Free Disability Claim Evaluation

Social Security Disability and Supplemental Security Income (SSI)

Complete our free disability claim evaluation form today, and one of our attorneys will review your submission. All information you submit is confidential and used only to evaluate your claim and to contact you regarding your claim. All items with an asterisk (*) must be completed. There is no cost and no obligation incurred by your submission.

Please note that under most circumstances, you have only sixty (60) days from the date stamped or printed on the Social Security Administration’s (SSA) notice denying your application for disability benefits. If you are at or near the 60 day deadline, you should go to your local SSA office and file a request for hearing (Form HA-501) to preserve your appeal rights. Submission of this online claim evaluation form will not preserve your appeal rights with SSA.

For assistance with Veterans Benefits claims, please use the Contact Us page or telephone our office.

Matthew D. Lane, Jr.

556 Jefferson St., Suite 102
Lafayette, LA 70501

Phone: (337) 289-5352

Toll Free: (800) 451-0300


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