AccountId: 011433970860
ContactId: 25589776-52ec-4565-a118-e086176df419
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1325869 ms
Total Talk Time (AGENT): 460853 ms
Total Talk Time (CUSTOMER): 482752 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/25589776-52ec-4565-a118-e086176df419_20250516T21:16_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], good afternoon. Um, my name is [PII], and I needed to talk to somebody regarding, uh, an explanation of benefits letter that I received.
[AGENT][NEUTRAL] OK, [PII], I can help you with that. Do you have a policy number?
[CUSTOMER][POSITIVE] Awesome, yeah, let me pull that up.
[CUSTOMER][POSITIVE] Make sure we got the right one.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, see, we do not have the right policy number.
[CUSTOMER][NEUTRAL] So the policy number.
[CUSTOMER][NEUTRAL] On this
[CUSTOMER][NEUTRAL] Exploration benefits is 025.
[CUSTOMER][NEUTRAL] 08326
[AGENT][NEUTRAL] OK. And what is your date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And you have a good callback number in case we're disconnected?
[CUSTOMER][POSITIVE] Yes, thank you for asking [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I just need your address and email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And email?
[CUSTOMER][NEUTRAL] Email [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And you said it was for, is this for a disability claim?
[CUSTOMER][NEUTRAL] It is, it is, um.
[CUSTOMER][NEUTRAL] But that's not the policy number that I filed my claim under.
[AGENT][NEUTRAL] OK. Um, let's see. So what was the date of the injury?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the first time I went to seek medical attention.
[CUSTOMER][NEUTRAL] Was
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um, and so.
[CUSTOMER][NEUTRAL] I thought it was just a screen.
[AGENT][NEUTRAL] Was it work related?
[CUSTOMER][NEUTRAL] Yes, yes, it was work related and the policy that I had when I was injured is a different policy number than the one on this letter.
[CUSTOMER][NEUTRAL] The policy number I had.
[CUSTOMER][NEUTRAL] When I was injured was 0 to 4.
[CUSTOMER][NEUTRAL] 19152 and that policy covered on the job injuries.
[AGENT][NEUTRAL] OK, but you didn't seek treatment until [PII]?
[CUSTOMER][NEGATIVE] I was hoping it was a strain and that it would get better with just rest and ibuprofen and ice and a knee brace, and it didn't get better, it got worse.
[CUSTOMER][NEUTRAL] So I went to see the doctor. He took X-rays and he said it, it looks like it's your lateral meniscus, but.
[CUSTOMER][NEUTRAL] He wanted to get an MRI to be sure.
[CUSTOMER][NEGATIVE] So then I had to make the MRI appointment and then scheduled to come back and see the doctor. And when I came back and saw him, he confirmed that it was a lateral meniscus tear and that I would need surgery to get it fixed. So as of that day, he put me off.
[CUSTOMER][NEUTRAL] So I guess my question would be,
[CUSTOMER][NEUTRAL] What date do we use? does what date does.
[CUSTOMER][NEUTRAL] APL use.
[CUSTOMER][NEUTRAL] To approve uh uh a claim.
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so the claim form that you fill, uh, the attending physician's form that was completed.
[AGENT][NEUTRAL] Stated date, symptoms first appeared [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that it was work related?
[CUSTOMER][NEUTRAL] No, you're looking at the wrong one.
[CUSTOMER][NEUTRAL] Did you receive an updated position statement?
[AGENT][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] It was sent out [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I caught that one actually I a couple weeks ago.
[CUSTOMER][NEUTRAL] I caught that one and I went ahead and printed up a new one.
[CUSTOMER][NEUTRAL] And took it down to my physician's office.
[CUSTOMER][POSITIVE] I even included, you know, some notes for them, the, the state claim number so that they knew specifically what we were talking about.
[AGENT][NEUTRAL] OK, uh, let me see.
[AGENT][NEUTRAL] And the only thing that we've received is we've got the employer initial claim.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Date last work [PII].
[CUSTOMER][NEUTRAL] They would have sent it over by fax.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the, the other thing that we've received is the claim form from the attending physician.
[AGENT][NEUTRAL] And that one, let's see.
[AGENT][NEUTRAL] I, I don't see a a updated attending physician statement, so you said they sent it.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, and I can send you an email copy of that right now.
[AGENT][NEUTRAL] Um, yeah, you'll have to fax it. We don't take emails because it's not secure. Um, let me look on your other policy. Hold on just a second.
[AGENT][NEUTRAL] OK. Mm.
[AGENT][NEUTRAL] OK, just, just looking at what we received, make sure that we have everything squared away. Let's see.
[AGENT][NEUTRAL] OK, time position statement. All right.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So, so the, we did get the uh the corrected attending physician statement.
[AGENT][NEUTRAL] It stated that it was work related and it said the date the disability began was [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] But what, that's when he put me off work. But what date does it show for injury?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But it's short term disability is based on when you're off work. That's what it's for.
[AGENT][NEUTRAL] That's the purpose of the short term disability is to pay you when you're off work for a disability.
[AGENT][NEUTRAL] So he put the date that disability began was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So that's why it's under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was covered from 51 to 7/[PII].
[AGENT][NEUTRAL] Which does not cover work injuries. So have you filed anything with workers' compensation?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, have they sent a denial or?
[CUSTOMER][NEUTRAL] No, they sent an approval.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so in order for this to be covered under the short term disability policy because the disability began on [PII].
[AGENT][NEUTRAL] This policy excludes workers related worker, you know, injuries that are sustained on the job.
[AGENT][NEUTRAL] So unless there's a denial from
[CUSTOMER][NEUTRAL] Was that
[CUSTOMER][NEUTRAL] Mhm, I'm listening.
[AGENT][NEUTRAL] Unless there's a denial from your workers' compensation, we wouldn't have any benefits payable under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Again, the injury happened in January.
[CUSTOMER][NEUTRAL] And I filed a claim in January.
[AGENT][NEUTRAL] OK, I, yeah, I understand what you're saying. It's just, again, this is.
[CUSTOMER][NEGATIVE] Actually, no, no, no, I take it back. Yeah, no, that's the day the doctor put me off and said, yeah, you can't work like this.
[AGENT][NEUTRAL] OK, well, we don't.
[CUSTOMER][NEUTRAL] And and I understand that's passed.
[CUSTOMER][NEUTRAL] Past the date
[AGENT][NEUTRAL] Yeah, it's it
[CUSTOMER][NEUTRAL] But my question is.
[CUSTOMER][NEUTRAL] Injury date doesn't count.
[AGENT][NEUTRAL] No, it's, it's solely based on when do you go off work. So, so that's because that's the purpose of short-term disability is to replace your income when you are gone from work.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, based on the
[CUSTOMER][NEUTRAL] But I still wouldn't be grandfathered in with an injury that happened prior to that date.
[AGENT][NEUTRAL] No, because again, the policy is pays you when you are off work, not when you're injured, it pays you when you're off work because of an injury.
[AGENT][NEGATIVE] Because you can't, you can't collect.
[CUSTOMER][NEUTRAL] So you don't use the injury date for anything?
[AGENT][NEUTRAL] No, because you, it's again, it's based on when you're off of work. You can't collect your full paycheck plus collect short term disability when you're going when you're going to work every day.
[AGENT][NEUTRAL] Then you're just getting extra money.
[AGENT][NEUTRAL] Cause that's the purpose of the short-term disability policy is to, to pay you money while you're off work because of an injury, regardless of when it happened.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The moment you go off work, that's the purpose of the short-term disability policy.
[CUSTOMER][NEUTRAL] That's when the policy takes effect.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So if there's any information that you know maybe they've just you could potentially send in information if workers' compensation is only paid to.
[AGENT][NEUTRAL] If they've denied some portion of it, we can look at that documentation to potentially consider something, but.
[AGENT][NEUTRAL] Work injuries are not covered and, and it would have to be denied by your worker's compensation.
[AGENT][NEUTRAL] Um, stating that they're not gonna cover.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] Yeah, no, this is my fault. I was hoping, like I said, it was just a strain.
[CUSTOMER][NEGATIVE] And I avoided filing any paperwork until it just got to that point where I was like yeah this is bad and it's getting worse so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Sorry about that. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Is that, is that?
[CUSTOMER][NEUTRAL] Yes, is that that specific?
[CUSTOMER][NEUTRAL] Is there specific um information within my policy that I have my original policy that I signed that states that?
[AGENT][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] When coverage begins.
[AGENT][NEUTRAL] Did you create an online account with us when you had the policy?
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][POSITIVE] This is funny. No, I did not, um, I didn't try to create an account until.
[CUSTOMER][NEUTRAL] Way after the fact and because I was putting in an old policy number.
[CUSTOMER][NEUTRAL] Um, I couldn't create an account.
[AGENT][NEUTRAL] OK. Um, so let me verify your
[AGENT][NEUTRAL] Hold on just a second
[CUSTOMER][NEUTRAL] So we're, we're going off of, of like the previous policy of, of when.
[CUSTOMER][NEUTRAL] When APL covered on the job injuries.
[AGENT][NEUTRAL] Um, where I can mail you a copy of your.
[CUSTOMER][NEUTRAL] And that's, that's ceased.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So would you like me to mail you a copy of the policy certificate?
[CUSTOMER][NEUTRAL] Of the
[CUSTOMER][NEUTRAL] Of the old policy certificate or the new policy certificate?
[AGENT][NEUTRAL] The policy certificate that applies to the claims that you've filed.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So that would be the old policy certificate that was in effect [PII].
[AGENT][NEUTRAL] I mean, I can mail you both, but again, I, the date of disability is when you go off work because that's the purpose of disability like I said, it wouldn't even, even on the old policy, it wouldn't matter. It's gonna be the same thing because again, that's, you can't collect short term disability plus your full paycheck.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because that's, that's the purpose of short term disability is to pay you when you can't get paid from work because of an injury. So even if, I mean, I can, I'm happy to send you that, that I can do that. But again, this is based on when your doctor says he's off work now because of this injury.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know what, yeah, which, and, and I'm looking at this from another perspective.
[CUSTOMER][NEUTRAL] The doctor put me off work, [PII] or [PII].
[CUSTOMER][NEUTRAL] So I was still under the old policy when he put me off work.
[AGENT][NEUTRAL] Or [PII], you mean, or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me look, let me pull up your old policy. Hold on.
[CUSTOMER][NEUTRAL] I was
[AGENT][NEUTRAL] Most short term disability policies don't cover work-related injuries because again that's then you're
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, the purpose of any injury, whether it's to stay on the job or not, you, is to be made whole or partially whole, not over what's whole.
[AGENT][NEUTRAL] So as not to collect more than what you would normally collect.
[CUSTOMER][NEUTRAL] Let
[CUSTOMER][NEUTRAL] So let me, let me update you because I've gone, I had to start off with um.
[CUSTOMER][NEUTRAL] What's her name?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I had to start off.
[CUSTOMER][NEUTRAL] Contacting.
[CUSTOMER][NEUTRAL] Employee retention benefits.
[CUSTOMER][NEUTRAL] So I just start off contacting them.
[CUSTOMER][NEUTRAL] And they said OK you're gonna need to speak to APL directly um but they updated me as to what happened um.
[CUSTOMER][NEUTRAL] And what's
[CUSTOMER][NEUTRAL] What's going on is basically.
[CUSTOMER][NEUTRAL] As of now we're I believe under a different company they they found a different company to cover us because what happened was.
[CUSTOMER][NEUTRAL] See, I work for the fire department, County of [PII].
[CUSTOMER][NEUTRAL] So, through work, we're offered different group plans.
[CUSTOMER][NEUTRAL] Um, for disability, um.
[CUSTOMER][NEUTRAL] Coverage or disability, uh, supplemental, um, what do they call it?
[CUSTOMER][NEUTRAL] Supplemental payroll or supplemental supplemental pay when we get hurt at work.
[CUSTOMER][NEUTRAL] So what happened is.
[CUSTOMER][NEUTRAL] My old policy.
[CUSTOMER][NEUTRAL] The one that I had [PII] and the one that I had [PII] or [PII], that policy um as of [PII].
[CUSTOMER][NEGATIVE] Um, I believe expired.
[CUSTOMER][NEGATIVE] And we were expired for a one month period.
[CUSTOMER][NEUTRAL] From APL
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII] or [PII], I believe it took them all month, but [PII].
[CUSTOMER][NEUTRAL] They came back and said, OK, we could well the APL will still provide coverage but they no longer cover anything on the job.
[CUSTOMER][NEUTRAL] Which was the whole purpose of my department.
[CUSTOMER][NEUTRAL] Signing up
[CUSTOMER][NEUTRAL] For that policy.
[CUSTOMER][NEUTRAL] So what I'm trying to say is the old policy covered on the job injuries. The new policy.
[CUSTOMER][POSITIVE] Didn't cover on the job injuries anymore. So the day I got hurt and the day I got put off on disability, we're both covered.
[CUSTOMER][NEUTRAL] Under the old policy.
[AGENT][NEUTRAL] OK, um, it, but so.
[AGENT][NEUTRAL] Again, the the short term disability pays you when you're off of work, so I understand what you're saying.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But you weren't off work until [PII], but you're saying it's [PII]?
[CUSTOMER][NEUTRAL] [PII] is when I first went in to see him.
[AGENT][NEUTRAL] OK, but it's, it's based on when you're absent from work, when you're, you can no longer work due to the disability.
[AGENT][NEUTRAL] So regardless, so I understand what you're like your old policy, if it covered work injuries, that's fine, but it's still based on paying you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] When you are off of work.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Starting when you're off of work.
[AGENT][NEUTRAL] Correct. That's when it's, no matter what, whether it pays for work work injuries or not.
[AGENT][NEUTRAL] It will only pay when you are off of work. That's when the short-term disability begins.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And so based on what we
[CUSTOMER][NEUTRAL] Well, that would have been in the.
[CUSTOMER][NEUTRAL] Yeah, based on what you're saying I'm not eligible.
[AGENT][NEUTRAL] Based on
[AGENT][NEUTRAL] Correct, because we show that the disability began 5-28, 24. That's what your doctor told us.
[AGENT][NEUTRAL] The first day your disability began.
[CUSTOMER][NEGATIVE] Which was actually the day he said I can't work anymore.
[AGENT][NEUTRAL] Right, well that's what he attested to was that was 528 24.
[AGENT][NEUTRAL] So if that's incorrect, we'll need another statement.
[CUSTOMER][NEUTRAL] Mhm. That's when you put.
[AGENT][NEUTRAL] No, if, if that's wrong.
[CUSTOMER][NEGATIVE] Well, that's when he put me off on total temporary disability.
[AGENT][NEUTRAL] And so you weren't off prior to that point, correct? You're just dealing with the injury?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I just toughed it out.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, again, regardless of whether the policy covers a work injury or not, disability is always determined upon when are you disabled and unable to attend work.
[CUSTOMER][NEUTRAL] So what happens during that month.
[CUSTOMER][NEGATIVE] That our policy was put on hold.
[AGENT][NEUTRAL] Uh, I, I show your policy.
[AGENT][NEUTRAL] I show you had continuous coverage. It's just the policy switch. So you had a policy from 111 to 5124, and then the policy changed effective [PII] and then terminated [PII].
[AGENT][NEUTRAL] So I don't, I don't show any.
[AGENT][NEUTRAL] I don't show any gap in coverage, just the policies changed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You had your short term disability.
[CUSTOMER][POSITIVE] The policy change is effective.
[AGENT][NEUTRAL] Yeah, so 5120 24, yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The beginning of the month when I went off on injury, OK.
[CUSTOMER][NEUTRAL] OK, and that effective date is written in the policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sure I have it somewhere.
[AGENT][POSITIVE] Yeah, I, I'm happy to still mail you one though if you'd like me to.
[CUSTOMER][POSITIVE] Yeah, if you would I'd appreciate it.
[AGENT][NEUTRAL] OK, sure. Yeah, I'll get that in the mail.
[CUSTOMER][NEUTRAL] I have a lot of paperwork to dig through.
[AGENT][NEUTRAL] Yeah, I understand. Um, I'll get that in the mail to you. Um, so look out for that. Just give it about 3 to 5 working days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else I can help with?
[CUSTOMER][POSITIVE] Will do. Thank you, [PII].
[AGENT][NEUTRAL] OK. Well, thank you and I hope you have a, I hope you have a, I understand. I'm so sorry for the frustration, but yeah, it's unfortunate. I, it's again based on when you're off of work, not when the injuries are sustained. So, but yes, I'll get that sent to you, [PII], and then um I hope you have a good weekend, OK?
[CUSTOMER][NEGATIVE] No, I wish.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you you do the same take care.
[AGENT][POSITIVE] Thank you. Bye bye.