Liver disease is a cause for significant mortality and morbidity which often is clinically asymptomatic until it reaches a state of decompensated cirrhosis. Underwriting risk requires an understanding of the fundamentals of the pathological processes as well as connecting clinical signs, laboratory values, and imaging studies to assess the grade and stage of the disease. Some liver diseases are genetic, idiopathic, or secondary to systemic diseases, and others are acquired with commonalities in the inflammatory process only to be distinguished by biopsy and specialized laboratory testing. The key to determining the prognosis and risk assessment will be determined by the diagnosis itself and factors to be considered with regard to treatment and often lifestyle changes. This chapter will review the red flags to look for in the medical records which will assist in determining whether there is high suspicion of end-stage liver disease, warranting postponement for further clinical evaluation by hepatologists. Given the asymptomatic nature of progressive liver fibrosis, individuals may be unknowingly unaware until they apply for insurance.