AccountId: 011433970860
ContactId: 192cece3-1349-4230-ab74-d85dc85463bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 989520 ms
Total Talk Time (AGENT): 482817 ms
Total Talk Time (CUSTOMER): 393174 ms
Interruptions: 6
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/192cece3-1349-4230-ab74-d85dc85463bc_20250417T21:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, I need to go about filing a claim.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] But I think I'm like I'm gonna need some help here to find out if.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] It it's
[CUSTOMER][NEUTRAL] If I still had APL at the time.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, I see. OK, yeah, we need to make sure that your policy was active at the time that uh you received treatment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, I'm still under treatment now, um, but when I called yesterday, I called, um, employee employer ERB.
[CUSTOMER][NEUTRAL] When I called them to to find out um.
[CUSTOMER][NEUTRAL] I was directed to, I was told MetLife is the new insurance, but at the time of
[CUSTOMER][NEUTRAL] The time I injured myself it was APL.
[AGENT][NEUTRAL] Oh I see. OK, so we can make sure that those dates are accurate. OK, um, I'm sorry, that's a mess right, we'll see what we can do to help, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, well, it's my fault for waiting so long but I think I'm still under the one year one year window.
[AGENT][NEGATIVE] No, no.
[AGENT][NEUTRAL] Sure, OK, um, I'm so sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] And my last name is spelled [PII] and I might actually have a policy number for you.
[AGENT][POSITIVE] Sure, yeah, I can take that whenever you're ready.
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 19152.
[AGENT][POSITIVE] OK, and then really quick [PII], can I also get a good call back number from you in case we're disconnected please?
[CUSTOMER][POSITIVE] Oh, I love when people ask that question. 714.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] It's, it's just, it's so helpful 308.
[CUSTOMER][NEUTRAL] 546 3.
[AGENT][NEUTRAL] Well, it happens so much and especially with things like this, you know, you don't wanna have to call back and repeat everything to somebody else, so we like to try to do that. All right. [PII], just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then uh can I get your mailing address please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect all right thank you so much for verifying all of that. OK, let's see and so is this for your, uh, short term disability, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, so when did the injury take place?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, so yes, um, the policy number that you gave me, uh, that was active during that time that was active from [PII] [PII], and then it looks like they picked up again shortly after that, um, so you've got another policy that was active between [PII] until uh [PII], so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see, are you currently out of work at the moment?
[CUSTOMER][NEUTRAL] I am and there's a little bit more to the story.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, so I didn't think my injury was, like, I thought I pulled a muscle cause it was on the side of my shin just below my knee.
[CUSTOMER][NEUTRAL] And I, um, you know, I just took extra ibuprofen and tried to stretch it every day and ice it and
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] But after a few months, it wasn't getting better and it actually started to get worse. So, by April is when I went to see the doctor.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it took about a month because he, he took an X-ray said he thinks he sees something but he wanted an MRI.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So when I went back for my MRI review, um, because it takes time to get it scheduled.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Uh, by the time I went back, he said, yeah, yeah, I have a tear in my right lateral meniscus.
[AGENT][POSITIVE] Oh my gosh.
[CUSTOMER][NEGATIVE] And he put me off then.
[CUSTOMER][NEGATIVE] So I ended up having to get it surgically repaired.
[AGENT][POSITIVE] Dang. Oh, I'm so sorry. I understand now. I'm, I get like that. I, I don't go to the doctor unless, you know, I'm like, it's OK, it'll heal itself.
[CUSTOMER][NEGATIVE] Which it, it's not even really a repair.
[CUSTOMER][NEUTRAL] I didn't want to. I wasn't, I, I just, I didn't want to. I thought it's gonna get better, it's gonna get better, it's gonna get better.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEGATIVE] You know, shit, I even had to do a physical exam, uh, treadmill exam the following month in February.
[AGENT][NEUTRAL] I do, that's
[AGENT][NEUTRAL] Ah,
[CUSTOMER][NEUTRAL] So that I could, yeah, because there's a max age of [PII].
[CUSTOMER][NEUTRAL] Unless you um go to a county doctor, I, because I work for County Fire, LA County Fire.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And over the age of [PII], they require you to go to this clinic and have a treadmill test done with an EKG.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] I did. I did. I mean, it hurt, but.
[AGENT][NEGATIVE] Oh, I bet that was awful.
[AGENT][MIXED] That's impressive, but I bet that was awful.
[CUSTOMER][NEUTRAL] But I still.
[CUSTOMER][NEUTRAL] I still convinced myself it's a pulled muscle, a pulled muscle. But anyway, so doctor put me off at the end of May.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] OK, OK, so.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Here is what we can do um.
[AGENT][NEUTRAL] If you don't have one already, I can go ahead and send you a claim form, the disability claim form there is going to be a portion of that form that your physician will have to fill out, um, and we do have to have them fill it out.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I will get that um did you want me to just, I can email it to you if that's easier if you've got an email.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, uh, what was that email address for you?
[CUSTOMER][NEUTRAL] This is.
[CUSTOMER][NEUTRAL] Physicians, so you need a physician's statement.
[CUSTOMER][NEUTRAL] OK, um, you ready?
[AGENT][POSITIVE] Yeah there's gonna be a portion of the form that they would just fill out yes yes I'm ready when you are.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] O Q
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back so that was [PII]. is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it, it reads knock down is what it's supposed to read.
[AGENT][NEUTRAL] Oh.
[AGENT][POSITIVE] Oh, that's cool. OK.
[CUSTOMER][NEUTRAL] Total fire, I know, geek geek fireman email, but.
[CUSTOMER][NEUTRAL] I've had it for 3433 years.
[AGENT][POSITIVE] No, that's clever.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] That's cool. OK, so I will go ahead and email this to you, um, and then you, as far as filing this information getting it sent to us, uh, there's a few different ways. Do you have access to a desktop or a laptop computer, [PII]?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, uh, the reason I ask is our online portal is typically gonna be the quickest and easiest way and it really does not have support for mobile devices like phones or tablets uh so it would have to be on a desktop or a laptop so you would simply um go to our website and in this email that I send I'll go.
[AGENT][NEUTRAL] Head and include a link to that website as well uh you would create an account using all of this information we just verified so the same email um there's gonna be a spot that asks for a member ID or a social you'll go ahead and put in your social uh the member ID is different than uh um your policy number and then once you create the account on the main page there, there's a spot where it'll say you can upload uh claim information or upload documents you would simply submit that claim form there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And we get it pretty quickly, um, it can take about 7 to 10 business days for claim information to process, but and it doesn't always take quite that long that's just kind of a good ballpark estimate, um, and of course you can keep an eye on the status on the website or you're more than welcome to give us a call and check on it as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can, what was your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] OK, [PII], what were those effective dates of my policies again?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, let me get that. Give me just a moment.
[CUSTOMER][NEUTRAL] Because you have like a couple.
[AGENT][NEUTRAL] Yes, OK, so the one that you gave me, the one ending in 152, uh, that one was effective [PII].
[AGENT][NEUTRAL] Until [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you had one, another one that picked up after that for just a couple of months, uh, that was active from [PII] until [PII]. I can give you that policy number if you would like that.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I mean it will it will all be on the website so.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] I heard, well, I heard myself [PII], so it falls under that.
[AGENT][POSITIVE] Oh yeah it would be that first one that you gave me, yes sir.
[CUSTOMER][NEUTRAL] Falls under that 152 policy number, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, then we're good. Did I have um just a short term disability or did I also have an accident?
[AGENT][NEUTRAL] All right. Mhm.
[AGENT][NEUTRAL] Um, you had the short term disability. The only other policy you did have was a critical illness policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] OK, I'm hopefully I'll never be in that point, but, OK, so this is good, so I'm not, I'm not going through MetLife and I, I can go through APL.
[AGENT][NEUTRAL] Yes, that's when it was, uh, well it was active, yeah.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Mhm, OK, um, if you could uh send that email I'll uh I'll create an account.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes, I
[CUSTOMER][NEUTRAL] Um, and I'm actually going to my physician's office next week.
[AGENT][POSITIVE] Oh perfect.
[CUSTOMER][NEUTRAL] Uh, so I'll be able to drop that paperwork off to them and I think.
[CUSTOMER][NEUTRAL] Is there an email on the form for them to send it to?
[AGENT][NEUTRAL] Um, it, so it will all be on the same form. Um, I will give you, of course, the email that I send to you, that will be the return email if you have any questions. It's [PII], um, but I would strongly recommend if you know of course using our website to upload it that way if you don't have a scanner or access to a scanner that is perfectly fine if you wanted to just take a picture.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Of the forms as long as it's clear and legible that is perfectly fine. It just gets to us much quicker if you prefer though or if the physician doesn't mind if they've got like a fax I've got a fax number too.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it on the form?
[AGENT][NEUTRAL] Um, let me see. I don't know that it is actually.
[AGENT][NEUTRAL] Let me just a moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, yes, so at the bottom.
[CUSTOMER][NEGATIVE] I don't know, I don't know how you guys still use tax, uh huh.
[AGENT][NEUTRAL] A lot of places do. I know I'm kind of surprised by it too, actually, um, but, uh, so on the first page where it's basically the instructions at the very very bottom it's kind of tiny but that's got our mailing address um of course our phone number fax number, um, and that's all four claims so any claim information can be sent there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got it all down.
[AGENT][NEUTRAL] All right, and if you have any questions or issues, your doctor has questions or anything, more than welcome to give us a call. I know it's quite confusing. There's a lot of information, so we're here to help.
[CUSTOMER][NEUTRAL] Yeah, just, I started off with one company and then I went to another company and I have.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have no idea where I'm at right right until yesterday when I, I finally got a hold of somebody at ERB and then they said, oh yeah, according to that date you just gave us, you gotta go back to APL.
[AGENT][POSITIVE] Oh my goodness.
[CUSTOMER][NEUTRAL] So, all right.
[CUSTOMER][NEUTRAL] It's OK. I'm getting it tracked down, um.
[AGENT][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] Do you or could you tell me the benefits through APL, the disability benefits?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see, give me just uh, you know what, if you would like, I can also include a copy of your policy in this email that has that information just so you've got all of that. Let me see if I can just pull it up and give that to you real quick.
[CUSTOMER][NEUTRAL] I think I, I have one here but it says some benefits for ERB California plan and up in the corner it says APL.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Disability benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Monthly amounts of the disability benefits are available from $300 up to $6000.50 dollars increments. Your disability benefit will be $3000 not to exceed 25% of your monthly compensation.
[AGENT][NEUTRAL] OK, so the minimum is 20%, so yeah, I think.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maxim
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Did you want me to send this to you as well so you've got it for your record?
[CUSTOMER][NEUTRAL] Could you please
[AGENT][POSITIVE] Sure, absolutely.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and so it does state that the maximum uh the maximum disability period is for a year, so it would be of course a year from that.
[CUSTOMER][NEUTRAL] All right, and I'll check my email and uh.
[AGENT][NEUTRAL] Gosh, yeah, that's, it's been a year we're in [PII], yeah.
[CUSTOMER][NEUTRAL] Well,
[AGENT][POSITIVE] So at that point, I'm sorry.
[CUSTOMER][NEGATIVE] From the, from the point the doctor put me off.
[AGENT][NEUTRAL] Yes, and of course that will be all on the physician statement.
[CUSTOMER][POSITIVE] OK, thank God, OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm, I'm like one month, one month ahead of the deadline.
[CUSTOMER][POSITIVE] So, OK, perfect.
[AGENT][POSITIVE] Yeah, you're good.
[AGENT][NEUTRAL] All right, did you have any other questions for me, [PII]? I know that was quite a bit.
[CUSTOMER][NEUTRAL] All right. [PII], what's
[CUSTOMER][POSITIVE] If no, I've got it all down. I'm good at taking notes um if I do call back.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] You have an extension number or could I get your last name?
[AGENT][POSITIVE] I do not, um, I am the only [PII] here but my last initial is [PII] um I don't have my own extension. I will say if I'm not available you can ask for me if you prefer, um, but I will say everybody on our team is great. I will leave, you know, notes on your account so if you do have to call back you know they'll kind of know where we're at with everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Wonderful thank you [PII]. I appreciate it.
[AGENT][POSITIVE] All right. Yes, sir, you are very welcome. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too and have a good Easter.
[AGENT][POSITIVE] You too thank you bye bye.
[CUSTOMER][POSITIVE] Thanks bye.