Elkind & Shea

Do I Have A Case?

Please take a few minutes and complete the following form. We are pleased to provide a FREE CONSULTATION. We will do our best to respond promptly, but please allow 24 – 48 hours to hear from us. Thank you.

Fields in bold are required.

Your Name
Street Address
City
State

Zip
Phone Number
Email
Claimant Information
For whom are you inquiring?

Claimant's date of birth

Marital status

Is the claimant working? Yes, my occupation is

No, my prior occupation was

Date that claimant last worked
What are the present means of support?

Does the claimant have a lawyer?

Yes No 
If yes, for which claims?

Long/Short Term Disability Claims Process (skip if not applicable)
Name of insurer
Are you receiving benefits?

Yes No 

Amount of monthly benefit to be received
Where are you in the process?

What was the date of your last denial?

Social Security Claims Process (skip if not applicable)
Have you applied for Social Security Disability?

Have you had a hearing for Social Security Disability?

After the hearing, were you denied Social Security Disability Benefits?

If you were denied benefits, have you filed an appeal to the Appeals Council?

Case Description
Please describe your case - (2000 characters max)


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I agree that information provided by ELKIND & SHEA in response to this question does not constitute a request for legal advice and that I am not forming an attorney-client relationship by submitting this question. I understand that I may only retain an attorney by entering into a fee agreement, and submission of an inquiry does not constitute entry into a fee agreement. I agree that the information that I will receive in response to the following question is general information for which I will not be charged for the response. I further understand that the law for each state may vary, and therefore, I will not rely upon this information as legal advice. Because this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter. Further, I understand that the Internet is not a secure media and that information conveyed by me here through the Internet is not secure and may be viewed by a third party unknown to me.

 

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We collect only the personal information you provide to us and we do not distribute it to any third parites. Any legal information offered by Elkind & Shea, The Disability Benefits Law Firm, regarding social security disability benefits, long term disability benefits, short term disability benefits, ERISA, long term care denial and life insurance denial or other legal information offered herein is not formal legal advice nor the formation of an attorney client relationship. All communications with counsel are confidential in accordance with the applicable Rules of Professional Responsibility which require that even consultations without retention are held confidential.