AccountId: 011433970860
ContactId: 253f47cd-e806-4a9e-a1f9-78a918c43bf8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 457540 ms
Total Talk Time (AGENT): 121261 ms
Total Talk Time (CUSTOMER): 148887 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/253f47cd-e806-4a9e-a1f9-78a918c43bf8_20250428T21:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling about a claim. I'm trying to find out what, what's going on. My name, my name is uh [PII].
[CUSTOMER][NEUTRAL] I'm trying to find out what's going on with this claim cause it, it stayed on the accident so what somebody explain to me what's going on.
[AGENT][NEUTRAL] You have a claim number or do you have a policy number?
[CUSTOMER][NEUTRAL] Policy number is 968816.
[CUSTOMER][NEUTRAL] But I sent in the part in on there where I said, it was just an accident and it said yes. So what's the problem?
[AGENT][NEUTRAL] OK, is it for yourself?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. I just need a few pieces of information. What is your birthday?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, do you have a good callback number, telephone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you. And then,
[AGENT][NEUTRAL] What's your address, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is your email address?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and then is this for, let me see, is this for [PII]?
[AGENT][NEUTRAL] Or what date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then they said it was uh.
[CUSTOMER][NEUTRAL] Oh, well.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And I sent in the thing they on there and say well this is it.
[CUSTOMER][NEUTRAL] Yeah, so what's the problem?
[AGENT][NEUTRAL] Um, let me see what we received.
[CUSTOMER][NEUTRAL] They got on it
[CUSTOMER][NEUTRAL] They would do to him.
[AGENT][NEUTRAL] I'm getting it pulled up. Just give me one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like somebody look at they do what they did and went on, OK, just, you already see it Friday somebody already made the depend on already. Somebody did something.
[AGENT][NEUTRAL] Uh let me pull up your policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Yeah, I'm gonna say they don't sound right now. Y'all just see the sign and date Monday y'all ready to process. I ain't right with that.
[CUSTOMER][NEUTRAL] Like somebody just doing something.
[AGENT][NEUTRAL] I'm trying to see what exactly it covers on your policy, so give me just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was a call, man, so what, what, what do they don't come.
[AGENT][NEUTRAL] Oh, that's what I'm looking at if you'll give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me, um, can I get you to our claims department and they'll be able to help you explain to you what's going on here because they're the ones who process the claims and they they're able to explain why they don't pay something.
[AGENT][NEUTRAL] So, can I get you over to that department?
[CUSTOMER][NEUTRAL] Well, that's it.
[AGENT][NEUTRAL] OK. Hold on.
[CUSTOMER][NEUTRAL] Uh yeah you can connect with what I'm just saying though it was simply the pay was state that it was due to an accident.
[AGENT][NEUTRAL] OK, let, hold on one moment.
[CUSTOMER][NEUTRAL] So I, I, I don't know.
[AGENT][POSITIVE] I'm gonna get you transferred over and somebody will be able to help you, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Well, this is [PII] and the care team and I've got a member on the line that um we've denied the claim and I was gonna see if you could kind of help explain why it's not covered because he, he's just adamant that it should be covered because it's an accident.
[CUSTOMER][NEUTRAL] OK, and what's the policy number?
[AGENT][NEUTRAL] Policy number is 968817.
[CUSTOMER][NEUTRAL] OK, just give me one moment.
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] For [PII], Mr. [PII].
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] It's the most recent policy or recent claim. Uh, I got him verified. I've got a callback number.
[CUSTOMER][NEUTRAL] OK, is that the callback number listed there on the screen [PII]?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] And he's upset, I take it.
[AGENT][NEUTRAL] Yeah, he just, he doesn't understand why it's not covered. He just kept saying it's an accident. I mean, I see that it's a fall, but I was trying to look through the policy and see.
[AGENT][NEUTRAL] Did it define some of these accident policies have like a list of everything, but I'm not seeing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I guess I'm not really seeing that like they.
[CUSTOMER][NEUTRAL] Well, yeah.
[CUSTOMER][NEUTRAL] Even, even though it's a fault, we have to have an accidental bodily injury diagnosis, and it looks like the diagnosis is pain. So, therefore, the adjuster denied it is no bodily injury. So I'll pull up the claim documents and just verify that information.
[CUSTOMER][NEUTRAL] Um, but you can go ahead and put him through.
[AGENT][NEUTRAL] And you did say [PII], right? I'm just make sure I uh heard your name right.
[CUSTOMER][POSITIVE] Yeah, [PII] That's correct, [PII], mhm.
[AGENT][POSITIVE] OK, perfect. I'll introduce you and then I'll release them to you. Thank you so much for your help. I appreciate you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, Mr. Mr. [PII], I've got [PII] on the line. She's gonna help you and explain, uh, on this claim what's going on, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much.