ERISA Case Referral Form - Alabama - The Martin Law Group, LLC

Complete the questionnaire below, click submit, and we will be in touch about the potential ERISA claim in your client's case. We can take the ERISA claim from there (if you want), and you will receive a referral fee.

Referring Attorney Name * This field is required.
Referring Attorney Email * This field is required.
Referring Attorney Phone * This field is required.
Type of Case * This field is required.
Is your client unable to perform most of their occupational duties full time? (May be eligible even if able to work part time, or if covered by worker's compensation, or if seeking lost wages) * This field is required.
If yes, please provide us with more detail.
Does your client have a sickness or injury, in addition to or other than the injury that occurred in the workplace, that prevents them from working? * This field is required.
If yes, please provide us with more detail.
Do you know if your client is covered by short or long term disability (STD or LTD), life insurance, pension, or 401(k)? * This field is required.
If yes, please provide us with more detail.
Do you have a copy of a recent paycheck stub showing a deduction / contribution for LTD, STD, Life Insurance, Pension, or 401(k) for your client? * This field is required.
Does your client's employer have a website that references benefits? (Do a Google search) * This field is required.
If yes, please provide us with the web address.
Is your client's employer a governmental entity, or a church entity? (This might take it out of ERISA) * This field is required.
Has your client now or previously filed a claim for STD, LTD, dismemberment, or retirement? * This field is required.
If yes, please provide us with more detail.
Do you have any copies of any letters from an insurance company or pension plan to your client? * This field is required.
Did your client's employer give them a notice of their right to continue their life insurance or to convert it to a private policy? * This field is required.
If yes, please provide us with more detail.

ERISA Case Referral Form - Alabama - The Martin Law Group, LLC

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