AccountId: 011433970860
ContactId: 1aa68ebd-bef2-452e-8cd9-777046414589
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 792260 ms
Total Talk Time (AGENT): 253442 ms
Total Talk Time (CUSTOMER): 431955 ms
Interruptions: 3
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/1aa68ebd-bef2-452e-8cd9-777046414589_20250414T21:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I'm actually with my wife. Um, and we just have, uh, questions regarding, uh, her benefits and also, um, eligibility, uh, for this short-term disability.
[AGENT][NEUTRAL] OK, let's take a look at the policy. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, policy number is, um, you know what, I don't know my policy number. Can you get it through social security?
[AGENT][NEUTRAL] I can look it up by name or social security, yeah.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh my name is [PII]
[AGENT][NEUTRAL] OK, let me try this here give me one.
[CUSTOMER][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] for a long time.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And your last name is spelled [PII]?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] That is so.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] have
[AGENT][NEUTRAL] And then can I please verify your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then address and email address on file please.
[CUSTOMER][NEUTRAL] Address is [PII]. Email is um [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, [PII], so I'm, it looks like the policy, are you still um with your employer right at school? Um, are you on leave right now?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, I'm still at right at school. Uh, it's, uh, a spring break right now.
[CUSTOMER][NEUTRAL] We're on a break for a week.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, did you re-enroll for the first of the year because I'm showing that the policy lapsed in January.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] No, yeah, yeah, they were, um, she was not informed um regarding the uh re-enrollment, however, the incident, um, this, uh. Claim was last year. Well, we're trying to claim for last year because the um physical illness happened last year in [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, so let's see.
[CUSTOMER][NEUTRAL] And yeah, but we were, she was, she was not even aware about all of this until, you know, her sister that works in the medical field says, hey, maybe you have um, you know, uh um different benefits, you know, like.
[CUSTOMER][NEUTRAL] So she searched and yeah, now she now remember that she basically enrolled for APL.
[CUSTOMER][NEGATIVE] Um, you know, it's just a waste that we didn't.
[CUSTOMER][NEUTRAL] found out early enough, you know.
[AGENT][NEUTRAL] Um, OK, so let's see.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Uh, there is an elimination period on the policy, meaning that you wouldn't be eligible for pay for 7 days if the um disability was due to sickness. If it was due to injury, there is no elimination period that was on the policy.
[AGENT][NEUTRAL] Um, it looks like the disability benefit monthly amounts of the disability benefits are available from $300 up to $8000.50 dollars increments. Disability benefit will be $2000 not to exceed 60% of your monthly compensation.
[AGENT][NEUTRAL] And it looks like the maximum allotted time was 3 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So that was the longest it would pay out for.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um, as far as filing a claim.
[AGENT][NEUTRAL] Um, I would need to get you guys a claim form filled out. You're gonna need to go back to the provider, uh, that she had seen at the time and have some documentation and paperwork filled out as well.
[AGENT][NEUTRAL] And then to get it back to us you would need to either fax it or mail it um unfortunately it can't be done online since this policy right now is not still showing active.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, but it, but it is possible to basically file a claim from last year, right? Because there's, um, what is the statute of limitation?
[CUSTOMER][NEUTRAL] Um, to file screen.
[AGENT][NEUTRAL] I don't know if there's a timely filing moment on it. Let me see.
[CUSTOMER][NEUTRAL] You could say on a year 12 months.
[CUSTOMER][NEUTRAL] Yeah, because like what I said we.
[CUSTOMER][NEGATIVE] And she forgot that she got this um benefit and it it sucks that we're not, you know, um.
[CUSTOMER][NEUTRAL] So that
[CUSTOMER][NEUTRAL] And it's also
[CUSTOMER][NEGATIVE] And like shame to write at school for not
[CUSTOMER][NEUTRAL] Reminding her, hey, by the way, you know, you can avail this benefit that you're paying.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Yes, so
[CUSTOMER][NEUTRAL] I don't know. They uh how come they didn't mention that.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Benefit to her.
[CUSTOMER][POSITIVE] Yeah, we don't wanna point fingers, right? We just, we just wanna make sure that we, we get the, the benefit that we, we deserve.
[CUSTOMER][NEUTRAL] Here's to be and the actual.
[CUSTOMER][NEUTRAL] out
[CUSTOMER][NEUTRAL] Of.
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] Yeah, it doesn't so that you can.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So it looks like it's a 2 year period.
[AGENT][NEUTRAL] So as long as it occurred within that time, I don't feel like it should be any sort of issues from what I'm reading and the limitations. Would you guys like me to email you the claim forms and also the policy certificate itself and then you can look at it?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, we, we.
[CUSTOMER][NEUTRAL] We, we got it, we got the claim form and, uh, yeah, we, we got the claim form that actually they emailed it to her, um, uh, the claim form, but uh we're just a little confused because the claim form is like 9 pages. um, do we need to fill up all these 9 pages, uh.
[CUSTOMER][NEUTRAL] Or just questions pertaining to our condition and situation.
[AGENT][NEUTRAL] In
[CUSTOMER][NEUTRAL] This is a critical illness claim form um from.
[AGENT][NEGATIVE] That's not, yeah, that's not, that's not the right claim form, um.
[CUSTOMER][NEUTRAL] OK, alright, yeah.
[CUSTOMER][NEUTRAL] OK, yeah, just can you just email that one?
[AGENT][NEUTRAL] You need the you.
[AGENT][NEUTRAL] Yeah, you need the short term disability one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the short term disability, go ahead.
[CUSTOMER][NEUTRAL] But, but the critical, you.
[CUSTOMER][NEUTRAL] Go ahead, go ahead, go ahead.
[CUSTOMER][NEUTRAL] The short term disability.
[AGENT][NEGATIVE] It's 8 pages and you will need to have it all filled out and there's a physician's page that needs to be filled out and signed and everything as well.
[CUSTOMER][NEUTRAL] It it's up to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um, just wanna, uh, get some clarification. Uh, her benefits for short term disability, um, did she include family or just the employee?
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] But she's entitled to do short term disability because of FMLA, right?
[AGENT][NEUTRAL] If she was getting compensation from work, she may not be compensated for the disability, uh, just depending upon the amount, but I thought that's the policy you were wanting to go back and claim under, not the critical illness.
[CUSTOMER][NEUTRAL] Um, well, both, uh, because a critical illness, um, also I just wanna make sure that, um, you know, uh, a spouse is included to that benefit in that policy because she's not the one who had the stroke. I did.
[AGENT][NEUTRAL] OK, so she was the only one on the, she was the only one on the disability one. On the critical illness one, that was um her, you, and then 3 dependents. That was everybody, it looks like.
[CUSTOMER][NEUTRAL] And um we just.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so that's family. OK. So the critical illness, um, we can, we can file a claim, uh, through family, right? And then the short term disability, she can still file a claim because she went 2 weeks FMLA.
[CUSTOMER][NEGATIVE] Not even 2 weeks, uh, uh.
[CUSTOMER][NEUTRAL] Yeah, so basically that 2 weeks, um, I see.
[AGENT][NEUTRAL] Was it
[AGENT][NEUTRAL] Was it due to, was it due to an injury or was it due to sickness?
[CUSTOMER][NEUTRAL] Due to sickness.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] So she was out less than 14 days and there's a 7-day elimination period, she wouldn't get paid for the 1st 7 days.
[CUSTOMER][NEUTRAL] Yes, yes, we understand that 1st 7 days, but at least the 7 days.
[AGENT][NEUTRAL] OK, OK, yeah.
[CUSTOMER][NEUTRAL] Uh, she couldn't, well, here's the thing, she couldn't, she couldn't take, um, uh, you know, the time off because she doesn't have the time, um, you know, to take that time off, but she couldn't, she could have.
[CUSTOMER][NEGATIVE] Um, taken more, uh, longer, uh, through FMLA but unpaid, because she didn't know that she has that benefit. If she knew, uh, she could have taken short term disability through FMLA and not being paid to care for me when I had my stroke, cause I was off for two months.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] No, that's, yeah, it's totally fine if you want to do the paperwork. It, it can be sometimes a lot of paperwork, so I just wanted to make sure that you knew exactly what the um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, what the amount would be if, you know, and what the time frame would be eligible for, that's all.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yeah, yeah, yeah, no, thank you, thank you for that information, we really appreciate it and uh for the paperworks, yeah, we're willing to do all the paperwork because like what I said is, this is a benefit that she didn't know and and.
[CUSTOMER][NEUTRAL] Um, we would like to proceed and, and file this claim.
[AGENT][NEUTRAL] OK, so I'm sending you the short term disability claim form. What other information did you need from me today?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, uh, so the critical illness, we can still file a claim, right, for, for family, uh, for me, um, so, OK, perfect, and we have the form for critical illness and, um, the SDI you're gonna provide that form and we'll complete it. So if ever we have additional questions, we'll call back. Thank you.
[AGENT][NEUTRAL] Yes, yes.
[AGENT][POSITIVE] You're very welcome. Have a good day.
[CUSTOMER][POSITIVE] Yeah you too thank you bye.
[AGENT][NEUTRAL] Mhm.