Case Referral Form


Complete the questionnaire below, click “Submit”, and we will be in touch regarding the potential ERISA claim lurking in your client’s case. We can take the ERISA claim from there (if you want), and you get the added benefit of a referral fee.

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 workers' compensation, or seeking lost wages)
Does your client have a sickness or injury, in addition to or other than an injury that occurred in the workplace, that prevents them from working?*
Do you know if your client is covered by short or long term disability (STD or LTD), life insurance, pension, or 401(k)?*
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?*
Max. file size: 15 MB.
Does your client's employer have a website which references benefits? (Do a Google search)*
Is your client's employer a governmental entity or a church entity? (This may take it out of ERISA.)*
Has your client now or previously filed a claim for STD, LTD, dismemberment, or retirement?*
Do you have copies of any letters from an insurance company or pension plan to your client?*
Max. file size: 15 MB.
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 for validation purposes and should be left unchanged.

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