total_compensation
(
nullable: true, editable: true, defaultValue: N/A, alias: What is the total compensation amount being sought after?, type: esriFieldTypeDouble
)
insurance_fraud_disclaimer
(
nullable: true, editable: true, defaultValue: N/A, length: 255, alias: Disclaimer Box, type: esriFieldTypeString
, Coded Values:
[Confirmed: Submitting an appeal for a denied claim to the Utah Department of Transportation (UDOT) through this system does not constitute acceptance by UDOT of any legal, financial, or other type of claims-related liability in any way whatsoever. A request for an appeal submission does not constitute a waiver of any of the provisions or requirements of the Governmental Immunity Act of Utah, Utah Code §§ 63G-7-101 to -904, nor does it serve as sufficiency for a claimant's responsibility to file a notice of claim as required by the Act.]
)
data_disclosure
(
nullable: true, editable: true, defaultValue: N/A, length: 25, alias: Data Disclosure, type: esriFieldTypeString
, Coded Values:
[Confirmed: (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 basic Personally Identifiable Information (PII), such as the name and contact details provided in this form, to process claim requests. This data facilitates loss investigation, claim adjustment, dispute resolution, and claimant communication. De-identified data is also used for research. (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 PII Data Required: Providing complete data is required for processing claims. Claims will not be processed with all of the required information. UDOT intentionally reduces PII data collection to maximize your information privacy. (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 resolution, or program process improvement.]
)
protected_records
(
nullable: true, editable: true, defaultValue: N/A, length: 20, alias: Protected Records, type: esriFieldTypeString
, Coded Values:
[Confirmed: 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.]
)