You have a new Workers Comp Lead:
| Field | Value |
|---|---|
| First Name | {first_name} |
| Last Name | {last_name} |
| Phone | {phone_home} |
| City | {city} |
| State | {state} |
| Postal | {zip_code} |
| E-Mail Address | {email_address} |
| Have a Lawyer | {lawyer} |
| Type of Injury | {_type} |
| Fault | {fault} |
| Date | {date} |
| Injured | {injured} |
| Notes | {notes} |