<div class="x-body-el x-container-body-el x-component-body-el x-scroller x-nativescroller x-overflow-x-auto x-overflow-y-auto x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start" id="ext-element-745"><div data-componentid="ext-component-29" class="x-component x-user-selectable-text x-component-bg-white x-component-blue x-layout-box-item x-layout-vbox-item" data-xid="273" id="ext-component-29" njm-id="view-claims-claim-num"><div class="x-innerhtml" id="ext-element-845"><div class="claim-number">Claim Number: <strong>2024-900503</strong></div></div></div><div data-componentid="ext-container-34" class="x-container x-component x-container-bg-white x-component-bg-white x-container-blue x-component-blue x-layout-box-item x-layout-vbox-item" data-xid="274" id="ext-container-34" njm-id="view-claims-hdr-panel"><div class="x-body-el x-container-body-el x-component-body-el x-layout-box x-pack-center x-layout-hbox x-horizontal x-align-stretch x-user-selectable-text x-container-bg-white-body-el x-component-bg-white-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-746"><div data-componentid="ext-button-59" class="x-component x-button x-widthed x-has-text x-icon-align-left x-arrow-align-right x-button-green x-component-green x-layout-box-item x-layout-hbox-item" data-xid="275" id="ext-button-59" njm-id="view-claims-upload-photo" style="margin: 3px 0px 5px !important; width: 200px;"><div class="x-inner-el" id="ext-element-749"><div class="x-body-el" id="ext-element-748"><div class="x-icon-el x-font-icon" id="ext-element-751"></div><div class="x-text-el" id="ext-element-750">Upload Photographs</div></div><div class="x-arrow-el x-font-icon"></div></div><div class="x-badge-el"></div><button class="x-button-el" type="button" id="ext-element-747" data-gb-name="view-claims-upload-photo" data-componentid="ext-button-59"></button></div></div></div><div data-componentid="ext-component-30" class="x-component x-user-selectable-text x-component-bg-white x-component-blue x-layout-box-item x-layout-vbox-item" data-xid="276" id="ext-component-30" njm-id="view-claims-details-info"><div class="x-innerhtml" id="ext-element-846"><table class="overview display-table"><thead><tr><th scope="col">Claim Type</th><th scope="col">Vehicle Involved in Loss</th><th scope="col">Date of Loss</th><th scope="col">Claim Status</th></tr></thead><tbody><tr><td data-label="Claim Type"><strong>Auto</strong> F529119</td><td data-label="Vehicle Involved in Loss">2019 Subaru Crosstrek 2.0 I Limited Awd<br>VIN (JF2GTANC3KH262292)</td><td data-label="Date of Loss">12/05/2024</td><td data-label="Claim Status" class="Open">Open</td></tr></tbody></table></div></div><div data-componentid="ext-panel-9" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item" data-xid="277" id="ext-panel-9" njm-id="view-claims-general-info"><div data-componentid="ext-panelheader-15" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="279" id="ext-panelheader-15"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-753"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-15" data-xid="280" id="ext-paneltitle-15" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-754"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-755" data-title="General Claim Information">General Claim Information</div></div></div><div tabindex="0" data-componentid="ext-paneltool-3" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="327" id="ext-paneltool-3"><div class="x-icon-el x-font-icon x-tool-type-up" id="ext-element-829"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el" id="ext-element-756"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-752"><div data-componentid="ext-component-31" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="278" id="ext-component-31" njm-id="view-claims-general-info-details"><div class="x-innerhtml" id="ext-element-847"><table class="exposures display-table"><thead><tr><th scope="col">Coverage</th><th scope="col">Status</th><th scope="col">Claims Rep</th><th scope="col">Phone</th><th scope="col">Email</th></tr></thead><tbody><tr><td data-label="Coverage">Collision</td><td data-label="Status" class="Open">Open</td><td data-label="Claims Rep">Angie Zingrone</td><td data-label="Phone">609-956-2663</td><td data-label="Email">
[email protected]</td></tr></tbody></table></div></div></div></div></div><div data-componentid="ext-panel-10" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-hidden x-hidden-display x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item" data-xid="281" id="ext-panel-10" njm-id="view-claims-medical-cov-info"><div data-componentid="ext-panelheader-16" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="283" id="ext-panelheader-16"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-758"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-16" data-xid="284" id="ext-paneltitle-16" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-759"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-760" data-title="Medical Coverage Information">Medical Coverage Information</div></div></div><div tabindex="0" data-componentid="ext-paneltool-4" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="328" id="ext-paneltool-4"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-830"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el x-hidden-display" id="ext-element-761"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-757"><div data-componentid="ext-component-32" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="282" id="ext-component-32" njm-id="view-claims-medicalcov-details"></div></div></div></div><div data-componentid="ext-panel-11" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item x-hidden x-hidden-display" data-xid="285" id="ext-panel-11" njm-id="view-claims-hdr-panel"><div data-componentid="ext-panelheader-17" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="287" id="ext-panelheader-17"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-763"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed x-has-icon x-icon-align-right x-paint-monitored" data-componentid="ext-paneltitle-17" data-xid="288" id="ext-paneltitle-17" njm-id="view-claims-subro-info" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-764"><div class="x-icon-el x-font-icon x-help-icon x-fa fa-question-circle" id="ext-element-766"></div><div class="x-text-el" id="ext-element-765" data-title="Subrogation Information">Subrogation Information</div></div><div class="x-paint-monitor cssanimation"></div></div><div tabindex="0" data-componentid="ext-paneltool-5" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="329" id="ext-paneltool-5"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-831"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el x-hidden-display" id="ext-element-770"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-762"><div data-componentid="ext-component-33" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="286" id="ext-component-33" njm-id="view-claims-subro-assign-info"><div class="x-innerhtml" id="ext-element-848"><table class="subrogations display-table"><thead><tr><th scope="col">Subrogation Status</th><th scope="col">Subrogation Rep</th><th scope="col">Phone</th><th scope="col">Email</th></tr></thead><tbody></tbody></table></div></div></div></div></div><div data-componentid="ext-panel-12" class="x-panel x-container x-component x-noborder-trbl x-header-position-top appraisal-repair-panel x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item" data-xid="290" id="ext-panel-12" njm-id="view-claims-repair-shop-info"><div data-componentid="ext-panelheader-21" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="303" id="ext-panelheader-21"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-793"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-21" data-xid="304" id="ext-paneltitle-21" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-794"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-795" data-title="Appraisal and Repair Information">Appraisal and Repair Information</div></div></div><div tabindex="0" data-componentid="ext-paneltool-6" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="330" id="ext-paneltool-6"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-832"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el x-hidden-display" id="ext-element-796"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-771"><div data-componentid="ext-component-34" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="291" id="ext-component-34" njm-id="view-claims-repair-shop-details"><div class="x-innerhtml" id="ext-element-849"><div class="repair-shop"><div style="color: #0077bd; padding-bottom: 8px"><strong>Repair Shop</strong></div><div class="mb5 repair-shop-name"><strong>Modern Auto Body</strong></div><div class="repair-shop-address"><div class="mb5">343 Valley Street, South Orange, NJ 07079</div><div>Phone: 973-763-1149</div></div></div></div></div><div data-componentid="ext-container-35" class="x-container x-component x-layout-box-item x-layout-vbox-item" data-xid="292" id="ext-container-35"><div class="x-body-el x-container-body-el x-component-body-el x-layout-auto" id="ext-element-772" style="padding: 5px 20px 5px 6px !important;"><div data-componentid="ext-panel-13" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-offwhite x-container-offwhite x-component-offwhite x-managed-borders x-layout-auto-item" data-xid="293" id="ext-panel-13" style="margin: 15px 0px !important; max-width: 100%;"><div data-componentid="ext-panelheader-18" class="x-panelheader x-container x-component x-panelheader-offwhite x-container-offwhite x-component-offwhite x-docked-top x-horizontal x-noborder-trl" data-xid="294" id="ext-panelheader-18"><div class="x-dock x-dock-horizontal" id="ext-element-834"><div tabindex="0" data-componentid="ext-paneltool-7" class="x-tool x-component x-paneltool x-paneltool- x-tool-offwhite x-component-offwhite x-paneltool-offwhite x-dock-item x-docked-left x-end" data-xid="331" id="ext-paneltool-7"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-833"></div></div><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-offwhite-body-el x-container-offwhite-body-el x-component-offwhite-body-el" id="ext-element-774"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-layout-box-item x-layout-hbox-item x-flexed x-paneltitle-offwhite x-component-offwhite" data-componentid="ext-paneltitle-18" data-xid="295" id="ext-paneltitle-18" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-775"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-776" data-title="Vehicle Status <span class="x-help-icon x-fa fa-question-circle" style="font-size: 14px"></span>">Vehicle Status <span class="x-help-icon x-fa fa-question-circle" style="font-size: 14px" id="ext-element-779"></span></div></div></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-offwhite-body-wrap-el x-container-offwhite-body-wrap-el x-component-offwhite-body-wrap-el x-hidden-display" id="ext-element-782"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-auto x-panel-offwhite-body-el x-container-offwhite-body-el x-component-offwhite-body-el x-noborder-rbl" style="border-width: 0px; padding: 8px 10px 0px 15px;" id="ext-element-773"><div class="x-innerhtml" id="ext-element-843">Your vehicle may be repairable.</div></div></div></div><div data-componentid="ext-panel-14" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-offwhite x-container-offwhite x-component-offwhite x-managed-borders x-layout-auto-item" data-xid="297" id="ext-panel-14" style="margin: 15px 0px !important; max-width: 100%;"><div data-componentid="ext-panelheader-19" class="x-panelheader x-container x-component x-panelheader-offwhite x-container-offwhite x-component-offwhite x-docked-top x-horizontal x-noborder-trl" data-xid="298" id="ext-panelheader-19"><div class="x-dock x-dock-horizontal" id="ext-element-836"><div tabindex="0" data-componentid="ext-paneltool-8" class="x-tool x-component x-paneltool x-paneltool- x-tool-offwhite x-component-offwhite x-paneltool-offwhite x-dock-item x-docked-left x-end" data-xid="332" id="ext-paneltool-8"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-835"></div></div><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-offwhite-body-el x-container-offwhite-body-el x-component-offwhite-body-el" id="ext-element-784"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-offwhite x-component-offwhite x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-19" data-xid="299" id="ext-paneltitle-19" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-785"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-786" data-title="Appraisal Method">Appraisal Method</div></div></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-offwhite-body-wrap-el x-container-offwhite-body-wrap-el x-component-offwhite-body-wrap-el x-hidden-display" id="ext-element-787"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-auto x-panel-offwhite-body-el x-container-offwhite-body-el x-component-offwhite-body-el x-noborder-rbl" style="border-width: 0px; padding: 8px 10px 0px 15px;" id="ext-element-783"><div class="x-innerhtml" id="ext-element-844">You have chosen one of our Premier Car Care facilities. Contact Modern Auto Body to schedule your appraisal and repairs.</div></div></div></div><div data-componentid="ext-panel-15" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-offwhite x-container-offwhite x-component-offwhite x-managed-borders x-layout-auto-item" data-xid="300" id="ext-panel-15" style="margin: 15px 0px !important; max-width: 100%;"><div data-componentid="ext-panelheader-20" class="x-panelheader x-container x-component x-panelheader-offwhite x-container-offwhite x-component-offwhite x-docked-top x-horizontal x-noborder-trl" data-xid="301" id="ext-panelheader-20"><div class="x-dock x-dock-horizontal" id="ext-element-838"><div tabindex="0" data-componentid="ext-paneltool-9" class="x-tool x-component x-paneltool x-paneltool- x-tool-offwhite x-component-offwhite x-paneltool-offwhite x-dock-item x-docked-left x-end" data-xid="333" id="ext-paneltool-9"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-837"></div></div><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-offwhite-body-el x-container-offwhite-body-el x-component-offwhite-body-el" id="ext-element-789"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-offwhite x-component-offwhite x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-20" data-xid="302" id="ext-paneltitle-20" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-790"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-791" data-title="Appraisal Status">Appraisal Status</div></div></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-offwhite-body-wrap-el x-container-offwhite-body-wrap-el x-component-offwhite-body-wrap-el x-hidden-display" id="ext-element-792"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-auto x-panel-offwhite-body-el x-container-offwhite-body-el x-component-offwhite-body-el x-noborder-rbl" style="border-width: 0px; padding: 8px 10px 0px 15px;" id="ext-element-788"><div class="x-innerhtml" id="ext-element-851">Modern Auto Body will complete and submit your estimate and any supplemental estimates directly to NJM. Our appraisers review all estimates to ensure the greatest care for your vehicle.</div></div></div></div></div></div></div></div></div><div data-componentid="ext-panel-16" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item" data-xid="305" id="ext-panel-16" njm-id="view-claims-rental-info"><div data-componentid="ext-panelheader-22" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="307" id="ext-panelheader-22"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-798"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-22" data-xid="308" id="ext-paneltitle-22" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-799"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-800" data-title="Rental Reservation">Rental Reservation</div></div></div><div tabindex="0" data-componentid="ext-paneltool-10" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="334" id="ext-paneltool-10"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-839"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el x-hidden-display" id="ext-element-801"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-797"><div data-componentid="ext-component-35" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="306" id="ext-component-35" njm-id="view-claims-rental-details"><div class="x-innerhtml" id="ext-element-850"><table class="reservations display-table"><thead><tr><th scope="col">Rental Company</th><th scope="col">Reservation Number</th><th scope="col">NJM Authorized Rate/Type</th></tr></thead><tbody><tr><td data-label="Rental Company">Enterprise</td><td data-label="Reservation Number">WWMVXH</td><td data-label="NJM Authorized Rate/Type">30.00/Daily</td></tr></tbody></table></div></div></div></div></div><div data-componentid="ext-panel-17" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item x-hidden x-hidden-display" data-xid="309" id="ext-panel-17" njm-id="view-claims-medical-info"><div data-componentid="ext-panelheader-23" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="311" id="ext-panelheader-23"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-803"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-23" data-xid="312" id="ext-paneltitle-23" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-804"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-805" data-title="Independent Medical Examination(s)">Independent Medical Examination(s)</div></div></div><div tabindex="0" data-componentid="ext-paneltool-11" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="335" id="ext-paneltool-11"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-840"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el x-hidden-display" id="ext-element-806"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-802"><div data-componentid="ext-component-36" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="310" id="ext-component-36" njm-id="view-claims-medical-details"><div class="x-innerhtml" id="ext-element-852"><table class="exams display-table"><thead><tr><th scope="col">Specialty Information</th><th scope="col">Physician Name</th><th scope="col">Physician Address</th><th scope="col">Phone Number</th><th scope="col">Date of Exam</th></tr></thead><tbody></tbody></table></div></div></div></div></div><div data-componentid="ext-panel-18" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item" data-xid="313" id="ext-panel-18" njm-id="view-claims-docs"><div data-componentid="ext-panelheader-24" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="320" id="ext-panelheader-24"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-818"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-24" data-xid="321" id="ext-paneltitle-24" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-819"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-820" data-title="Claim Documents">Claim Documents</div></div></div><div tabindex="0" data-componentid="ext-paneltool-12" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="336" id="ext-paneltool-12"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-841"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el x-hidden-display" id="ext-element-821"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-807"><div data-componentid="ext-component-37" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="314" id="ext-component-37" njm-id="view-claims-docs-info"><div class="x-innerhtml" id="ext-element-808"><div class="documents"><div class="instruction">Following are your claim specific documents for your reference:</div></div></div></div><div data-componentid="ext-dataview-3" class="x-dataview x-container x-component x-layout-box-item x-layout-vbox-item x-hidden x-hidden-display" data-xid="315" tabindex="0" id="ext-dataview-3" njm-id="view-claims-docs-sitecore-view"><div class="x-body-el x-dataview-body-el x-container-body-el x-component-body-el x-scroller x-nativescroller x-overflow-x-auto x-overflow-y-auto x-show-selection x-layout-auto" id="ext-element-809"></div></div><div data-componentid="ext-component-38" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="316" id="ext-component-38" njm-id="view-claims-docs-onbase-view"><div class="x-innerhtml" id="ext-element-853"><div class="document"><a target="_blank" href="/cssapi/download/529213060">Claim Acknowledgement Auto</a></div></div></div><div data-componentid="ext-container-36" class="x-container x-component x-hidden x-hidden-display x-layout-box-item x-layout-vbox-item" data-xid="317" id="ext-container-36"><div class="x-body-el x-container-body-el x-component-body-el x-layout-auto" id="ext-element-810"><div data-componentid="ext-button-60" class="x-component x-button x-has-text mt20 mb20 theft-qnr-btn x-icon-align-left x-arrow-align-right x-button-link x-component-link x-button-small x-component-small x-layout-auto-item" data-xid="318" id="ext-button-60" style="max-width: 100%;"><div class="x-inner-el" id="ext-element-813"><div class="x-body-el" id="ext-element-812"><div class="x-icon-el x-font-icon" id="ext-element-815"></div><div class="x-text-el" id="ext-element-814">Vehicle Theft Questionnaire (To be completed)</div></div><div class="x-arrow-el x-font-icon"></div></div><div class="x-badge-el"></div><button class="x-button-el" type="button" id="ext-element-811" data-componentid="ext-button-60"></button></div><div data-componentid="ext-container-37" class="x-container x-component page-error x-hidden x-hidden-display x-layout-auto-item" data-xid="319" id="ext-container-37" style="margin: 0px 10px 10px 15px !important;"><div class="x-body-el x-container-body-el x-component-body-el x-layout-auto" id="ext-element-816"><div class="x-innerhtml" id="ext-element-817">An error occurred while requesting the Vehicle Theft Questionnaire form. Please try again later.</div></div></div></div></div></div></div></div><div data-componentid="ext-panel-19" class="x-panel x-container x-component x-noborder-trbl x-header-position-top x-hidden x-hidden-display x-panel-bg-white x-container-bg-white x-component-bg-white x-panel-blue x-container-blue x-component-blue x-managed-borders x-layout-box-item x-layout-vbox-item" data-xid="322" id="ext-panel-19" njm-id="view-payment-details-info"><div data-componentid="ext-panelheader-25" class="x-panelheader x-container x-component x-panelheader-bg-white x-container-bg-white x-component-bg-white x-panelheader-blue x-container-blue x-component-blue x-docked-top x-horizontal x-noborder-trl" data-xid="324" id="ext-panelheader-25"><div class="x-body-el x-panelheader-body-el x-container-body-el x-component-body-el x-layout-box x-layout-hbox x-horizontal x-align-center x-pack-start x-panelheader-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panelheader-blue-body-el x-container-blue-body-el x-component-blue-body-el" id="ext-element-823"><div class="x-unselectable x-paneltitle x-component x-text-align-left x-icon-align-left x-horizontal x-paneltitle-bg-white x-component-bg-white x-paneltitle-blue x-component-blue x-layout-box-item x-layout-hbox-item x-flexed" data-componentid="ext-paneltitle-25" data-xid="325" id="ext-paneltitle-25" style="flex: 1 1 auto;"><div class="x-body-el" id="ext-element-824"><div class="x-icon-el x-font-icon"></div><div class="x-text-el" id="ext-element-825" data-title="Payment Details">Payment Details</div></div></div><div tabindex="0" data-componentid="ext-paneltool-13" class="x-tool x-component x-paneltool x-paneltool- x-tool-bg-white x-component-bg-white x-paneltool-bg-white x-tool-blue x-component-blue x-paneltool-blue x-layout-box-item x-layout-hbox-item x-end" data-xid="337" id="ext-paneltool-13"><div class="x-icon-el x-font-icon x-tool-type-down" id="ext-element-842"></div></div></div></div><div class="x-body-wrap-el x-panel-body-wrap-el x-container-body-wrap-el x-component-body-wrap-el x-panel-bg-white-body-wrap-el x-container-bg-white-body-wrap-el x-component-bg-white-body-wrap-el x-panel-blue-body-wrap-el x-container-blue-body-wrap-el x-component-blue-body-wrap-el x-hidden-display" id="ext-element-826"><div class="x-body-el x-panel-body-el x-container-body-el x-component-body-el x-layout-box x-layout-vbox x-vertical x-align-stretch x-pack-start x-user-selectable-text x-panel-bg-white-body-el x-container-bg-white-body-el x-component-bg-white-body-el x-panel-blue-body-el x-container-blue-body-el x-component-blue-body-el x-noborder-rbl" style="border-width: 0px; padding: 0px;" id="ext-element-822"><div data-componentid="ext-component-39" class="x-component x-layout-box-item x-layout-vbox-item" data-xid="323" id="ext-component-39" njm-id="view-payment-details-info-details"><div class="x-innerhtml" id="ext-element-854"><table class="exposures display-table"><thead><tr><th scope="col">Date</th><th scope="col">Pay To</th><th scope="col">Amount</th><th scope="col">EOB</th></tr></thead><tbody></tbody></table></div></div></div></div></div></div>
