, on its own, establish the likelihood of treatment, cancellation or other covered costs during the trip.

For travel insurers, those are different questions. Risk assessment needs to account for the medical circumstances while also reflecting the potential medical costs covered by the policy.

The fracture example shows how clinical knowledge, claims experience and the design of the assessment can come together in a product review. It is not simply a matter of adding more medical information, it is about understanding which distinctions matter and how the assessment can reflect them.

Keeping pace with medical evidence

Claims experience is one source of insight. Evolving medical knowledge is another. Treatments develop, evidence grows and understanding of particular conditions changes. An approach that was appropriate at one point may need to be reconsidered as the evidence develops.

Hannes Hagson, Associate Medical Director, brings a background in medicine, public health and epidemiology. His work draws on the relationship between clinical evidence and population-level health understanding, helping inform the medical thinking behind risk assessment methodologies.

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This broader perspective matters because medical risk cannot always be understood through a diagnosis in isolation. The course of a condition, the effectiveness of treatment and wider health factors can all influence how it should be interpreted.

Keeping pace with medical evidence is therefore an important part of maintaining relevant risk assessment solutions. It involves considering what the evidence tells us, understanding how it applies to the insurance context and reviewing whether the approach continues to reflect that understanding.

For insurers, this helps explain why the expertise behind a risk rating solution matters beyond its initial development. The medical content needs to be informed by current knowledge and considered alongside the experience of applying it in practice.

Balancing individual circumstances with consistency

Understanding individual circumstances is one part of the challenge. Applying clear and consistent principles across risk assessments is another.

Insurers need approaches that can be applied reliably while accounting for the medical factors that matter. This means balancing the complexity of individual cases with the need for a structured, practical approach to underwriting.

Isabel Moreno Aroca, Senior Medical Product Manager for Health, Life and Critical Illness, brings experience across nursing, emergency and intensive care, as well as disability assessment. Her work sits at the intersection of clinical knowledge, underwriting requirements and product development.

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That perspective informs an important consideration in risk assessment: fairness does not necessarily mean treating every case identically. It means understanding which differences are relevant while applying clear, objective and evidence-led principles.

For medical risk assessment, this balance matters. An approach needs to recognise meaningful differences between individuals without losing the consistency required for underwriting decisions.

The thinking behind the system

The expertise of individual specialists is important, but so is the way that expertise informs the wider approach.

As Medical Director, Dr Jochem Caris provides clinical leadership and oversight across the portfolio. His work reflects a central principle: the objective is not to make underwriting more permissive or more restrictive, but to make it more precise.

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Achieving that requires evidence-based medical judgement to be considered alongside the practical realities of insurance. Clinical information needs to be understood and translated into an approach that can support real underwriting decisions.

The fracture review is one illustration of what this involves: investigating a real-world case, examining the medical distinctions that matter, reviewing how those distinctions are represented in the assessment and testing the revised approach against relevant claims experience.

It also demonstrates why product development is not simply about building an assessment and leaving it unchanged. Reviewing the evidence and experience can help identify where an approach may need further consideration, while structured investigation and testing help determine whether a change is appropriate.

This is how medical expertise contributes to the ongoing management of risk rating solutions - bringing clinical understanding to the questions that arise, helping inform the assessment methodology and considering how it can reflect the risks relevant to insurance.

Understanding the expertise behind the assessment

A risk rating solution is more than the information it processes. The medical thinking that informs its content and interpretation is also important.

Verisk’s Medical Team brings together experience across clinical practice, nursing, veterinary medicine, product development and public health. Their perspectives contribute to a broader understanding of medical risk: why context matters, how conditions differ, how evidence evolves and how medical knowledge can be applied within an insurance setting.

For insurers, understanding this approach provides a clearer view of what sits behind the assessment. It shows how clinical expertise informs the medical content underpinning Verisk’s risk rating solutions, and how claims experience and evolving evidence can prompt further investigation and review.

The objective is not to change an assessment for the sake of change. It is to understand the evidence, recognise the distinctions that matter and ensure that decisions about the methodology are considered carefully.

Because understanding insured risk takes more than a diagnosis. It takes expertise in the medicine behind it.

Discover Verisk’s Risk Rating solutions here, or speak to our team to explore how our approach could support your underwriting needs.

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