See work restrictions and denied-payment details before the
The intake walks prospective clients through job-related injury details, doctor-ordered work restrictions, and any denied or reduced payments, then collects medical notes and pay stubs so you see wage-loss exposure before you book a consultation.
The exact intake your temporary disability benefits leads complete
This is the real 7-question guided intake for Temporary Disability Benefits — the same flow your customers finish before you ever pick up the phone.
What a qualified temporary disability benefits lead should tell you
Wage-replacement payments owed to a worker who cannot perform their job, or can only work reduced or restricted duties, because of a job-related injury or illness while their workers' compensation claim is open.
- Injury Or Illness Happen
- Working Employer (Not Self-Employed)
- Doctor Tell Miss Work,
- Missed At Least One
- Report Injury Or Illness
- Filed Workers’ Compensation Claim
- Temporary Disability Payments Been
The questions your team needs answered
Every temporary disability benefits intake asks these — and why each one matters.
| Question | Why it matters |
|---|---|
| Did your injury or illness happen because of your job or while you were doing work duties? | Confirming the injury happened on the job is the foundational eligibility gate for any temporary disability claim. |
| Were you working for an employer (not self-employed) when this happened? | A self-employed answer scores near the disqualifying end because temporary disability benefits generally require an employer/insurer relationship. |
| Did a doctor tell you to miss work, reduce your hours, or restrict your duties because of this condition? | A doctor-ordered restriction is the medical proof of disability that temporary benefits are meant to compensate, so it carries top weight. |
| Have you missed at least one full day of work or lost wages because of this condition? | Confirming actual lost work days verifies there is measurable wage loss behind the claim, not just a diagnosis. |
| Did you report the injury or illness to your employer within 30 days of when it happened (or when you first realized it was work-related)? | Late reporting can give an insurer grounds to contest the claim, so this answer flags a potential defense issue early. |
| Have you filed a workers’ compensation claim or asked your employer/insurer for temporary disability payments? | Whether a claim has already been filed tells staff if the lead needs proactive outreach or is already mid-dispute. |
| Have your temporary disability payments been denied, delayed, stopped, or paid at an amount you believe is too low? | A denied, delayed, or underpaid answer is the highest-weighted signal in the catalog, marking an active dispute worth attorney time. |
How Cliont scores temporary disability benefits leads
Every answer is weighted automatically — no manual review required.
Value signals
- Injury Or Illness Happen: yes
- Working Employer (Not Self-Employed): yes
- Doctor Tell Miss Work,: yes
- Missed At Least One: yes
- Report Injury Or Illness: yes
- Filed Workers’ Compensation Claim: yes
See the lead your team receives
Temporary Disability 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 temporary disability benefits workflows
| Cliont capability | Temporary Disability Benefits application |
|---|---|
| Weighted scoring engine | Weights a denied, delayed, or underpaid answer above a first-time filing, so active payment disputes reach the CRM as higher-priority than routine wage-loss claims. |
| Answer-based lead segmentation | Separates claimants who confirm an employer relationship and job-related injury from self-employed respondents, who score lower on the core eligibility questions. |
| Document upload capture | Collects the doctor's work-restriction note and pay stubs during intake so wage-loss exposure is visible before the consultation, not requested afterward. |
| CRM routing | Sends only claimants who clear the work-relatedness and employer-relationship questions into your CRM, keeping non-employee injuries out of the consultation queue. |
Common temporary disability benefits lead scenarios
Payments denied or cut short
A claimant with an open case reports their temporary disability payments were denied, delayed, or reduced, which flags the highest-weight signal in the catalog and pushes the lead to the top of the queue.
Injured but hasn't filed yet
The claimant confirms a job-related injury, employer relationship, and doctor-ordered restriction, but hasn't yet filed a claim, so the intake still qualifies the case even though outreach to the insurer hasn't started.
Reported the injury late
The claimant admits they told their employer more than 30 days after the injury, a weaker answer that surfaces a possible timeliness defense the reviewing attorney needs to see before the call.
Self-employed on a job site
The claimant was hurt while working but confirms they weren't an employer's employee, which weakens the case against a workers' comp claim and lets staff route it for a quick fit check instead of a full consultation.
Restricted duty, no lost wages
A doctor has limited the claimant's hours or duties but they haven't yet missed a full day of pay, distinguishing an early-stage restriction case from a confirmed wage-loss claim.
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
Temporary Disability Benefits lead-intake FAQs
How does the intake separate a real temporary disability case from a general injury inquiry?
It walks the claimant through whether the injury happened on the job, whether they were an employer's employee rather than self-employed, and whether a doctor actually ordered missed work or restricted duty before scoring the lead.
What happens when a prospect says their payments were already denied or reduced?
That answer carries the highest weight in the catalog, so denial, delay, or underpayment disputes are scored and routed to your CRM as priority leads rather than blended in with first-time filings.
Can the intake flag someone who's actually self-employed?
Yes, the employer-relationship question is weighted so a self-employed answer scores much lower, since temporary disability benefits generally require an employer/insurer relationship.
Does it catch late reporting that could hurt the claim?
It asks whether the injury was reported to the employer within 30 days, and a late answer is weighted lower so your team can review the timeliness issue before the consultation instead of during it.
What documents does the intake collect before a consultation?
It requests a doctor's work-restriction note, recent pay stubs showing lost wages, and any denial or delay letter, so you can review wage-loss evidence before scheduling time.
How is this different from the Lump Sum Settlements or Permanent Partial or Total Disability intakes?
This intake focuses on active wage-loss questions like missed work days and current payment status, while the settlement and permanent-disability intakes on those sibling pages ask about case resolution stage and disability rating instead.
Turn temporary disability benefits visitors into qualified cases
Give every temporary disability benefits visitor a guided intake instead of a dead contact form — and get a scored, qualified lead before you book a consultation.