Workers' Compensation and Social Security Disability Specialist
Law Offices of Robert B. Williams
 
CONTACT INFORMATION


LAW OFFICE OF ROBERT B. WILLIAMS

33 North LaSalle Street
Suite 2119
Chicago, Illinois 60602

312.782.9400
312.444.9400 fax

   info@ilworkerscomp.com
   rbw@ilworkerscomp.com

   Location Map

 


Name: *
Date of Birth:  
Address:
City:
State: Zip:
Area Code &
Phone Number
:
- *
Area Code &
Cell Phone#
:
-
Email Address: *
Are You Currently Working?
YES NO
Date of latest employment:  
Your job position at above date:
Date did you become disabled?  
Have you already applied for
Social Security Disability?
YES NO
If Yes, when?  
At what stage is you claim?
Are you currently under the
care of a doctor or physician?
YES NO
other pertinate information
regarding your disability?