Client Login

Refer a Case

 


Representing Claimants Nationwide


No Fees Unless Awarded Disability Benefits

 

 

 

 

Please click here for recommended browser settings.

After submitting your information, you will have the option of uploading any supporting files.

* = Required

Your Name*:
Your Email Address*:

Claimant Name
*:

Claimant Email Address:

Address:

City/State:

Phone:

DOB:

LTD File#:

Other File#:

Date Last Worked:

Employer:

Occupation:

Education:

Status of SSA Application (if any):

Date of Last SSA Denial:


Special Instructions: