AccountId: 011433970860
ContactId: 22c0a0ca-4b8c-4204-8ad8-1362a38f280a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255809 ms
Total Talk Time (AGENT): 97681 ms
Total Talk Time (CUSTOMER): 66357 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/22c0a0ca-4b8c-4204-8ad8-1362a38f280a_20250617T15:30_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], this is [PII] with the care team. Um, I have a [PII]. I'm sorry, flabbergasted today, um, on the line in regards to her son's most recent claim for policy 244-6222.
[CUSTOMER][NEUTRAL] Um, showing that it was, it was not a covered accident. I was wondering if you could go over with her why um it wasn't a covered accident. I'm not able to look into that.
[AGENT][NEUTRAL] OK, what's the dependent's name?
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And it's the claim ending in 1544.
[AGENT][NEUTRAL] OK, let me take a look.
[AGENT][NEUTRAL] Oh, this claim was just processed today, so let me see.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I mean really all I could do is read her the claim remarks and she just said it was an accident. She doesn't know how it's not covered.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, it looks like based on the information that we have, it's not a result of a covered accident. So let me see what she sent. Let me see, she sent.
[AGENT][NEUTRAL] Yeah, cause the polish defines uh accident as uh.
[CUSTOMER][NEUTRAL] Yeah and I I know we're not allowed to do research, but.
[AGENT][NEGATIVE] Bodily injury.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] So she's.
[CUSTOMER][NEUTRAL] Yeah, and all I, all I saw was X-ray and X-ray is covered, so I, I wouldn't know what to say either.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] So far, I'm just seeing it's just seeing pain and
[AGENT][NEUTRAL] Pors pain has been going on. No trauma, no acute injury. Yeah, the information we have doesn't indicate, OK, yeah, I, yeah, it's, what we have here, there's no indication of any injury or trauma based off the information we have. The policy only covers due to bodily injury.
[AGENT][NEGATIVE] So this wouldn't be a covered, covered, covered.
[CUSTOMER][NEUTRAL] OK, do you want me to transfer her to you? I, I said that exact same thing.
[AGENT][NEUTRAL] So yeah, it's, it's exactly what it specifies. Yes, it's exactly what's specified in that remark code. Yeah, cause the only thing that we have.
[CUSTOMER][NEUTRAL] Yeah, and I read that to her.
[AGENT][NEUTRAL] Yeah, the only thing that we have is.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's the only thing that I would tell her that same information based on what we have, it doesn't indicate that it an injury occurred and read exactly what their remark code outlines.
[CUSTOMER][POSITIVE] Yeah I did OK.
[CUSTOMER][NEUTRAL] So it doesn't look like there's an injury from it.
[AGENT][NEUTRAL] No. Based on the information we have, it only lists that there was that he was experiencing pain and there's no acute injury or trauma from what we have.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, I will let her know. Thank you so much.
[AGENT][POSITIVE] OK. Oh, you're welcome.
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Mm bye.