Disability Insurance Appeal Guide

Table of Contents

Chapter 1: Is Your Disability Policy an ERISA Policy?
Chapter 2: Appealing the Denial of Disability Insurance Benefits – ERISA Policies
Chapter 3: Non-ERISA Policies
Chapter 4: Exertion Levels
Chapter 5: Understanding Your Policy
About the Author

Introduction: Who Is This Guide For?

Individuals who, due to illness or injury, can no longer continue to engage in full-time employment. While there are no guarantees that the appeal of your claim will be approved on the first try, this guide will help you file an appeal that is clear, concise, and complete with all necessary information.

We also recommend that you utilize our free Ultimate Appeal Checklist. This checklist will assist you in gathering the evidence you need to provide the claim adjuster with proof of your disability.

Disability Insurance Appeal Guide: Chapter 1

What is an ERISA Disability Plan?

Many medium to large-size companies offer benefits through an ERISA-governed disability plan. But what’s the difference between an insurance policy and an insurance plan? Typically, the long-term disability policy is one part of an overall benefit plan. The benefit plan may include other benefits like life insurance, health insurance, disability benefits and other types of group plan benefits.

Is Your Disability Policy an ERISA Policy?

ERISA, which is short for the Employee Retirement Income and Securities Act of 1974 has certain requirements for plan administrators like your employer who’s offering these benefits. Specifically, ERISA requires the plan administrators to provide participants with key information about the plan benefits, the funding of the plan, their fiduciary responsibilities, management of the plan, the grievance process, and appeals process for denials under the plan.

One thing that’s really crazy is that ERISA allows plan administrators to interpret the plan provisions so long as there’s a clause in the policy that allows them to interpret the plan provisions, which means the insurance company is allowed to determine whether or not you meet the requirements of the policy.

If you are covered by a Group Long Term Disability Policy through your employment, your claim is probably governed by ERISA. As stated throughout the remainder of this website, if you did not obtain disability coverage through your employer or employee group, and instead purchased it as an individual policy from an insurance agent or broker, then there is a good possibility that your disability claim will not be covered by ERISA and your legal options and remedies are more favorable. Moreover, church and governmental (including most City and University) employees are also exempt from ERISA.

What to Do If You Are Denied Coverage for a Non-ERISA Policy

If you have church policy, a governmental employee policy, or an individual disability policy purchased directly from an agent or broker then you may not have to appeal the denial before filing a lawsuit. In these instances, you should consult an attorney immediately.

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Disability Insurance Appeal Guide: Chapter 2

Appealing The Denial of Disability Insurance Benefits – ERISA Policies

You should not give up if the insurance company denies or terminates your claim for long-term disability (LTD) benefits.  Most employees have disability insurance coverage through a group plan with a private-sector employer. If your employer is large enough, or if you obtained your policy through an employee organization or union, then ERISA rules and regulations come into play. According to ERISA, you must “exhaust” your administrative remedies before you can file a lawsuit. This means you must follow the terms of the insurance policy and go through each step of the appeals process directly with the insurance company. If the insurance policy states that you must file one appeal, then you may only need to file one mandatory appeal. If the insurance policy requires you to file two appeals, then you must go through two appeals before filing a lawsuit. Other insurance policies have one mandatory appeal and one “optional” appeal.

It may seem unlikely that the same insurance company that denied your claim will suddenly change its mind and approve you on appeal. However, the appeals are evaluated by a different claims handler at each level of appeal and the new claims handler may just disagree with the denial. Many claimants receive benefits during this appeals process.

Step by Step Guide to Appealing the Denial of Your Disability Claim

BEFORE YOU START: Read and Understand the Denial Letter

Your denial letter should specify why your claim was denied and how to file an appeal. Pay close attention to the reasons given for the denial so you can determine how you proceed with your appeal. For example, if you were denied because the insurance company stated your claim file lacks “objective documentation”, you would want to submit additional CT-Scans, x-rays, or MRIs.

Common reasons cited by insurance companies as to why they are denying long term disability benefits include:

1. Long term disability insurance companies oftentimes deny claims on the grounds that they say there is insufficient evidence or objective medical finding to support the claim. For example, in a case involving back pain, if all there is an x-ray, then perhaps a better piece of evidence would be an MRI or a CT scan. In a mental health claim, if there are cognitive deficits or difficulty thinking and processing information, then a good piece of evidence may be neuropsychological testing. This is the type of evidence that an insurance company is looking for in evaluating a case.
2. There may be clerical or procedural errors in the claim. For example, the claimant, their doctor, or their employer maybe didn’t fill out a form that was necessary to process the case. Another procedural error is that the claim wasn’t brought in time, meaning that in most cases you have a specific time limit within which to bring your long-term disability case to the insurance company’s attention.
3. Long term disability insurance companies deny claims based on surveillance video that they’ve taken of you or the claimant. What that means is oftentimes the insurance company will hire a private investigator to conduct surveillance and record the claimant in their daily activities, and if there is evidence that the claimant is engaged in an activity that seems to contradict what’s in the medical records, then that can be used as a basis for a denial.
4. There may be policy exclusions for certain illnesses or injuries. For example, let’s say that the injury that leads to the disability that is the basis for the claim is a result of a self-inflicted wound. Some long-term disability policies will not allow the disability to be covered if it’s a self-inflicted injury. Number two, let’s say that the injury was incurred during criminal activity, then a lot of policies will say that you cannot receive coverage for an injury that you received while engaged in criminal activity, so that could be another basis for the denial.
5. This is a common one. Insurance companies often deny benefits based on a pre-existing medical condition. A pre-existing medical exclusion will oftentimes apply if the employee just recently started working for the employer. In most instances, if your disability begins within one year of employment and you received treatment for that same condition within three months prior to your employment, then you may not have coverage due to a pre-existing condition.
6. There may be contradictory online evidence in your case. Social media is a big one – especially Facebook. Oftentimes, the insurance companies will go to your Facebook profile and download pictures that you posted and videos that you posted. Let’s say that the pictures/videos show you engaged in certain activities. The disability insurance company may try to use that type of visual evidence against you in your case.
7. Fraud or misrepresentation. So let’s say that there’s just wrong or directly inaccurate information that’s put on a form, or let’s say that the form from a doctor was manipulated, then that can be the basis for denial due to fraud or misrepresentation.
8. Treatment compliance. Oftentimes, claims are denied because the patient or the claimant is not getting enough treatment, or they’re not following prescribed treatment by their doctor. For example, if the doctor is prescribing a certain treatment that may improve the claimant’s medical condition and improve it to the point where they may even be able to return to work, but the claimant is not undergoing that treatment (so the claimant can remain on disability), then that can be a basis for denial due to noncompliance.
9. The claimant must meet all the eligibility requirements under the policy to have coverage, and some of those requirements may be non-medical in nature. For example, most policies require the employee to have worked a certain number of hours or worked a certain number of days before they’re eligible for long-term disability coverage. I’ve seen denials where the insurance company is claiming that the claimant didn’t work a sufficient number of days or hours to have coverage under the policy.
10. You must always look at the actual definition of the term disability under the policy. Each policy specifically defines how they evaluate the term disability, so for example, under most policies, you’re disabled if you cannot perform all or substantially all of the material duties of your occupation, but you must look at the definition under your individual policy. Another part of the definition is that it oftentimes changes over time, such that after two years it’s not just whether you can do your job. It’s whether you can do other occupations, as well, so you must always be aware of how the definition of the term disability is defined in your policy.

STEP ONE: Calendar Your Appeal Deadline

If your disability policy is part of a group plan subject to ERISA, you will have 180 days to send your written appeal and supporting medical evidence. These time limits are very important! That is why you must read the denial letter and your disability policy carefully to determine everything you must do to make sure your appeal is timely and properly filed. Remember – if you have a claim governed by ERISA you will not have the opportunity to testify or submit any new evidence during the federal court lawsuit. That is why you should make sure to “pack the record” with all the evidence to support the claim that you can possibly muster.

STEP TWO: Request a Full Copy of Your Disability Plan and Claim File

Before you file your formal appeal, request a complete copy of your long term disability claim file in writing from your insurer (i.e., via fax, mail or email). A claim file consists of all medical records, internal notes and memos, internal correspondence, outside doctor reviews, surveillance video and any other information the insurance company used to make a decision on your claim.

STEP THREE: Make Doctors’ Appointments

When the insurance company is reviewing your long term disability claim, they will be evaluating your credibility. They will be looking to see if the evidence you provided proves that you have been truthful about your symptoms, pain levels, and inability to work.

The most common way the insurance company checks this is to see whether you sought treatment for your disability. Naturally, if you have not seen a doctor about your disability, you will have no evidence to support your claim, and you will be denied. The meaning of “treatment” is more than just an initial visit to the doctor for a diagnosis. “Treatment” refers to the continuous amount of time that you will need to see doctors, take medication, have physical therapy, lab work, and the like. This is also referred to as your treatment plan.

If your doctor is willing to provide a statement in support of your long term disability claim, you should obtain a written medical source statement. Be aware, however, that overly conclusory statements that essentially say “my patient is 100% disabled and unable to work” are nearly useless.

Long-term disability claims examiners who review disability claims are not interested in short, conclusory statements from personal physicians. Instead, the doctor should explain why the claimant is unable to work. How can a treating physician do this? In a letter or by filling out a residual functional capacity form. The LTD insurance company is looking for a doctor’s evaluation of how well the disability claimant can:

• Lift and carry weight;
• Sit;
• Stand;
• Walk;
• Push and/or pull;
• Bend;
• Balance;
• Crouch;
• Stoop;
• Kneel;
• Grip and manipulate objects;
• Reach overhead and in other directions; and
• A doctor should also provide information regarding a patient’s range of motion in all major joints.

Unfortunately, many doctors are unwilling to provide this type of detailed statement, even though this is exactly what the insurance company is seeking. Despite resistance from medical providers, claimants who are seriously interested in winning their disability claims should strive to obtain this type of statement from their doctor.

A form that is typically used to provide this type of detailed statement is called a residual functional capacity (RFC) form. The insurance company probably has its own generic RFC that it uses in all claims, but its form is typically too generic and is used to deny claimants benefits. To obtain an RFC form that may actually assist you in winning your claim, use our free RFC form.

STEP FOUR: Review Your Claim File

You need to know what is in your claim file before you file your appeal in order to know what additional information you can submit in order to have your claim approved. For example, you may discover that the insurance company was missing medical records from a doctor that you thought the insurance company had already considered. If you discover records are missing, you can provide them with your appeal to make sure all positive medical evidence is in the claim file when the insurance company renders its decision.

Claims are usually denied because you did not provide sufficient evidence for approval, which is why it is so important to double-check everything before you submit it.

• Did you provide the correct doctor’s names and addresses?
• Did you provide the correct dates of service?

Most claims are denied due to simple mistakes that can lead to months of frustration for you. Some insurance companies will try to point out “bad facts” that are on your medical record. This could be drug abuse, alcoholism, working after you say your disability started, or a doctor notating that you are exaggerating your claim.

STEP FIVE: Request Updated Medical Records From Your Medical Providers

The longest and most tedious process is gathering your data to prove your disability. After you read through your policy, you should be able to determine if you may qualify for LTD based on your insurers’ definition of disability. You will need to provide the claim adjuster with proof of your disability. This will include the opinion and notes from your treating physician(s), all lab and test results, x-rays, MRI scans, notes from doctors that have treated you, and detailed surgical reports. This information will need to be gathered from all doctors that are treating you for your disability not just your primary physician.

At the end of the day, it is the claimant’s burden to prove that a physical or mental condition has so negatively affected the claimant that the claimant can no longer continue in his or her career. Most insurance policies require proof of objective evidence before the insurance company will pay out benefits on an LTD insurance claim. This is the evidence that insurance companies cannot deny exists.

STEP SIX: What to do at Your Doctors’ Appointments

To learn what your residual capabilities are, the insurance company may ask for you to take an Attending Physician’s Statement (APS) form to your doctor (this form is also known as a Residual Functional Capacity form). If the insurance company claims handler does not believe the APS is sufficient (for example, if the doctor’s responses on the form are totally inconsistent with the medical records in the claim), the adjuster may schedule you an appointment to attend an “Independent Medical Examination” by a doctor hired by the insurance company. This doctor will then perform an RFC (residual functional capacity) assessment for your claim. The examiner will determine what level of exertion you are capable of performing, and what restrictions you have that may limit the jobs you can do. The medical examiner may also review your medical records and your doctor’s notes about your functional abilities and restrictions to come up with your RFC.

An RFC form assesses a disability claimant’s “residual functional capacity,” which is the claimant’s functional capacity (ability to function or perform work activity) that remains after taking into account the claimant’s mental and/or physical disabilities.

An RFC is also commonly called a Medical Source Statement or Attending Physician’s Statement.

A statement from a treating doctor can often make the difference between winning or losing a long term disability claim. But that does not mean any statement will do. The statement should not be too brief to be of any use or too conclusory. I cannot tell you how many times our office has received a call from an excited client and the client says the doctor wrote them a statement that will win the case. We tell the client to bring the statement into our office. It is typically an extremely short note on a prescription pad that says little more than “My patient is completely disabled and unable to work”.

I’m afraid to say that this type of statement is extraordinarily useless to the insurance company disability claims examiner (who makes the decision on an application for disability or on the appeal).

There is no question that the LTD insurance company is very interested in receiving the opinion of a claimant’s treating physician. In fact, most insurance companies have an Attending Physician’s Statement to be filled out by a doctor as part of the disability claim application.

A doctor who submits a statement should be a treating physician. A treating physician is qualified to give a valid opinion as to the claimant’s medical condition and how the condition affects the claimant because the doctor has a history of treating the claimant. Medical opinions also only carry weight if they are specific enough to indicate the patient’s specific limitations and why the physician believes that his or her patient is disabled and unable to work.

If the claimant’s disabling condition is mental, the treating psychiatrist or psychologist should indicate which cognitive deficits they have. For example, do they have trouble retaining information, learning information, concentrating, getting along with supervisors or co-workers, etc? Does the patent have a poor memory, decreased energy, illogical thinking, and so on? The mental RFC may also indicate the patient’s ability to persist in the areas of concentration and attention, as well as the patient’s ability to interact socially in work settings, assimilate new information, and successfully engage in SRRTs (simple, routine, repetitive tasks).

STEP SEVEN: If You Find Yourself Running Out of Time

While preparing your appeal you may find yourself running out of time. If so, you should immediately send an appeal letter to the insurance company enclosing all the evidence you have gathered thus far and ask for more time to submit additional evidence. Even if you haven’t obtained any evidence at this point, send your appeal letter to the insurance company anyway.

You do not have to wait to hear back from the insurance company. Even if the insurer denies your request for an extension, continue to submit additional evidence in support of your appeal until the insurer issues its appeal decision. If you are unable to obtain additional evidence prior to the insurer issuing its decision, the appeal letter alone is enough to fulfill your duty to file an appeal.

STEP EIGHT: Submitting Your Appeal and Waiting

You should not submit your appeal to the insurance company before you have obtained and reviewed your entire claim file and policy (unless you are on a deadline).

You should not submit a simple letter as your entire appeal. The most important part of your appeal is the additional evidence you should be submitting with your appeal letter. Besides pointing out why you think the insurance company’s decision to terminate or deny benefits is wrong, you should submit updated medical records, opinion evidence (such as a letter or Attending Physician Statement) from your doctors identifying how your medical conditions impair your ability to perform work activity, and more. Your appeal letter should be more like a cover letter, identifying why you disagree with the insurance company’s decision, and enclosing the information that may change the insurance company’s decision. This is a critical stage of the claims process. In most cases involving an ERISA-governed long term disability policy, the claim is closed once a decision is made on your final appeal. This is why it is important to submit all records you think you may need in future litigation during the appeal. Any information you leave out may never be heard or considered by a federal court in litigation!

Do not submit your documents by “regular mail”. You should be using a trackable method of shipments, such as Federal Express, Overnight Mail, or certified mail.

You should not “appeal” your case on the phone and you should not answer many questions from the insurance company over the phone. You should request that all communications be in writing, in traceable forms such as certified mail, fax or e-mail.

The appeal is filed with the updated supporting documentation, and from that point, the insurance company has 45 days after receiving the appeal letter to make a decision. The insurance company can extend the decision process by another 45 days if they request it in writing before the end of the first 45 days. By law, the insurance company must reach a decision within the 90 day period.

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Disability Insurance Appeal Guide: Chapter 3

Non-ERISA Policies

There may be other situations where you do not have to file an appeal at all before filing a lawsuit. Generally, you do not need to appeal if you have an individual policy purchased directly from an insurance agent or broker, or if your policy is sponsored by a government or church employer directly (in other words, if the policy is not through a union or employee organization). In such situations, you may not even have to file any appeals with the insurance company before suing the insurance company in court. You should really look at what your insurance policy requires, and if there are some required appeals in the policy itself.

While you’re not subject to the same stringent requirements under ERISA, you are still subject to whatever the requirements are under your policy. It’s oftentimes good to have an experienced attorney who knows the differences between ERISA and non-ERISA policies and can help you evaluate what your rights and responsibilities are under the different types of policies, to help you look at the file, look at the policy, and help explain to you what it is that you need to do to get your benefits either instated or reinstated.

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Disability Insurance Appeal Guide: Chapter 4

Exertion Levels

Your physical Residual Functional Capacity (or RFC for short) will determine whether you can perform sedentary, light, medium, or heavy-duty work. For example, if your doctor has restricted you to walking and standing no more than two hours total in an eight-hour day, your RFC will be for sedentary work. Here is a more detailed breakdown of the various exertional levels:

Sedentary Work: A sedentary job is one that is primarily sitting, with occasional walking and standing. To perform a sedentary occupation, you usually do not need to lift and carry more than ten pounds at a time, and you may be required to occasionally lift or carry things like files or small tools.

Light Work: Light work typically requires frequent walking and/or standing, as well as the ability to reach, push and pull with your arms or legs. Light duty jobs typically require the ability to lift and up to 20 pounds occasionally, and up to ten pounds frequently. If one can perform light work, one is generally considered capable of performing sedentary work.

Medium Work: A medium-duty job typically requires one to be able to lift and carry up to 50 pounds at a time, and the ability to frequently lift and/or carry up to 25 pounds. If one can perform medium work, one is generally considered capable of performing light and sedentary work.

Heavy Work: Heavy-duty work typically requires the ability to lift and carry up to 100 pounds at a time, and the ability to frequently lift and/or carry up to 50 pounds. If one can perform heavy work, one is generally considered capable of performing medium, light, or sedentary work.

Very Heavy Work: Very heavy work typically requires the ability to lift and carry objects that weigh more than 100 pounds, and the ability to frequently lift and/or carry 50 pounds or more. If one can perform very heavy work, one is generally considered capable of performing all other levels as well.

Your RFC will also include any non-exertional restrictions, such as not being able to stoop, use your fingers, or remember instructions.

Mental Impairments

Your mental RFC will determine whether you can perform work-related mental activities. When evaluating the claimant’s mental residual functional capacity, the claims handler will look at four primary functional areas: (1) understanding and memory; (2) social interactions; (3) sustained concentration, persistence, and pace; and (4) adaptation to changes in the work environment.

Thus, a mental RFC form completed by a mental health professional (such as a psychologist or psychiatrist) should make reference to a claimant’s mental impairments due to the claimant’s mental conditions (for example, poor memory, decreased energy, illogical thinking, and so on). The mental RFC should also opine as to the claimant’s ability to persist in the areas of concentration and attention, as well as a claimant’s ability to interact socially in work settings, assimilate new information, and successfully engage in SRRTs (simple, routine, repetitive tasks).

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Disability Insurance Appeal Guide: Chapter 5

Understanding Your Policy

The first thing you need to do is read through your LTD policy. You can pick up a copy of your plan from your employer’s human resources department. Sometimes human resource departments will try to delay providing you with this documentation. If you request a copy verbally or in-person and you do not get a response within 7-10 days, send a letter requesting a copy of your policy. If you are provided with a summary of benefits but the summary does not answer all of your questions, you need to request a copy of your full policy.

How Does Your LTD Policy Define “Disability”?

Every long term disability policy has a definition of what “disability” means to the insurance company. They are usually “totally disabled” which means you can no longer work at all and “partially disabled” which means you can no longer work full time in your current job. It is also important to know that your policy will outline exactly what they consider to be a disability, and your injury or illness must meet those minimum criteria to be eligible for benefits.

What Are the Minimum Work Hours to Qualify?

In general, most LTD policies require you to work full-time (35 hours or more, or as otherwise defined in your policy) per week over a period of time. The exact working hour requirements will be outlined in your policy. Be sure that you have worked this minimum amount before applying for benefits.

What is the Waiting Period?

In most cases, the LTD policy will have a waiting period; sometimes called an “elimination period.” This is the period of time that you have to wait to receive benefits. For long term disability claims, this is between 90 and 180 days but check your policy for the exact number of days. You will also be required to exhaust your short-term disability before you can apply for long term disability.

Pre-existing Conditions and Exclusions

Under most LTD policies – if you have a pre-existing condition, you will not be able to receive benefits for that illness for the first year of your long term disability benefits. Some workplace illnesses and accidents are excluded from LTD policies. The use of alcohol and drugs or diseases caused by them are usually excluded as well. There is also a 24-month cap on long term benefits for mental health-related illnesses.

Change in Definition of Disability After 24 Months: Transition from “Own Occupation” to “Any Occupation”

Most group LTD policies contain a provision that changes the definition of the term “disability” after 24 months. In order to be eligible for long term disability benefits during the first 24 months, most LTD insurance policies employ an “Own Occupation” standard; namely, the claimant must be unable to perform the Material and Substantial Duties of his or her regular occupation due to a physical or psychological impairment.

After the initial 24-month period, a claimant may be eligible for continued benefits if he or she is unable to perform, with reasonable continuity, the Material and Substantial Duties of Any Occupation. A typical LTD policy defines “Any Occupation” as “any occupation that the claimant is or becomes reasonably fitted by training, education, experience, age, physical and mental capacity” to perform. Most courts have interpreted such language to mean that if you’re medically capable of performing virtually any job that exists in the economy, your LTD benefits may be terminated. This determination does not usually take into account whether such jobs are available, only that they exist. yt’/Even if an LTD insurance company agreed to pay benefits because it found the claimant could not perform the material duties of his or her own occupation, the insurance company may find that the claimant can perform other work and cut-off benefits at the 24-month mark under the broader “any occupation” standard.

Time Limitation on Mental / Nervous Conditions and Disabilities Diagnosed by Subjective Complaints

Most group policies have a 24-month limitation for claims involving disabilities arising from mental, nervous, and psychological impairments. If you are receiving LTD payments due to depression, anxiety, post-traumatic stress disorder, agoraphobia, obsessive-compulsive disorder (OCD), or a similar impairment, you may be limited to receiving 24 months of benefits. However, if you are institutionalized or confined to an inpatient treatment facility when your 24 months expire, most insurance companies will continue to pay benefits until you are no longer hospitalized, subject to a cap.

There are often (but not always) exceptions to this time limitation for organic mental disorders like dementia and organic brain disease, and perhaps even for mental illnesses such as schizophrenia and bipolar disorder. You must look to the specific language in your policy to determine what conditions are subject to the two-year limitation (and to determine which conditions are exempt from the two-year limitation).

Some policies also have a two-year limitation for chronic pain conditions such as arthritis and chronic back pain, and for medical conditions that are primarily diagnosed based on “subjective” complaints, including chronic fatigue syndrome, neuromusculoskeletal and soft tissue disorders, and/or fibromyalgia. Again, some insurance policies may carve out exceptions to this limitation.

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Disability Insurance Appeal Guide: About the Author

Nick Ortiz represents policyholders in individual disability, group disability, and ERISA long term disability claims. Mr. Ortiz also represents individuals with disability policies covered by “self-funded” employer organizations, such as Solutia and UnitedHealth Group.

He assists clients in filing administrative appeals in their disability claims in an attempt to restore the benefits without the need to go to court and sue the insurance company in a lawsuit. However, if the insurance company does not grant the appeal and pay the benefits owed, then Mr. Ortiz has no problem with litigating against the disability insurance company (filing a lawsuit against the insurance company).

Mr. Ortiz has handled LTD appeals and/or filed lawsuits against all of the major disability insurance companies, including Aetna, CIGNA, MetLife, The Hartford, The Standard, UNUM, Lincoln National, Liberty Life, Mutual of Omaha, Paul Revere, Assurant, Sun Life, and Prudential. The firm is dedicated to excellent client service and outstanding results.

Mr. Ortiz offers a free consultation to meet new client referrals. He routinely meets with disability policyholders to evaluate their claims and provides legal advice with respect to their potential actions against their individual (or group) insurance carriers.

He grew up in Fort Walton Beach, Florida. He first became interested in the legal profession after participating in his high school’s debate program. He also played a lawyer in a high school mock trial. These experiences led him to become a student in the art of persuasion and argument.

With this foundation, Mr. Ortiz went on to obtain a Bachelor’s degree in Political Science from Yale University. He took two years off after college to work in Washington D.C. at the prestigious law firm Covington & Burling as a paralegal. He then went on to attend UCLA Law School in Los Angeles, California. While in law school, Mr. Ortiz participated in moot court and trial advocacy program. He also participated in legal aide, assisting the poor and indigent in legal matters. He clerked for plaintiffs’ law firms during the summers between academic school years.

Following law school graduation in 2001, Mr. Ortiz stayed in Los Angeles. He passed the State Bar of California and worked as an insurance defense attorney. After only one year representing insurance companies, Mr. Ortiz realized he did not want to represent corporate entities. He wanted to represent individuals. He, therefore, joined a small law firm representing injury claimants.

By 2004-2005, the cost of living in Los Angeles was becoming outrageous. So, in 2004 Mr. Ortiz sat for the Florida Bar and passed. In 2005, Mr. Ortiz returned to Florida with his wife and practiced law at a small disability and personal injury law firm in Pensacola. While at this firm, Mr. Ortiz broadened his practice from representing injury victims to representing injury victims and disabled workers. He learned how to handle a Social Security disability claim from beginning to end, and also how to handle long term ERISA disability claims.

After seven years with this firm as an Associate, Mr. Ortiz decided it was time to branch out on his own as a solo attorney. On June 1, 2012, he opened The Ortiz Law Firm.

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