Personal injury case evaluation form template
PI firms sign a fraction of what they pay to attract, because most inquiries fail one of four tests: too old, too minor, untreated, or at fault. This evaluation runs all four tests in six taps, so case managers spend their callbacks on files with settlement value and statutes still open.
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Open it on your phone. Links to the live demo funnel, not this page.
What's inside this template
Six evaluation questions ordered from effortless to sensitive, contact last. Every answer is one of the criteria intake attorneys screen on, and the ordering matches the structure behind the 34% platform average.
- 1
Accident type
Motor vehicle, slip and fall, work injury, or other, with a follow-up tap refining the category.
engagement_firstconditional_routing - 2
Timeframe
When it happened runs straight against statute-of-limitations math, the hardest disqualifier in PI.
buyer_qualification - 3
Injury severity
Severity bands separate the soft-tissue files from the surgery cases firms compete for.
buyer_qualification - 4
Medical treatment
Treated versus untreated changes case value more than any other single answer after severity.
buyer_qualification - 5
Fault determination
Who was at fault, per the visitor. Clear-liability files route to the front of the callback queue.
intent_captureconditional_routing - 6
Contact details, verified
Name, email, and phone close the evaluation with live checks, consent above the submit.
email_verifyphone_verifytcpa_consent
Built to deliver qualified leads
Same ad spend. Capture 2X the qualified leads. PI media is among the most expensive traffic online, and the doubling comes from screening: statute, severity, treatment, and fault checks mean the retainers come from the same spend that used to buy noise. This evaluation structure averages a 34% conversion lift across the platform.
Case value on arrival
Severity, treatment, and fault answers arrive structured, letting intake rank files by likely settlement range.
Lead scoring →Statute-safe pipelines
Timeframe screening keeps expired claims from consuming case-manager hours.
Lead gen compliance →Claimants who pick up
Verified phones protect the signed-retainer race every PI firm is running against competitors.
Lead verification →PI intake notes
Kept inside the lines by default:
- No settlement-amount promises anywhere in the template copy
- Category answers only, no incident narratives collected on the form
- One-to-one consent above the submit for the firm or network calling back
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Frequently asked questions
Does this replace an attorney consultation?
No. It decides which inquiries earn one. The legal evaluation still happens with counsel; the form just makes sure that time goes to viable claims.
What makes a PI lead qualified?
A qualified lead is one with a verified email, a verified phone, enriched data, and a Contact Score above your threshold, checked before the visitor leaves the page. Severity, treatment, and timeframe answers stack the case screen on top.
Can MVA and premises cases route separately?
Yes. Accident type is a routing key, so vehicle cases, falls, and work injuries can each reach their own firm or desk.
How are at-fault inquiries handled?
Your rules decide: score them out, route them to a different practice, or capture them unbilled for review.
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Run the evaluation as built, or generate one for your case criteria.