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Most claims for social security disability or ssi disabiliy benefits are initially denied. Unfortunately this often happens even when the claimant's case is strong. For this reason having representation on a disability case is particularly important and can make the difference between winning or losing

These questions are designed to provide our lawyers /advocates with more specific details about your case. You'll be encourage to describe the events and circumstances of your situation in detail. Although we do not require you to answer these questions to present your case, by doing so you are helping us match you with the most suitable lawyer. Or you may request a home visit.

Contact Information: (Fields with * are required)
*Your name
*E-mail address
*Home number
*Home address
Mobile number
Best time to contact you
City
State
Zip Code
   
Case Information:
Impairments/Disability
(Describe your disability)
*Your age or childs age

Have not applied
Have applied but have not received a determination
Have applied and been denied
At original claim
At reconsideration
At hearing stage

How many times have you previously filed?
1    2    3    4    5 or more

If denied, what level?
Initial
Reconsideration
Administrative Law Judge
Appeals Council

Most recently denied:   

Date you became disabled:   

Have you worked 5 out of the last 10 years?  Yes   No

Last date you worked:   

Are you working?  Yes   No

Physical / Mental Limitations:


Conditions & Symptoms:
Back Injury
Neck Injury
Hip Injury
Knee Injury
Foot Problems
Asthma
Bronchitis
Sleeping Problems
Depression Disorder  
Epilepsy
ADD
ADHD
 Heart Problems
Poor Circulation
Nerve Problems
HIV
Hepatitis
Mental Illness
Anxiety Disorder
Panic Attacks
Bi-Polar
Multiple Sclerosis
Concentration Problems
Memory Problems

Are you being treated?  Yes   No

Do you have an attorney?  Yes   No

Is the injury work-related?  Yes   No

Medications:


Other claims:
Workers Compensation
Long Term Disability
Personal Injury
Medical Malpractice
Other

Have you visited a doctor in the last 12 months about your condition?
Do you have health insurance?

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All attorney listings are a paid attorney advertisement, and do not in any way constitute a referral or endorsement by an approved or authorized lawyer referral service. By clicking the button below, you agree to use SSD Service Free Case Review at your own risk. The SSD Services Free Case Review is provided "as-is". SSD Services disclaims all warranties with regard to this information, including all implied warranties of merchantability and fitness for a particular purpose. In no event shall SSD Services be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortuous action, arising out of or in connection with the use or performance of this web site, even if SSD Services has been advised of the possibility thereof. SSD Services reserves the right to make changes to any information contained within its web site pages and to make improvements and/or changes in the products and programs described in its web pages at any time and without notice. *Use of this Service is not intended to and does not create an attorney-client relationship between a Subscriber Attorney and any Requestors.
 

Disability Benefits – GET HELP NOW!

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