AccountId: 011433970860
ContactId: 0de61b51-0047-4639-b78d-0d3565159fa4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473160 ms
Total Talk Time (AGENT): 310337 ms
Total Talk Time (CUSTOMER): 105917 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/0de61b51-0047-4639-b78d-0d3565159fa4_20250529T20:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] on the care team. How are you doing?
[AGENT][POSITIVE] I'm good. How are you, [PII]?
[CUSTOMER][NEUTRAL] I'm doing good. Um, I have an insured on the other line. She's asking me about leave of absence for the short-term disability claim or policy.
[CUSTOMER][NEUTRAL] And I don't really know how that works. I mean, I went to the definitions and I see it says that the policy could have it if it's approved.
[CUSTOMER][NEUTRAL] But she's like asking me how that works and what form needs to be filled out and how that works with the employer.
[AGENT][NEUTRAL] Hm, so if they're wanting to report or request a leave of absence, um,
[AGENT][NEUTRAL] That has to be handled through your HR department.
[AGENT][NEUTRAL] We're not going to approve or deny any of that because we're only gonna process claims when you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Specifically disability when you are on a leave of absence.
[AGENT][NEUTRAL] Um, or for disability or whatever the case may be and you're trying to file a claim, that's what we're looking at, but we're not going to approve or deny those instances that's gonna be handled through the employer.
[CUSTOMER][NEUTRAL] Right, well, I don't even, so I don't even know what the next steps are. I see it in the, so she needs to go to the employer to ask for a leave of absence.
[AGENT][NEUTRAL] Yeah, let me pull up the policy just so I can.
[CUSTOMER][NEUTRAL] Because all it says
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's that policy number?
[CUSTOMER][NEUTRAL] It's 2, 2000.
[CUSTOMER][NEUTRAL] 335.
[AGENT][POSITIVE] I just love it when they come at us with stuff that it's like, what?
[CUSTOMER][NEUTRAL] I'm like, uh.
[AGENT][NEUTRAL] Oh my. OK.
[AGENT][NEUTRAL] We get some odd questions, that's for sure.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Adjustment was sickly for other salary or wage continuance plan extending beyond the following number of calendar days.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So when you were looking at leave of absence, were you looking, what were you looking at specifically?
[CUSTOMER][NEUTRAL] It's on
[CUSTOMER][NEUTRAL] Section 5, let me see what page.
[CUSTOMER][NEUTRAL] It's section 5.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I don't even see a page on here.
[AGENT][NEUTRAL] That's, I, I can, OK, wait, yeah, your coverage may be continued for up to one year during a leap of absence approved in writing by your employer.
[CUSTOMER][NEUTRAL] Let me see it, you see it?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, this is regarding termination of insurance.
[AGENT][NEUTRAL] So, when it starts going over.
[AGENT][NEUTRAL] Termination.
[AGENT][NEUTRAL] It's saying you know it's gonna end that you don't meet eligibility requirements if you retire, if you cease to be an active employee with the exception.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As provided under the leave of absence provision. So,
[CUSTOMER][NEUTRAL] It won't terminate the policy, not you're gonna get more. OK.
[AGENT][NEUTRAL] Exactly right, so we, if we have a written leave of absence from your employer, then we can basically approve coverage for up to one year during that leave of absence.
[CUSTOMER][NEUTRAL] One year.
[AGENT][NEUTRAL] Because you're not an active employee at that time because you know a lot of times they'll do like a leave of absence or a lay off or something like that because that person's not able to come back and they need to fill the position but they can't feel it if you're still an active employee so they'll do that leave of absence.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To
[AGENT][NEUTRAL] Allow them for insurance purposes to still have coverage but to also be able to feel the role that is not being filled at the time so that's really it's it's just in termination of coverage that's really it.
[CUSTOMER][NEUTRAL] And this
[CUSTOMER][NEUTRAL] OK, and the 6 months max or the 180 days, that's
[CUSTOMER][NEUTRAL] So once her 6 months are exhausted, that's it, or is it like if she hurt something else then she can file another claim? It's just 6 months for whatever this claim is that we're paying out on.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Mhm. So the disability benefits are um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Injury and or sickness. So it's like per injury and or sickness. So if you, now there will be some, you know, differences where there's going to be like, I wonder if it has percurrence or something like that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So let's say disability payments will be provided.
[AGENT][NEUTRAL] Uh, so disability payments will be provided for only one disability when more than one exists at the same time or a disability results from two or more causes.
[AGENT][NEUTRAL] Um, if any disability payments to be paid for less than a full month, then you know that blah blah. So successive disabilities are those which result from a same or related calls and are payable on their policy and that's considered one period of disability. So basically we would.
[AGENT][NEUTRAL] Add on to it. So like if you were disabled for 2 months and then you came back to work, but then you had to go out for the same or related condition.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You still have been paid for 2 months, right? It's gonna be more of a continuation than it is a new, um, and then it says unless disabilities are separate, let's see, considered one period of disability unless they are separated by your return to active employment or any other type of gainful occupation for at least 3 months, a disability due to a different or unrelated calls will be considered a new period of disability.
[CUSTOMER][NEUTRAL] You can continue that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So same or related it's it's more of a continued claim and we still only pay up to the 180 days completely different reason.
[AGENT][NEUTRAL] You go out for, I don't know, having a baby.
[CUSTOMER][NEUTRAL] In the time. Mhm.
[AGENT][NEGATIVE] And you come back, you've done your, however long, your 2 months, your 4 months, however long it is you wanted to take with the baby.
[AGENT][NEUTRAL] You come back
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] You've now had an accident where, you know, you're, you have a very labor intensive job and you've broken something, broken an arm, broken a leg, you can't work. There's not even light duty available. That's a completely different instance. That disability starts at day one. It's not a continuation because it's unrelated to the pregnancy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] To the first. OK. I got it. I can explain that. All right. Well, I'm good. Well, thank you, [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, cool.
[AGENT][POSITIVE] All right then. You're very welcome.
[CUSTOMER][NEUTRAL] All right, bye-bye.
[AGENT][NEUTRAL] All right, bye.