Put the award winning POWER of Social Security disability lawyer Tomasz Stasiuk to work on your case! Tell us about your Colorado Social Security disability case, and find out if we can help you! Name* First Last Phone*What is the BEST number to reach you?Email* Enter Email Confirm Email Are you in Colorado?*Yes, I am in ColoradoNo, I am not in ColoradoI am sorry. My office only reviews cases in the State of Colorado. Even though I cannot offer to review your case, you can send me a message below.Message:Acknowledgement* I accept the following: this contact form is not an offer of representation and does not form an attorney-client relationship. What BEST describes your situation?*--I want to apply for disabilityI applied and I am waiting for the decisionI applied and was deniedI am waiting for a hearingMy hearing is scheduled / postponedI was denied by the hearing judgeI was denied by the Appeals CouncilOtherOther:*When did you apply on the CURRENT claim?*When were you DENIED?*Have you filed an appeal?*YesNoWhen did you APPEAL the denial?*What is your judge's name?*TIP: The judge's name is on the Notice of Hearing (in the signature block -- around page 7 or 8).Have you PREVIOUSLY applied for Social Security disability?*NoYesWhat is/was your hearing date?*If your hearing was continued or postponed and you do NOT have a new hearing date yet, list the prior hearing date.Tell me about your prior application(s)*As best as you can recall, how many times you have applied for disability benefits. Please do not count appeals, just new applications. You can estimate if needed. Which DISABILITY PROGRAM are you applying for?*SSD (based on what I paid in to Social Security)SSI (~$750/mo)(not enough credits for SSD)Both SSD & SSII don't knowDo you have a DATE LAST INSURED for disability benefits?*For example: has Social Security noted, "We have determined that your condition was not disabling on any date through, [month day, year] when you were last insured for disability benefits."NoYesI don't knowWhat is the date you were "last insured for disability"?* MM DD YYYY Have you hired a REPRESENTATIVE on this claim?*NoYesAre you looking to hire a new representative or get a second opinion?*I want to hire a new representativeI want a second opinion on my case (but I am not sure I want a new representative)NOTE: if you would like the Stasiuk Firm to take over representation on your disability case, you will need to both a WITHDRAWAL and a WAIVER OF FEES, IN WRITING, from your prior or current representative. If your representative withdraws but does not waive fees, we will not be able to take your case.NOTE: if you are looking for a "second opinion" on your case (but do not necessarily want to hire a new representative), please be advised that a second opinion is a PAID CONSULTATION ($250 up to 60 minutes). Were you in the MILITARY?*NoYes. I am CURRENTLY in the military.Yes. I was PREVIOUSLY in the military.What is your VA impairment rating (if any)?*What is your separation date?*Estimate if needed.How old are you?*Are you currently working?NoYesTip: if you are still employed but on leave, select, "no".When did you last work?*Tell me about your last job:*What did you do? How long were you there? How did it end?Tell me about your job:*What kind of work are you doing? How many hours are you working?Tell me about your DISABILITIES:*List your TOP disabling conditions and tell me how they keep you from being able to work.Have you been seen by your healthcare provider(s) in the last 12 months?This includes your doctor as well as nurses, PAs, LCSWs and other healthcare providers.YesNoWhat kind of doctors are you treating with?*(E.g. primary care, neurologist, orthopedist etc.)One last thing...* I accept the following: this contact form is not an offer of representation and does not form an attorney-client relationship. Super! Click the SUBMIT button and we will be in touch shortly!