Ask three firms what a qualified workers’ compensation claimant looks like and you will get three different answers. That is not a problem to be solved. It is the reason a written definition matters more than a vendor’s adjectives.
“Qualified” is not a property of the claimant
The word gets used as though it describes the person. It does not. It describes the fit between a person’s circumstances and a particular firm’s criteria at a particular moment. A claimant who is a strong fit for a firm that takes denied claims may be worthless to a firm that only wants pre-adjuster contact. Neither firm is wrong, and neither claimant is objectively better.
This matters commercially. When a vendor says its leads are qualified without saying qualified against what, the word is doing no work. It cannot be tested, so it cannot be disputed, so it cannot be enforced.
The facts that usually decide it
Across most workers’ compensation practices, the same small set of facts does the heavy lifting:
- Was the person working when the injury happened? The single most disqualifying answer in the category, and the one most often skipped by general injury campaigns.
- Was the incident reported to the employer, and when? Reporting windows are short in many states and an unreported injury weeks after the fact changes the shape of the matter considerably.
- Has treatment started? Some firms want documented treatment before they will spend intake time. Others want to reach the claimant before an adjuster does. Both are defensible; they are opposite instructions.
- Is anyone already representing them? Existing counsel is usually a hard stop, and it is worth asking directly rather than inferring.
- Where did it happen? Not just the state. Venue and county matter to firms with specific admissions or office coverage.
- Is the contact information real? Everything above is worthless if the phone number does not connect.
Where firms under-specify
Most intake criteria are written in the positive: here is what we want. The gaps almost always sit on the negative side. What disqualifies a claimant outright? Is there a minimum injury threshold, and how is it described in words an ordinary person answering a form would understand? What happens with a claimant who reported late but has strong facts otherwise?
Writing the disqualifiers down is uncomfortable because it forces a firm to admit it will turn away business. It is also the fastest way to stop paying for records the intake team was never going to work.
Screening is not evaluation
A screening sequence establishes whether someone meets stated criteria. It does not establish whether a claim is valid, viable, or worth taking. Those are legal judgements and they belong to an attorney who has spoken to the person.
Keeping that line clear protects everyone. A vendor that starts describing claims as strong or promising has drifted into territory it has no business occupying, and a firm that relies on that description has outsourced something it cannot outsource.
A practical test
Take your current criteria and hand them to someone who has never worked in your intake team. Ask them to sort ten past claimants into accept and reject. If they cannot do it, or if their answers do not match what your team would have done, the criteria are not written tightly enough to hold a vendor to. Fix that before you buy anything.