PPD/PTD intake that captures impairment and restriction status up
Ask whether the injury happened on the job, whether a doctor has documented permanent restrictions, and whether benefits were denied or reduced — then collect denial letters and medical records before the case ever reaches your CRM.
The exact intake your permanent partial or total disability leads complete
This is the real 7-question guided intake for Permanent Partial or Total Disability — the same flow your customers finish before you ever pick up the phone.
What a qualified permanent partial or total disability lead should tell you
A workers' comp claim where a doctor has assigned lasting impairment or work restrictions, distinguishing permanent partial disability (reduced future earning capacity) from permanent total disability (unable to work in any capacity) after a job-related injury or illness.
- Injury Or Illness Happen
- Working Employer (Not Self-Employed)
- Reported Injury/Illness Employer Or
- Doctor Said Have Lasting
- Condition Kept From Returning
- Workers’ Comp Claim Been
The questions your team needs answered
Every permanent partial or total disability intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Did your injury or illness happen at work or because of your job? | A no answer here means the injury may not qualify as work-related at all, so it drives most of the early filtering. |
| Were you working for an employer (not self-employed) when it happened? | Self-employed claimants often fall outside standard workers' comp coverage, so this answer separates viable employer-based claims from likely non-fits. |
| Have you reported the injury/illness to your employer or started a workers’ comp claim? | Whether a claim has actually been started tells your team if the next step is a consultation or first walking the client through filing paperwork. |
| Has a doctor said you have a lasting impairment or permanent work restrictions because of this injury/illness? | A doctor-documented permanent impairment is the core medical fact that turns a general injury claim into a PPD or PTD case. |
| Has your condition kept you from returning to your old job or from working full-time in the same way as before? | Inability to return to the prior job at the same capacity is the functional signal that distinguishes a disability claim from a routine injury claim. |
| Has your workers’ comp claim been denied, delayed, or have your benefits been reduced or stopped? | A denied, delayed, or reduced claim usually means active benefits are at stake right now, which raises the urgency of a response. |
| Did the injury or illness happen within the last 2 years? | How recently the injury occurred affects how time-sensitive the case is and whether older claims warrant a different intake path. |
How Cliont scores permanent partial or total disability leads
Every answer is weighted automatically — no manual review required.
Value signals
- Injury Or Illness Happen: yes
- Working Employer (Not Self-Employed): yes
- Reported Injury/Illness Employer Or: yes
- Doctor Said Have Lasting: yes
- Condition Kept From Returning: yes
- Workers’ Comp Claim Been: yes
See the lead your team receives
Permanent Partial Disability 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 permanent partial or total disability workflows
| Cliont capability | Permanent Partial Or Total Disability application |
|---|---|
| Weighted lead scoring | Scores rise sharply when a claimant reports a job-related injury, employer status, doctor-confirmed permanent impairment, and inability to return to their old job — the combination most likely to be a viable PPD/PTD case. |
| Document capture | Collects denial or benefit-reduction letters and medical documentation of permanent restrictions directly in the intake, so your team can see claim status before the first call. |
| CRM routing by score band | Sends high-scoring cases with confirmed impairment and denied or reduced benefits into your CRM as priority leads, while lower-fit answers like self-employment status are still logged but flagged for a lighter-touch response. |
| Guided video or form widget | Lets the prospective client describe their injury, restrictions, and claim status in their own words before your team reviews the intake answers. |
Common permanent partial or total disability lead scenarios
Doctor-confirmed permanent impairment
A W-2 employee whose doctor has documented lasting restrictions and who can no longer do their old job full-time — the strongest combination of signals in the catalog.
Benefits denied or reduced mid-treatment
A claimant with a confirmed permanent impairment whose comp payments were cut or denied, pairing high medical severity with an active dispute worth prioritizing.
Injury reported but claim not yet started
The injury happened at work but no claim has been filed, so the intake still scores it but flags the missing paperwork step before a consultation is booked.
Self-employed or contractor injury
The person was hurt on a job site but wasn't an employer's employee, which the intake scores lower since PPD/PTD claims typically require an employment relationship.
Old injury outside the recent window
The injury or illness happened more than two years ago, which the intake weighs lower given the practical timing concerns that come with older claims.
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
Permanent Partial or Total Disability lead-intake FAQs
How does the intake tell a PPD case apart from a PTD case?
It combines the doctor-confirmed permanent impairment answer with whether the person can still work full-time in their old capacity — a permanent restriction plus an inability to return signals PTD, while a restriction alone often points to PPD.
What if the prospective client was hurt on a job site but wasn't technically an employee?
The intake asks directly whether they were working for an employer rather than self-employed, and self-employed responses score lower since most PPD/PTD claims depend on an employer-employee relationship.
Can the intake flag claims that were already denied or reduced?
Yes, the intake asks whether benefits have been denied, delayed, reduced, or stopped, and this answer weighs heavily toward prioritizing the lead for follow-up.
Does the intake check whether the injury happened too long ago to matter?
It asks whether the injury or illness occurred within the last two years, and older injuries are weighted lower so your team can see timing concerns before booking time.
What if the person hasn't reported the injury or filed a claim yet?
The intake still captures the case and scores it, but a 'not yet filed' answer is weighted lower than an active claim so your team knows there's a filing step outstanding.
How is this different from the Denied Claim Appeals or Lump Sum Settlements intake?
This intake is built around impairment ratings and ability to return to work; Denied Claim Appeals focuses on disputing a denial itself, and Lump Sum Settlements is built around a claimant looking to close out an existing claim.
Turn permanent partial or total disability visitors into qualified cases
Give every permanent partial or total disability visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.