ERISA and LTD Lawyer Referral Request Form

Thank You For Requesting a Referral

Note that I only provide referrals to lawyers located in the U.S. If you’re looking for a lawyer in another country, I can’t help you.

ERISA and LTD Lawyers can be hard to find. Lucky for you, I can help you find a local attorney guaranteed to know this somewhat obscure area of the law. No, I’m not just “Googling” them. These are attorneys in whom I have 100% confidence. I want you to win your case. Why? Two reasons: (1) Every ERISA case won makes it easier for other ERISA plaintiff’s attorneys (the converse is also true) and (2) If the lawyer to whom I refer you wins (or settles) your case, I can get a referral fee. Don’t worry, the referral fee comes entirely out of your lawyer’s portion of the recovery and doesn’t affect the amount you receive at all. I gladly pay referral fees on cases referred to me, so this won’t bother your lawyer one bit (it’s just one way we get clients). I’m going to send you to the best lawyer I know in your area, because if you lose your case, I don’t get anything (and it makes bad law for the rest of us). It’s in my own self-interest to put you in the hands of the best lawyer possible. Now, on to the form, which should only take you a few minutes to fill out.

Instructions

To be referred to a lawyer near you who practices LTD/ERISA law, please enter your information in the following form. Note that you must complete the fields marked “required.” All others are optional, but the more information you provide the easier it will be for me to find a lawyer interested in handling your case.

Don’t forget to enter the 4-digit code at the bottom of the page before hitting the “Send” button. It helps keep automated spambots from flooding my inbox.

Confidentiality

All information you submit will be kept strictly confidential and subject to attorney-client privilege (although I am not your lawyer, your solicitation of legal help from me is still subject to the privilege). By submitting this form, you give me permission to transmit your information to an attorney in your area for referral purposes. The attorney-client privilege is not waived by such sharing of information, and is in fact extended to the attorney receiving your information.

Referral Form

Your Full Name (required)

Your Email (required)

Your daytime phone number,
including area code (required)

City (required)

If you do not live in a major city,
what is the nearest major city?

State (required)

LTD insurance company name

Is this an ERISA policy?  Yes No I'm not sure

Has your claim already been denied? (required)

If Yes, what was the date of your claim denial
(the date on your denial letter)?

Before you became disabled, what was your occupation:

What is your social security disability status?

Briefly describe your primary disabling condition (e.g., herniated disc, fibromyalgia, depression):

If you would like to upload a scanned copy of your denial letter from the LTD Insurer, you may attach that here (10 MB limit):

(Note that large attachments will increase send time. Please be patient and wait for confirmation that your message was sent successfully.)

I give my permission to be contacted directly by the lawyer to whom I am referred (required):

Enter the 4 character code below before hitting "Send" (required):
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