Death benefits intake that captures dependent relationship up front
Ask whether the death was job-related, confirm the claimant's relationship to the deceased, and flag any prior benefit denials before a consultation gets booked. Death certificates and denial correspondence are collected upfront so your team reviews complete files, not first-call guesswork.
The exact intake your death benefits leads complete
This is the real 7-question guided intake for Death Benefits — the same flow your customers finish before you ever pick up the phone.
What a qualified death benefits lead should tell you
A workers' compensation death benefits claim filed by a dependent or family member after an employee dies from a job-related injury or illness, seeking wage-replacement or burial benefits from the employer's insurer.
- Person Pass Away Because
- Injury Or Illness Happen
- Person Employee (Not Independent
- Close Family Member Or
- Death Happen Within Last
- Employer Located In United
- Workers’ Compensation Death-Benefits Claim
The questions your team needs answered
Every death benefits intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Did the person pass away because of an injury or illness related to their job? | Confirms the death arose from a job-related injury or illness, the core causation fact required to file a death benefits claim at all. |
| Did the injury or illness happen while the person was working or doing something for their employer? | Establishes the death occurred within the course of employment, distinct from an off-the-job cause even if job-related. |
| Was the person an employee (not an independent contractor) at the time? | Independent contractors are typically excluded from workers' compensation death benefits, so employment classification determines basic eligibility. |
| Are you a close family member or dependent of the person who passed away (such as a spouse, child, or someone they supported financially)? | Only a dependent or close family member generally has standing to pursue the claim, so this identifies whether the inquirer is a qualifying claimant. |
| Did the death happen within the last 3 years? | Death benefits claims are subject to filing deadlines, so how recently the death occurred signals whether a timing issue may exist. |
| Was the employer located in the United States when this happened? | U.S. jurisdiction confirms the claim falls under a state workers' compensation system your firm can pursue. |
| Has a workers’ compensation death-benefits claim already been denied or benefits stopped? | A prior denial or stopped benefits signals the matter may need an appeal strategy rather than a first-time filing. |
How Cliont scores death benefits leads
Every answer is weighted automatically — no manual review required.
Value signals
- Person Pass Away Because: yes
- Injury Or Illness Happen: yes
- Person Employee (Not Independent: yes
- Close Family Member Or: yes
- Death Happen Within Last: yes
- Employer Located In United: yes
See the lead your team receives
Death Benefits Lead
From first click to qualified lead
Follow people and businesses seeking counsel through one smooth, guided flow.
They land & meet you
Your video greeting plays instantly — a real face instead of a blank form.
They explain the matter
Smart questions adapt to their matter and capture the full scope.
They share the documents
The facts, dates, and any paperwork come attached, so you can assess the matter before the consultation.
You get a ready lead
Scored and qualified — waiting for you to win it.
Built for death benefits workflows
| Cliont capability | Death Benefits application |
|---|---|
| Weighted scoring engine | Weighs job-relatedness, employment status, and dependent relationship heaviest, so a spouse of an employee who died on the job scores well above a distant relative asking about a contractor. |
| Conditional routing | A 'yes' on prior claim denial can be flagged for denied claim appeals context rather than treated as a first-time death benefits filing. |
| Document collection | Requests the death certificate and relationship documentation during intake instead of leaving your staff to chase them after the first call. |
| Disqualifying-answer detection | Flags cases where the deceased was an independent contractor or the death occurred outside the recent filing window so they don't consume a full consultation slot. |
Common death benefits lead scenarios
Recent workplace fatality, spouse inquiring
A spouse reports a job-related death within the last three years at a U.S. employer with no prior claim history — the intake confirms employment status and dependent relationship and routes this straight to a high-priority review.
Independent contractor status unclear
The deceased may have been classified as a contractor rather than an employee, which changes eligibility for death benefits — the intake flags this before staff spend time on a matter outside the practice.
Prior death-benefits claim already denied
A family member reports that benefits were previously stopped or a claim already denied — the intake captures this so the file can be routed toward denied claim appeals instead of a fresh filing.
Death occurred outside the recent window
An inquirer describes a death that happened well over three years ago, raising a potential timing issue — the intake surfaces this early so it can be screened before a consultation is scheduled.
Non-dependent inquiring on someone else's behalf
A friend or distant relative who is not a spouse, child, or financial dependent submits the inquiry — the intake distinguishes this from a qualifying claimant before it reaches your CRM.
Connect Cliont to your workflow
Send leads
HubSpot, HighLevel, Salesforce, JobNimbus
Book matters
Google Calendar, Outlook Calendar, Calendly
Notify your team
Email, SMS, Slack
Automate follow-up
Zapier, Webhooks, API
Simple, transparent pricing
Choose the plan that works for your business.
Professional
Unlimited intake forms and leads for your growing business.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Advanced analytics dashboard
Pay Per Lead
Only pay when you receive a qualified lead.
- Unlimited intake forms
- Custom video greetings
- AI-powered voice bot
- English + Spanish support
- Automatic lead scoring
- Digital estimates & e-signatures
- Photo, video & file upload
- Charged only for submitted leads
More workers compensation intake templates
Death Benefits lead-intake FAQs
How does the intake confirm the death was actually work-related?
It asks directly whether the death resulted from a job-related injury or illness and whether it happened while the person was working or performing a work duty, giving your team the two core causation facts before any call.
What if the person contacting us isn't the spouse or a dependent?
The intake asks whether the inquirer is a close family member or financial dependent of the deceased, since only that group typically has standing to pursue death benefits — non-dependents are still logged but scored differently.
Does the intake catch cases where a claim was already denied?
Yes, it asks whether a death-benefits claim has already been denied or benefits stopped, which helps you distinguish a new filing from a matter better suited to your denied claim appeals workflow.
How does the form handle independent contractor questions?
It asks whether the deceased was an employee rather than an independent contractor, since that classification directly affects eligibility for workers' compensation death benefits.
Does the intake flag claims that might be past the filing window?
It asks whether the death occurred within the last three years, giving your team an early signal on cases that may raise timing or statute concerns before you commit consultation time.
What documents does the intake collect before a claim reaches our CRM?
It's built to gather a death certificate, proof of the claimant's relationship to the deceased, and any denial correspondence, so files arrive with supporting documentation instead of just a narrative.
Turn death benefits visitors into qualified cases
Give every death benefits visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.