claim_subtype
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Type of Damage:, type: esriFieldTypeString
)
other
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If other, please describe:, type: esriFieldTypeString
)
damage_description
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide a detailed description of the damage to your vehicle or property:, type: esriFieldTypeString
)
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
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide the contractor name if known:, type: esriFieldTypeString
)
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
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Insurance Fraud Acknowledgment:, 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
(
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
(
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
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Is the point on a state route, type: esriFieldTypeString
)
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. If you feel this is incorrect, please continue filling out the claim form., type: esriFieldTypeString
)
requiredquestions
(
nullable: true, editable: true, defaultValue: null, length: 256, alias: Fields marked with an asterisk are required, and you will not be able to submit a claim if they are left blank., type: esriFieldTypeString
)
snowplow
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Did the incident involve a snow plow?, type: esriFieldTypeString
, Coded Values:
[yes: Yes]
, [no: No]
)
snowplow_info
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: If yes, did you get any information about the plow?, type: esriFieldTypeString
)
policenum
(
nullable: true, editable: true, defaultValue: null, length: 255, alias: Please provide the case number, if known:, type: esriFieldTypeString
)
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, alias: Data Subject Disclosures - § 63G-2-601(2)(a); please acknowledge the following:, type: esriFieldTypeString
, Coded Values:
[Data: (i) Data Collection Need: The Utah Department of Transportation (UDOT) collects claims-related data in order to conduct loss occurrence investigations, facilitate claims adjusting processes, and support the resolution of claim-related disputes. (ii) Limited Use Purpose: This data will be used to investigate reported loss occurrence claims, facilitate the claims adjusting process, assign, tender, and convey claims information and records to appropriate parties that have a specific loss mitigation role directed towards the resolution of a submitted claim. This data will also be used to facilitate ongoing communication and engagement with the claimant. In addition, redacted or de-identified data may be employed to support transportation research, improve the effectiveness of staff training, aid in proactive loss mitigation efforts, and improve longitudinal program performance outcomes. This data is protected against public information releases under Utah GRAMA (§ 63G-2-305(24)) and 23 U.S. Code § 407. It will not be shared, monetized, or otherwise sold to any third-party with data brokering or other commercialization-related interests. (iii) Refusal to Provide Data: A claimant cannot submit a claim without providing sufficient information to complete the claims intake system screens. UDOT will not process partial or incomplete damage claim reports. UDOT does, however, apply a data minimization principle and purposefully narrows structured data collection screens to the minimum the fields necessary to responsibly facilitate core program and process transactions. (iv) Classes of Persons and Governmental Entities Share/Receive Information: This data may be shared with specific UDOT employees that have an essential role in the claims data processing, prevention, mitigation, optimization, and resolution process. This data may also be shared with specific insurance carriers, UDOT contractors, UDOT consultants, state-level executive branch agencies, and others parties that fall within the scope of the expressed limited use purpose.]
)