constzone
(
modelName: constzone, nullable: true, editable: true, defaultValue: null, length: 255, alias: Did the damage occur in a construction zone?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
constzone_contractor
(
modelName: constzone_contractor, nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide the contractor name if known:, type: esriFieldTypeString
)
description
(
modelName: description, nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide a detailed description of the incident in which alleged damage occurred:, type: esriFieldTypeString
)
fraud_disclaimer
(
modelName: fraud_disclaimer, nullable: true, editable: true, defaultValue: null, length: 255, alias: Insurance Fraud Disclaimer:, type: esriFieldTypeString
, Coded Values:
[Fraud: It is a crime to present a written statement or representation in connection with a civil claim asserted for recovery of damages for personal or bodily injuries or property damage; and knowing that the statement or representation contains false, incomplete, or fraudulent information concerning any fact or thing material to the claim. § 76-6-521 Fraudulent insurance act.]
)
acknowledgement
(
modelName: acknowledgement, nullable: true, editable: true, defaultValue: null, length: 255, alias: Please confirm the following:, type: esriFieldTypeString
, Coded Values:
[Confirm: I confirm that all information in this form is accurate and true to the best of my knowledge.]
)
privateinsurance
(
modelName: privateinsurance, nullable: true, editable: true, defaultValue: null, length: 255, alias: Have you filed a claim with your homeowner's or auto insurance?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
isstateroute
(
modelName: isstateroute, nullable: true, editable: true, defaultValue: null, length: 255, alias: Is the point on a state route, type: esriFieldTypeString
)
routenote
(
modelName: routenote, nullable: true, editable: true, defaultValue: null, length: 255, alias: Looks like the route you chose is not a state route - please contact your local municipality., type: esriFieldTypeString
)
snowplow_info
(
modelName: snowplow_info, nullable: true, editable: true, defaultValue: null, length: 255, alias: If yes, did you get any information about the plow?, type: esriFieldTypeString
)
policenum
(
modelName: policenum, nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide the case number, if known:, type: esriFieldTypeString
)
protectedrecords
(
modelName: protectedrecords, nullable: true, editable: true, defaultValue: null, length: 255, alias: Protected Records Classification Notice; please acknowledge the following:, type: esriFieldTypeString
, Coded Values:
[Confirm: The data collected through this claims intake system including; any associated attachments, file uploads, and derivative data analytics-based information constitute records are part of a protected loss occurrence investigation that may be used for the purpose of identifying, evaluating, or planning the safety enhancement of potential accident sites or hazardous roadway conditions. As such, all associated records are expressly protected against public records release, discovery, and admission per Utah GRAMA - § 63G-2-305(24) and 23 U.S. Code § 407.]
)
datadisclaimer
(
nullable: true, editable: true, defaultValue: null, length: 255, type: esriFieldTypeString, modelName: datadisclaimer, alias: Data Subject Disclosures - § 63G-2-601(2)(b); please acknowledge the following:
, Coded Values:
[Data: (i) Identified Record Series: The Claims-related record series is tied to UDOT's General Retention Schedule (GRS). See GRS 9135 for more information. (ii) Collection Reason: UDOT collects claims-related data to investigate loss occurrences, adjust claims, and support the resolution of claim-related disputes. This data is also used for claimant communication and research (with data de-identified). (iii) Limited Use Purpose: This claims-related data will be used solely for investigating submitted loss occurrence claims, facilitating the claims adjusting process, assigning, tendering, and conveying claims information to parties involved in loss mitigation and claim resolution, communicating and engaging with you, the claimant, throughout the process, and utilizing redacted or de-identified data for transportation research, staff training, proactive loss mitigation, and program performance evaluation. This data will not be sold, shared for commercial purposes, or provided to third parties for data brokering. (iv) Minimum Data Required: Providing complete data is required for processing claims. Claims will not be processed with all of the required information. (v) Data Sharing: Claims data may be shared with UDOT employees, insurance carriers, contractors, state agencies, and other relevant parties essential to the expressed limited use purpose of resolving the claim. ]
)