Notes

Notes - notes.io

<body class="pb-lg-0 policy-body-pb-270px">
<header class="header policy-header">
<div class="container">
<nav class="navbar navbar-expand-lg">
<div class="container-fluid">
<div class="navbar-brand">
<img class="login-header-logo">
</div>
<button class="navbar-toggler" type="button" data-bs-toggle="collapse" data-bs-target=".navbar-collapse" aria-controls="navbarSupportedContent" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="navbar-collapse collapse" id="navbarContent">
<ul class="navbar-nav policy-header-navbar m-auto">
<li class="nav-item">
<a class="nav-link" href="/policyholder/Policy/Home">Overview</a>
</li>
<li class="nav-item dropdown">
<a class="nav-link dropdown-toggle" role="button" data-bs-toggle="dropdown" aria-expanded="false">
Policies
</a>
<ul class="dropdown-menu">
<li><h6 class="dropdown-header">Active Policies</h6></li>
<li><a class="dropdown-item" href="/policyholder/Policy/AccessPolicy?policyId=5564667&imageNum=6">GAF20049478: Verve 1.1</a></li>
</ul>
</li>
<li class="nav-item">
<a class="nav-link" href="/policyholder/Billing/BillingPaymentsHome">Payments</a>
</li>
<li class="nav-item">
<a class="nav-link" href="/policyholder/Claims/ClaimsHome">Claims</a>
</li>
<li class="nav-item text-nowrap d-xl-none">
<a class="nav-link" data-bs-toggle="modal" data-bs-target="#myAgentModal">My Agent</a>
</li>
<li class="nav-item d-none d-lg-flex d-xl-none">
<a class="nav-link policy-header-userbar" href="/policyholder/AccountHome?userId=21611">
<div class="avatar-circle">
<span class="initials">MP</span>
</div>
<div class="icon-arrow-carrot-down account-settings-arrow"></div>
</a>
</li>
<li class="nav-item text-nowrap d-lg-none">
<a class="nav-link policy-header-userbar" href="/policyholder/AccountHome?userId=21611">
<div class="avatar-circle">
<span class="initials">MP</span>
</div>
<div>Mistyq Park</div>

</a>
</li>
<li class="nav-item text-nowrap d-lg-none">
<a class="nav-link" href="/policyholder/Login/Logout?userId=21611">
<span class="spinner-border spinner-border-sm d-none" aria-hidden="true"></span>
<span class="icon-logout fw-bold"></span> Log Out
</a>
</li>
<li class="nav-item text-nowrap d-lg-none">
</li>
</ul>
<div class="policy-header-accountbar d-none d-xl-flex col-4">
<div class="nav-item d-none d-xl-flex col-4">
<a class="nav-link policy-header-myagent-link" data-bs-toggle="modal" data-bs-target="#myAgentModal">My Agent</a>
</div>
<div class="nav-item policy-header-userbar col-8">
<div class="d-flex d-lg-none d-xxl-flex">Mistyq Park</div>
<div class="p-1">
<div class="avatar-circle">
<span class="initials">MP</span>
</div>
</div>
<a class="btn icon-arrow-carrot-down account-settings-arrow d-none d-xl-flex" role="button" href="/policyholder/AccountHome?userId=21611"></a>
</div>
</div>
</div>
</div>
</nav>
</div>
</header>
<main role="main" class="container padding-header-height padding-footer-height mb-5">
<div class="container">
<div class="mb-3">
<a class="link-primary mb-3 w-auto" href="/policyholder/Policy/Home">
<span class="icon-arrow-left me-2 text-decoration-none d-inline-block"></span>Back to Overview
</a>
</div>
<div class="row d-flex justify-content-lg-between mb-4 mb-lg-5">
<div class="col-9 text-start mb-5 mb-lg-0">
<h2>Claims</h2>
</div>
<div class="col-12 col-lg-3 align-self-center text-end text-nowrap">
<a class="btn btn-primary w-100" data-bs-toggle="modal" data-bs-target="#fileClaimModal">
<span class="icon-edit"></span> Submit a new claim</a>
</div>

<div class="modal" id="fileClaimModal" tabindex="-1" aria-labelledby="fileClaimModalLabel" aria-hidden="true">
<div class="modal-dialog modal-fullscreen px-xl-5">
<div class="modal-content">
<div class="modal-header">
<div class="modal-title" id="fileClaimModalLabel">
<span class="icon-claim"></span>
<div>File a Claim</div>
</div>
<button type="button" class="btn-close" aria-label="Close" data-bs-dismiss="modal" id="modalClose">
</button>
</div>
<div class="modal-body p-0">
<form id="SubmitClaimForm" method="post" enctype="multipart/form-data">
<div class="row">
<div class="col-1"></div>
<div class="col-10 col-xxl-5 pt-5 px-5">
<div class="fw-bold">Which policy do you want to file a claim to?</div>
<div class="text-muted mb-4" style="font-size: small">Select a policy.</div>

<div class="d-flex flex-column" role="group" aria-label="Vertical Policy radio group">
<div class="form-check">
<input type="radio" class="btn-check claimPolicyRadio card-highlight-col" name="ClaimPolicyInfo" value="5564667 _ 6 _ 17" id="claimpolicy_5564667" data-policyid="5564667" data-policyimagenum="6" data-versionid="17" data-val="true" data-val-required="Please select a Policy">
<label class="btn text-start card card-highlight mb-2" for="claimpolicy_5564667">
<div class="row card-body">
<div class="col-auto">
<span class="icon-auto-policy d-flex flex-nowrap fs-1"><span class="path1"></span><span class="path2"></span><span class="path3"></span><span class="path4"></span><span class="path5"></span><span class="path6"></span><span class="path7"></span></span>
</div>
<div class="col-auto">
<div class="fw-bold">Verve 1.1</div>
<div class="text-muted" style="font-size: small">GAF20049478</div>
</div>
</div>
</label>
</div>
</div>
<span class="text-danger field-validation-valid" data-valmsg-for="ClaimPolicyInfo" data-valmsg-replace="true"></span>

<hr class="my-5">

<div class="fw-bold">Were any risks involved?</div>
<div id="riskOptions">
</div>

<hr class="my-5">

<div class="fw-bold">When did this loss happen?</div>
<p class="text-muted mb-4" style="font-size: small">Select a loss date.</p>
<div class="col-6">
<label class="form-label" for="LossDate">DATE TIME</label>
<input class="form-control" id="lossDate" type="datetime-local" data-val="true" data-val-remote="'LossDate' is invalid." data-val-remote-additionalfields="*.LossDate" data-val-remote-url="/policyholder/Claims/ValidateLossDate" data-val-required="Please enter a Loss Date" name="LossDate" value=""><input name="__Invariant" type="hidden" value="LossDate">
</div>
<span class="text-danger field-validation-valid" data-valmsg-for="LossDate" data-valmsg-replace="true"></span>

<hr class="my-5">

<div class="fw-bold">What type of loss did you experience?</div>
<p class="text-muted mb-2" style="font-size: small">Select the type of loss.</p>
<label class="form-label mb-2">TYPE OF LOSS</label>
<div id="lossTypeOptions">
</div>

<hr class="my-5">

<div class="fw-bold">Can you describe this incident?</div>
<p class="text-muted" style="font-size: small">Include a detailed description of the loss. <span id="text-counter">2048</span> characters remaining.</p>
<label class="form-label">DETAILED DESCRIPTION</label>
<textarea class="form-control" style="height: auto" id="lossDescription" name="LossDescription" rows="4" maxlength="2048" data-val="true" data-val-required="Please describe your incident"></textarea>
<span class="text-danger field-validation-valid" data-valmsg-for="LossDescription" data-valmsg-replace="true"></span>

<hr class="my-5">

<div class="fw-bold">Do you have any documents or photos to include?</div>
<p class="text-muted" style="font-size: small">Upload any documents or photos to include with your claim. This includes any bills, reports or photos of loss / damages.</p>
<div class="mb-3">
<label class="btn btn-secondary w-50" for="documentUpload"><span class="icon-upload"></span> Upload documents</label>
<input type="file" multiple="" class="form-control" id="documentUpload" style="display:none">
</div>
<div id="includedFiles"></div>

<hr class="my-5">

<div class="fw-bold">Is this the best way to reach you?</div>
<p class="text-muted" style="font-size: small">Confirm your contact information, or adjust it so we can send you any updates.</p>
<div class="card card-body p-4">
<div class="text-muted mb-4">CONTACT INFORMATION</div>
<div class="mb-4">
<label class="form-label text-muted">NAME</label>
<div class="row">
<div class="col-12 col-lg-6 mb-4 mb-lg-0">
<div class="input-group">
<input type="text" id="firstName" class="form-control" placeholder="First Name" data-val="true" data-val-required="First Name is required" name="ContactInfo.FirstName" value="Mistyq">
<img class="input-icon" src="/policyholder/images/icons/ui/person.svg">
</div>
</div>
<div class="col-12 col-lg-6">
<div class="input-group">
<input type="text" id="lastName" class="form-control" placeholder="Last Name" data-val="true" data-val-required="Last Name is required" name="ContactInfo.LastName" value="Park">
<img class="input-icon" src="/policyholder/images/icons/ui/person.svg">
</div>
</div>
</div>
</div>
<div class="mb-4">
<label class="form-label text-muted">ADDRESS</label>
<div class="row mb-3">
<div class="col-4 col-sm-3 pe-1 mb-3 mb-lg-0">
<input type="text" class="form-control" id="streetNum" placeholder="Street #" data-val="true" data-val-required="Street Number is required" name="ContactInfo.StreetNum" value="85">
</div>
<div class="col-8 col-sm-9 col-lg-7 ps-1 pe-lg-1">
<input type="text" class="form-control" id="streetName" placeholder="Street Name" data-val="true" data-val-required="Street Name is required" name="ContactInfo.StreetName" value="Deerfield Cir">
</div>
<div class="col-12 col-lg-2 ps-lg-1">
<input type="text" class="form-control" id="unitNum" placeholder="Unit #" name="ContactInfo.UnitNum" value="B">
</div>
</div>
<div class="row">
<div class="col-12 col-lg-7 pe-lg-1 mb-3 mb-lg-0">
<input type="text" class="form-control" id="city" placeholder="City" data-val="true" data-val-required="City is required" name="ContactInfo.City" value="ELLAVILLE">
</div>
<div class="col-6 col-lg-3 pe-1 px-lg-1">
<select class="form-select" id="state" aria-label="State" data-val="true" data-val-required="State is required" name="ContactInfo.State">
<option selected="" value="">State</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA" selected="selected">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="PR">PR</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
</select>
</div>
<div class="col-6 col-lg-2 ps-1">
<input type="text" class="form-control" id="zip" placeholder="Zip" maxlength="5" data-val="true" data-val-required="Zip Code is required" name="ContactInfo.ZipCode" value="31806-3258">
</div>
</div>
</div>
<div class="mb-4">
<label class="form-label text-muted">PHONE</label>
<div class="input-group">
<input type="tel" id="claimPhone" class="form-control phone" placeholder="(000)000-0000" maxlength="13" pattern="([0-9]{3})[0-9]{3}-[0-9]{4}" data-val="true" data-val-required="Phone Number is required" name="ContactInfo.HomePhone" value="">
<img class="input-icon" src="/policyholder/images/icons/ui/phone.svg">
</div>
</div>
<div class="mb-4">
<label class="form-label text-muted">EMAIL</label>
<div class="input-group">
<input type="text" id="claimEmail" class="form-control" placeholder="Email Address" data-val="true" data-val-required="Email is required" name="ContactInfo.Email" value="[email protected]">
<img class="input-icon" src="/policyholder/images/icons/ui/email.svg">
</div>
</div>
</div>

<hr class="mt-5">

<div class="row mb-3">
<div class="col-12 col-lg-6 mb-3 mb-lg-0">
<button type="submit" class="btn btn-primary w-100">
<span class="spinner-border spinner-border-sm d-none" aria-hidden="true"></span>
Submit Claim
</button>
</div>
<div class="col-12 col-lg-6">
<button type="button" class="btn btn-secondary w-100" data-bs-dismiss="modal">
Cancel
</button>
</div>

</div>
<p class="text-muted mb-3" style="font-size: small">By clicking "Submit Claim" you acknowledge that all information is valid and accurate.</p>
</div>
<div class="col-1"></div>
<div class="col-lg-6 col-xxl-5 modal-bg-primary d-none d-xxl-block">
<div class="card card-body mx-5 mt-5 p-4">
<div class="text-muted mb-2">CLAIM SUMMARY</div>
<span class="text-start" id="selectedClaimPolicy">-</span>

<hr class="my-3">

<div class="row mb-2">
<span class="col text-muted">Risks</span>
<span class="col fw-bold text-end" id="selectedRisks">-</span>
</div>
<div class="row mb-2">
<span class="col text-muted">Loss Date</span>
<span class="col fw-bold text-end" id="selectedLossDate">-</span>
</div>
<div class="row mb-2">
<span class="col text-muted">Type of Loss</span>
<span class="col fw-bold text-end" id="selectedLossType">-</span>
</div>
<div class="row mb-2">
<span class="col text-muted">Files Included</span>
<span class="col fw-bold text-end" id="selectedFiles">-</span>
</div>

<hr class="my-3">

<div class="row mb-2">
<span class="col text-muted">Contact Name</span>
<span class="col fw-bold text-end" id="selectedName">-</span>
</div>
<div class="row">
<span class="col text-muted">Contact Address</span>
<span class="col fw-bold text-end" id="selectedStreetAddress">-</span>
</div>
<div class="row mb-2">
<span class="col fw-bold text-end" id="selectedCityAddress">-</span>
</div>
<div class="row mb-2">
<span class="col text-muted">Contact Phone</span>
<span class="col fw-bold text-end" id="selectedPhone">-</span>
</div>
<div class="row mb-2">
<span class="col text-muted">Contact Email</span>
<span class="col fw-bold text-end" id="selectedEmail">-</span>
</div>

<hr class="my-3">

<button type="submit" class="btn btn-primary">
<span class="spinner-border spinner-border-sm d-none" aria-hidden="true"></span>
Submit Claim
</button>
</div>
<p class="text-muted text-center mt-3" style="font-size: small">By clicking "Submit Claim" you acknowledge that all information is valid and accurate.</p>
</div>
</div>
<input name="__RequestVerificationToken" type="hidden" value="CfDJ8MTNPGgmqM9Ju1WhvRKRt3aKkgv23jdMGg3XS6f7x0fO2Pwzun_39lbjAKCqHi2WhxfrK6G1EO9glwRk-HN1Xvle8A-vDG4SHaPZ9jUe5qo7B8F-jACM4It7vE35E4bFN8Yvtpk_CGYBqLWoQf80mbg"></form>
</div>
</div>
</div>
</div>
<div class="modal" id="claimSubmittedModal" tabindex="-1" aria-labelledby="claimSubmittedModalLabel" aria-hidden="true">
<div class="modal-dialog modal-xl modal-dialog-centered">
<div class="modal-content">
<div class="modal-header">
<div class="modal-title" id="claimSubmittedModalLabel">
<span class="icon-claim"></span>
<div>Claim Submitted</div>
</div>
<button type="button" class="btn-close" aria-label="Close" data-bs-dismiss="modal" id="modalClose">
</button>
</div>
<div class="modal-body modal-bg-primary align-content-center">
<div class="row">
<div class="col-12 col-lg-5">
<div class="card card-body mx-4 my-4 p-4">
<div class="text-muted mb-2">CLAIM SUMMARY</div>
<span class="text-start" id="submittedClaimPolicy">-</span>

<hr class="my-3">

<div class="row mb-3">
<span class="col text-muted">Risks</span>
<span class="col-12 col-lg fw-bold text-start text-lg-end" id="submittedRisks">-</span>
</div>
<div class="row mb-3">
<span class="col text-muted">Loss Date</span>
<span class="col-12 col-lg fw-bold text-start text-lg-end" id="submittedLossDate">-</span>
</div>
<div class="row mb-3">
<span class="col text-muted">Type of Loss</span>
<span class="col-12 col-lg fw-bold text-start text-lg-end" id="submittedLossType">-</span>
</div>
<div class="row mb-2">
<span class="col text-muted">Files Included</span>
<span class="col-12 col-lg fw-bold text-start text-lg-end" id="submittedFiles">-</span>
</div>
</div>
</div>
<div class="col-12 col-lg-7 text-light d-flex text-center text-lg-start align-items-center mb-3 ">
<div class="row">
<h3 id="claimSuccessMessage">Your claim has been submitted for review.</h3>
<div>We will follow up with any questions and next steps to the contact associated with the claim.</div>
<div style="font-size: small"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>

<script src="https://code.jquery.com/jquery-3.5.1.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/moment.js/2.18.1/moment.min.js"></script>
<script>
$('#SubmitClaimForm').submit(function (e) {
e.preventDefault();
disableButtonsOnSubmit();
var data = new FormData(this); // Retrieving data from form for proper document upload

//Binding files from fileUpload input to data object
$.each($('#documentUpload')[0].multiFiles, function (i, file) {
data.append('Documents', file);
});

$.ajax({
url: '/policyholder/SubmitClaimModal',
data: data,
cache: false,
contentType: false,
processData: false,
type: 'POST',
success: function (data) {
if (data.success) {
if (data.validationMessage != "") { alert(data.validationMessage); }

updateClaimSuccessModal(data.successMessage);
$("#SubmitClaimForm").trigger("reset");
$("#claimSubmittedModal").modal('show');
$("#fileClaimModal").modal('hide');

var documentUpload = document.getElementById("documentUpload");
var includedFiles = document.getElementById('includedFiles');
documentUpload.multiFiles = null;
includedFiles.innerHTML = "";
}
else {
alert(data.validationMessage);
resetButtonSpinners(e);
enableButtonsOnSubmit();
}
},
error: function (xhr) {
alert("Error occured during Claim Submission.");
resetButtonSpinners(e);
enableButtonsOnSubmit();
}
});
})
function updateClaimSuccessModal(successMessage) {
$("#submittedClaimPolicy").html($("#selectedClaimPolicy").html());
$("#submittedRisks").text($("#selectedRisks").text());
$("#submittedLossDate").text($("#selectedLossDate").text());
$("#submittedLossType").text($("#selectedLossType").text());
$("#submittedFiles").text($("#selectedFiles").text());

$("#selectedClaimPolicy").html("-");
$("#selectedRisks").text("-");
$("#selectedLossDate").text("-");
$("#selectedLossType").text("-");
$("#selectedFiles").text("-");

$("#claimSuccessMessage").text(successMessage);
}
</script>
<script>
//Using document ready to properly bind after modal is loaded
$(document).ready(function () {
$('#fileClaimModal').on('hidden.bs.modal', function (e) {
$('#SubmitClaimForm').trigger('reset');
resetSelectionFields();
})
});
function resetSelectionFields() {
$("#selectedClaimPolicy").html("-");
$("#selectedRisks").text("-");
$("#selectedLossDate").text("-");
$("#selectedLossType").text("-");
$("#selectedFiles").text("-");

$("#selectedName").html("-");
$("#selectedStreetAddress").text("-");
$("#selectedCityAddress").text("-");
$("#selectedPhone").text("-");
$("#selectedEmail").text("-");

$("#riskOptions").html("");
$("#lossTypeOptions").html("");
}
</script>
<script>
$('.claimPolicyRadio').click(loadRisks);

//Used to load content based on selected section from list
function loadRisks(event) {
var policyId = $(this).data("policyid");
var policyImageNum = $(this).data("policyimagenum");
$("#riskOptions").load('/policyholder/Claims/LoadPolicyRisks', { policyId: policyId, policyImageNum: policyImageNum });

var versionId = $(this).data("versionid");
$("#lossTypeOptions").load('/policyholder/Claims/LoadClaimLossTypes', { versionId: versionId });

$("#selectedClaimPolicy").html($(this).siblings('label')[0].innerHTML);
}

function updateLossRisks(htmlString) {
$("#selectedRisks").html(htmlString);
}

$("#lossDate").change(function () {
var lossDate = moment($(this).val()).format('MM-DD-YYYY');
$("#selectedLossDate").text(lossDate);
})

function updateLossType() {
var lossType = $("#lossType option:selected").text();
$("#selectedLossType").text(lossType);
}

$("#firstName").change(updateName);
$("#lastName").change(updateName);

function updateName() {
var firstName = $("#firstName").val();
var lastName = $("#lastName").val();
$("#selectedName").text(firstName + " " + lastName);
}

$("#streetNum").change(updateStreetAddress);
$("#streetName").change(updateStreetAddress);

function updateStreetAddress() {
var streetNum = $("#streetNum").val();
var streetName = $("#streetName").val();
$("#selectedStreetAddress").text(streetNum + " " + streetName);
}

$("#city").change(updateCityAddress);
$("#state").change(updateCityAddress);
$("#zip").change(updateCityAddress);

function updateCityAddress() {
var city = $("#city").val();
var state = $("#state").val();
var zip = $("#zip").val();
$("#selectedCityAddress").text(city + ", " + state + " " + zip);
}

$("#claimPhone").change(function () {
$("#selectedPhone").text($(this).val());
})

$("#claimEmail").change(function () {
$("#selectedEmail").text($(this).val());
})
</script>
<script type="text/javascript">
$(function () {
$('#documentUpload').on("change", function () {
// if it's the first time we add files
if (!this.multiFiles) {
// create the array that will keep our files in memory
this.multiFiles = [];
// add a pointer to the span where we'll display the file names
this.__fileHolder = document.querySelector('#includedFiles');
}

this.__fileHolder.innerHTML = '';
var i;
// add the new files to our array
for (i = 0; i < this.files.length; i++) {
this.multiFiles.push(this.files[i])
}

updateFileDisplay(this);
});
});
function addDeleteBtn(f, input) {
// create the element
var del = document.createElement('img');
del.src = '../images/icons/action/trash.svg';
del.style.cursor = 'pointer';
// del.title = 'Remove this file';
// add an onclick event
del.addEventListener('click', function () {
// update the array
input.multiFiles.splice(f, 1);
// update the fileHodler
input.__fileHolder.innerHTML = '';
var fileLength = input.multiFiles.length;
if (fileLength > 0) {
updateFileDisplay(input);
}
else input.__fileHolder.innerHTML = 'No files selected.';
}, false);
input.__fileHolder.appendChild(del);
}
function updateFileDisplay(input) {
//Updates selected file elements on UI
input.__fileHolder.appendChild(document.createTextNode('Included Files:'));
input.__fileHolder.appendChild(document.createElement("br"));
for (i = 0; i < input.multiFiles.length; i++) {
input.__fileHolder.appendChild(document.createTextNode(input.multiFiles[i].name + ' '));
addDeleteBtn(i, input);
input.__fileHolder.appendChild(document.createElement("br"));
}
$("#selectedFiles").text(input.multiFiles.length + " files");
}
</script>
<script>
$(function () {
$('#lossDescription').keyup(function (e) {
var max = $(this)[0].maxLength;
var currentLength = $(this).val().length;
var remaining = max - currentLength;
$('#text-counter').html(remaining);
});
});
</script>
</div>
</div>
<div class="container">
<div class="row">
<div class="col">
<div class="row flex-lg-row flex-column-reverse justify-content-lg-between mb-4">
<div class="col-lg-8 d-flex d-lg-block justify-content-evenly">
<select class="form-select filterSelect" style="width:auto;display:inline" id="PolicyFilter" aria-label="Policy Filter Options">
<option value="0" selected="">Policy: All</option>
<option value="5564667">GAF20049478</option>
</select>
<select class="form-select filterSelect" style="width:auto;display:inline" id="StatusFilter" aria-label="Status Filter Options">
<option value="0" selected="">Status: All</option>
<option value="1">Active</option>
<option value="2">Closed</option>
<option value="3">Pending</option>
</select>
<select class="form-select filterSelect" style="width:auto;display:inline" id="ClaimTermFilter" aria-label="Claim Term Filter Options">
<option value="0" selected="">Current Policy Term</option>
<option value="1">Last 3 Months</option>
<option value="2">Last 6 Months</option>
<option value="3">Year</option>
<option value="4">All Time</option>
</select>
</div>
<div class="col-lg-4 mb-4 mb-lg-0">
<div class="input-group">
<input type="text" class="form-control" placeholder="Search" id="SearchValue">
<img class="input-icon" src="/policyholder/images/icons/action/search.svg">
</div>
</div>
</div>
</div>
</div>
<div class="col" id="claimsList">
<div class="mb-4">
<div class="card col p-4">
<div class="text-muted">DATE OF LOSS - 1/8/2025</div>
<div class="row">
<div class="col-6 col-xl-8 d-flex flex-wrap flex-column flex-lg-row align-items-lg-center justify-content-lg-between">
<span class="col-xl-6 col-xxl-3"><b>#25GAF0000140</b></span>
<div class="col-xl-6 col-xxl-3 d-flex">
<span class="icon-policies d-flex flex-nowrap fs-3 me-2"></span>
GAF20049478
</div>
<div class="col-12 col-xxl-6 d-flex align-items-lg-center">
<span class="icon-claim fs-3 me-2"></span>
<span>Collision</span>
</div>
</div>
<div class="col-6 col-xl-4 d-flex flex-wrap align-items-center justify-content-end">
<div class="d-none d-lg-flex col-lg-5 flex-wrap align-items-center justify-content-end">
<a href="#ClaimAttachments_17942" role="button" data-bs-toggle="collapse" class="link-primary flex-nowrap" aria-expanded="false" aria-controls="ClaimAttachments_17942">
6 Attachments
</a>
</div>
<div class="col-12 col-lg-7 d-flex flex-wrap align-items-center justify-content-end">
<span class="status-tag me-3"><span class="icon-disable"></span>Closed</span>
</div>
<div class="d-lg-none col-12 d-flex flex-wrap align-items-center justify-content-end">
<a href="#ClaimAttachments_17942" role="button" data-bs-toggle="collapse" class="link-primary flex-nowrap" aria-expanded="false" aria-controls="ClaimAttachments_17942">
6 Attachments
</a>
</div>
</div>

</div>
</div>
</div>
<div class="collapse" id="ClaimAttachments_17942">
<div class="row fs-6 mb-5">
<div class="col-1 text-center">
<div class="vr h-100"></div>
</div>
<div class="col-11">
<div class="row justify-content-between mb-4">
<div class="col">GAF20049478_5564667_6_6675418_20250109-1126327599156.pdf.pdf</div>
<div class="col-auto text-end">
<a class="icon-download link-primary" href="/policyholder/Policy/LoadAttachment?attachmentId=2066062&attachmentName=GAF20049478_5564667_6_6675418_20250109-1126327599156.pdf.pdf"></a>
</div>
</div>
<div class="row justify-content-between mb-4">
<div class="col">IMG_20250109_112335818_HDR.jpg</div>
<div class="col-auto text-end">
<a class="icon-download link-primary" href="/policyholder/Policy/LoadAttachment?attachmentId=2066064&attachmentName=IMG_20250109_112335818_HDR.jpg"></a>
</div>
</div>
<div class="row justify-content-between mb-4">
<div class="col">IMG_20250108_212752111_HDR.jpg</div>
<div class="col-auto text-end">
<a class="icon-download link-primary" href="/policyholder/Policy/LoadAttachment?attachmentId=2066065&attachmentName=IMG_20250108_212752111_HDR.jpg"></a>
</div>
</div>
<div class="row justify-content-between mb-4">
<div class="col">IMG_20250108_212747017_HDR.jpg</div>
<div class="col-auto text-end">
<a class="icon-download link-primary" href="/policyholder/Policy/LoadAttachment?attachmentId=2066066&attachmentName=IMG_20250108_212747017_HDR.jpg"></a>
</div>
</div>
<div class="row justify-content-between mb-4">
<div class="col">25GAF0000140 LIAB ONLY INSURED .pdf</div>
<div class="col-auto text-end">
<a class="icon-download link-primary" href="/policyholder/Policy/LoadAttachment?attachmentId=2072719&attachmentName=25GAF0000140%20LIAB%20ONLY%20INSURED%20.pdf"></a>
</div>
</div>
<div class="row justify-content-between mb-4">
<div class="col">2CNDL63F056153323-IV MVR .pdf</div>
<div class="col-auto text-end">
<a class="icon-download link-primary" href="/policyholder/Policy/LoadAttachment?attachmentId=2074875&attachmentName=2CNDL63F056153323-IV%20MVR%20.pdf"></a>
</div>
</div>
</div>
</div>
</div>

</div>
</div>
<script type="text/javascript">
//Used to update dropdown title to reflect option chosen
function showDropdownOption(item) {
document.getElementById(item.getAttribute('data-dropdown')).innerHTML = item.innerHTML;
}
</script>
<script type="text/javascript">
$('.filterSelect').change(filterClaimList);

//Used to load content based on selected section from list
function filterClaimList(event) {
var policyFilterId = $('#PolicyFilter').val();
var statusFilterId = $('#StatusFilter').val();
var claimTermFilterId = $('#ClaimTermFilter').val();

$.ajax({
url: '/policyholder/FilterClaimList',
data: { policyFilterId: policyFilterId, statusFilterId: statusFilterId, claimTermFilterId: claimTermFilterId },
type: 'POST',
success: function (data) {
$("#claimsList").html(data);
},
error: function (xhr) {
alert("Error occured during Claim List filtering.");
}
});
}
</script>
<script type="text/javascript">
$('#SearchValue').change(searchClaimList);

//Used to load content based on selected section from list
function searchClaimList(event) {
var searchValue = $('#SearchValue').val();

$.ajax({
url: '/policyholder/SearchClaimList',
data: { searchValue: searchValue },
type: 'POST',
success: function (data) {
$("#claimsList").html(data);
},
error: function (xhr) {
alert("Error occured during Claim List search.");
}
});
}
</script>
<div class="modal" id="myAgentModal" tabindex="-1" aria-labelledby="myAgentModalLabel" aria-hidden="true">
<div class="modal-dialog modal-dialog-centered" style="max-width: 39.5rem;">
<div class="modal-content">
<div class="modal-header">
<div class="modal-title" id="myAgentModalLabel">
<span class="icon-agent"></span>
<div>My Agent</div>
</div>
<button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close" id="modalClose">
</button>
</div>
<div class="modal-body">
<div class="row mb-3 mt-3" style="display: flex; flex-wrap: nowrap;">
<div class="col-2" style="display: flex; justify-content: center;">
</div>
<div class="col-8" style="display: inline-flex; flex-direction: column; gap: 1.875rem;">

<div class="fs-2 fw-bold">Peachstate Insurance</div>

<div class="row">
<div class="text-muted fs-6">
ADDRESS
</div>
<div class="col-1">
<a class="w-auto" href="http://maps.google.com/?q= 4775 Buford Hwy NE Atlanta, GEORGIA 30329-0000" target="_blank">
<img src="/policyholder/images/icons/ui/pin.svg">
</a>
</div>
<div class="col-11">
<div>4775 Buford Hwy NE</div>
<div mb-2"="">Atlanta, GEORGIA 30329-0000</div>
</div>
</div>

<div class="row">
<div class="col">
<div class="text-muted fs-6">PHONE</div>
<div class="d-flex align-items-center text-nowrap gap-1 mb-2"><span class="icon-phone"></span> (404)320-9995</div>
</div>
<div class="col">
<div class="text-muted fs-6">FAX</div>
<div class="d-flex align-items-center text-nowrap gap-1 mb-2"><span class="icon-fax"></span> (404)320-9986</div>
</div>
</div>

<div class="row">
<div class="text-muted fs-6">EMAIL</div>
<div class="d-flex align-items-center gap-1 mb-2"><span class="icon-email"></span> [email protected]</div>
</div>

</div>
</div>
</div>
</div>
</div>
</div>
</main>
<footer class="footer">
<div class="d-none d-lg-flex policy-footer">
<div class="container">
<div class="row">
<div class="col-8">
<div class="policy-footer-links">
<a class="link-light" href="https://goverve.com/" target="_blank">GoVERVE.com</a>
</div>
<div class="policy-footer-company-info">
<div></div>
<div class=" policy-footer-company-info-dscr text-wrap">Verve Services, LLC is transforming the delivery of auto insurance and working every day to make the experience better for our policyholders, agents, and partners.</div>
</div>
</div>
<div class="col-1 d-flex justify-content-center"><div class="vr"></div></div>
<div class="col-3 policy-footer-contact">
<div>Need Help? Contact us.</div>
<div class="policy-footer-contact-phone">
(855) 226-4466
</div>
<div class="policy-footer-contact-hours">
<div>Monday - Friday</div>
<div>9:00am - 6:00pm EST</div>
</div>
</div>
</div>
</div>
</div>

<div class="d-lg-none policy-footer-sm">
<div class="container">
<div class="flex-column d-flex align-items-center">
<div class="policy-footer-contact flex-column d-flex align-items-center mb-4">
<div>Need Help? Contact us.</div>
<div class="policy-footer-contact-phone">
(855) 226-4466
</div>
<div class="row policy-footer-sm-contact-hours">
Monday - Friday, 9:00am - 6:00pm EST
</div>
</div>
<hr class="w-100 mb-4">
<div class="">
<div class="policy-footer-links-sm text-center">
<div class="row mb-4">

<a class="col link-light" href="https://goverve.com/" target="_blank">GoVERVE.com</a>
</div>
<div class="row">

</div>

</div>
<div class="policy-footer-company-info">
<div class="text-center"></div>
<div class=" policy-footer-company-info-dscr text-wrap">Verve Services, LLC is transforming the delivery of auto insurance and working every day to make the experience better for our policyholders, agents, and partners.</div>
</div>
</div>
</div>
</div>
</div>

<div class="d-none d-lg-block">
<div class="container global-footer">
<div class="container global-footer-copyright-and-terms">
<div class="global-footer-copyright-text text-wrap">© 2024 - Verve Services, LLC. All Rights Reserved</div>
<div class="global-footer-divider"></div>
<a target="_blank" class="global-footer-privacy-term-links link-light" href="/policyholder/Home/Privacy">Privacy Policy</a>
<a target="_blank" class="global-footer-privacy-term-links link-light" href="/policyholder/Home/TermsOfUse">Terms of Use</a>
</div>
<div class="rounded float-end">
</div>
</div>
</div>

<div class="d-lg-none">
<div class="container sm-global-footer">
<div class="container sm-global-footer-copyright-and-terms">
<div class="global-footer-copyright-text text-wrap">© 2024 - Verve Services, LLC. All Rights Reserved</div>
<div class="sm-global-footer-terms-row">
<a target="_blank" class="global-footer-privacy-term-links link-light" href="/policyholder/Home/Privacy">Privacy Policy</a>
<div class="global-footer-divider"></div>
<a target="_blank" class="global-footer-privacy-term-links link-light" href="/policyholder/Home/TermsOfUse">Terms of Use</a>
</div>
<div class="global-footer-social-links-row">
</div>
</div>
</div>
</div>
</footer>
<script src="/policyholder/lib/jquery/dist/jquery.min.js"></script>
<script src="/policyholder/lib/bootstrap/dist/js/bootstrap.bundle.min.js"></script>
<script src="/policyholder/js/site.js?v=2pFWPYdZLiXCRnZ33pmI0eP-pJaTCHtUyi6p0oOvPA8"></script>
<script src="/policyholder/js/PaymentJavaScript.js"></script>
<script></script>
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