Free Consultation with Disability Attorneys Dell & Schaefer

We welcome the opportunity to discuss your claim for long-term disability benefits.

If you are considering filing for long-term disability benefits, have been denied or are currently collecting disability benefits we will provide you with a free initial phone consultation to discuss how we may be able to assist you.

Your First Name: (required)

Your Last Name: (required)

Where do you live?

How would you like to be contacted?
Telephone Email No Preference

Your Email: (required)

Your Telephone Number (10 digits):

Have you filed your claim for disability insurance benefits?
yes no

Is this a Short Term (STD) or Long Term Disability (LTD) claim?
STD LTD

Who is your disability insurance company(s)?

What was your occupation at the time you became disabled?

How old were you on the date you became disabled?

What is the amount of your monthly disability income benefit?

What is the disability(s) that prevents you from working?

Is your disability insurance an employer provided benefit?
yes no

What is the status of your disability claim? (optional)

Are you receiving any other benefits such as state disability, social security, worker’s Comp? (If any, please explain.) (optional)

How did you hear about Attorneys Dell & Schaefer?

Please provide your mailing address so we can send you additional information about our firm.

Your address:

City:

State:

ZIP: