AccountId: 011433970860
ContactId: 5dd05eaf-ffd7-4132-a02d-663f136e9de4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 827320 ms
Total Talk Time (AGENT): 164048 ms
Total Talk Time (CUSTOMER): 176824 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/5dd05eaf-ffd7-4132-a02d-663f136e9de4_20250516T18:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], this is [PII] in customer care. How are you today?
[AGENT][NEUTRAL] I'm fine thanks how are you?
[CUSTOMER][NEUTRAL] I'm good. Um, I have an insured on the line who has a question about an accident claim, and it was denied. I can't figure out why it was denied. I was hoping maybe you could help.
[AGENT][NEUTRAL] OK, so let me take a look at it. What's the policy number?
[CUSTOMER][NEUTRAL] 1557812
[CUSTOMER][NEUTRAL] Should be for [PII] is part one that comes up.
[AGENT][NEUTRAL] OK, give me just a second.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Wait, this one that was for [PII]?
[CUSTOMER][NEUTRAL] No, no, no, I'm sorry, the claim is for Barry but part one is just the name I was giving you it's for Barry.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] It's a claiming and ending in 1213.
[CUSTOMER][NEUTRAL] So it was a car accident that happened and I'm, I looked I looked through everything she submitted. The only thing I could deduce was maybe she didn't submit any sort of like police report that I can see. Is that maybe the issue?
[AGENT][NEUTRAL] Uh, bear with me just a second.
[AGENT][NEUTRAL] OK, and what was their callback number?
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK, and you said it's Ms. [PII] on the other line?
[CUSTOMER][NEUTRAL] Yeah, we're talking with Ms. [PII], correct.
[AGENT][POSITIVE] OK, I can go ahead and assist her. Thank you.
[CUSTOMER][POSITIVE] OK, I'll send her over thanks one moment.
[AGENT][POSITIVE] Thank you for holding this is [PII].
[CUSTOMER][NEUTRAL] Hello, uh, my name's [PII], and I need some help on this claim, please. Um, it is claim number 3601. I'm looking at my phone. I took a picture of it. 3601213.
[AGENT][POSITIVE] Uh, yes, ma'am, and how can I help you today?
[CUSTOMER][NEUTRAL] Uh, well, I'm, I'm confused. It says check date is [PII], but then it says in the remark that it doesn't appear that an accidental bodily injury occurred, therefore, no benefits are payable, so.
[CUSTOMER][NEUTRAL] Uh anyway, I'm confused.
[AGENT][NEUTRAL] OK. You
[CUSTOMER][NEUTRAL] Maybe you could help me out.
[AGENT][POSITIVE] Oh, I'm sorry?
[CUSTOMER][NEUTRAL] Maybe you can help me out.
[AGENT][NEUTRAL] Sure, so you had a question regarding the the the denial of the claim?
[CUSTOMER][NEUTRAL] Yes, because I sent in the itemized bills and I sent in my statement that says he had neck and shoulder injuries because he got, uh, someone pulled out right in front of him.
[CUSTOMER][NEUTRAL] Uh, in vehicles and, uh, yeah, and I don't know what else to do. Is it is it accident and a vehicle not covered?
[AGENT][NEUTRAL] OK, well sure I take a quick look at that for you. Um, do you mind if I put you on hold for just a moment and I'll go through that claim for you.
[CUSTOMER][POSITIVE] Yeah, that'd be just a yes ma'am, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey there. Uh, so I guess I'm just trying to understand. So she's saying that his neck and shoulder was injured, so that doesn't qualify as bodily injury?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so I'm just looking through here just because I wanna be able to explain that to her. Um, so it says like motor vehicle oh, I'm sorry?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, so it's like the cause of injury.
[AGENT][NEUTRAL] Um, it's a blunt injury, it says.
[AGENT][NEUTRAL] Um, let me see if it has explained anything else.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, yes, I'm just looking at these notes here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much. I'll let her know.
[AGENT][POSITIVE] OK, great, thank you so much [PII].
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] You are on
[AGENT][POSITIVE] OK, I'm so sorry about that, Miss [PII]. Are you still there?
[CUSTOMER][NEUTRAL] Man
[AGENT][NEUTRAL] OK. So yes, I went through the claim and the medical records that we have received. And so the, the reason for that denial was because for this benefit under the your accident policy, um, the documents need to be able to verify the bodily injury. Um, so that's what the reimbursement would be, um, once we're able to verify what the bodily injury was due to the accident.
[AGENT][NEUTRAL] It looks like in the records, um, it only verifies that there is pain, um.
[AGENT][NEUTRAL] Like, yeah, it was pain, neck pain, and chest pain, and abdominal pain, um, and lower back pain, but it doesn't specify what the injury was.
[AGENT][NEUTRAL] Um, and so that's what the additional information that is needed to be able to provide that, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That the bodily injury benefit.
[CUSTOMER][NEUTRAL] OK, so if I got a hold of the uh emergency room or the hospital that the emergency room is located at and they were able to have something like that that I'm not aware of because theirs was just an itemized bill so I could if there was anything in the medical records that said that then you guys could take that and look at it is that right?
[AGENT][NEUTRAL] Uh yes, ma'am. Any of the records from the emergency room or if they did any diagnostic testing like a, like an X-ray or a CT scan, an MRI.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] X-ray, I'm writing this down. CT scan, um, or anything in the medical records that says a bodily injury. OK, all right, well I'll see what I get done and if I have that I can just upload that into the computer as well.
[AGENT][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, and they, they will be able to review that additional information for the claim.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][POSITIVE] OK, well thank you for the uh information on that and I'll see if I have anything thank you for your time.
[AGENT][NEUTRAL] Uh, sure, Ms. [PII], and was there anything else I could do to help you today?
[CUSTOMER][POSITIVE] Uh, no, that's it. I hope you have a good weekend.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a good day as well.
[CUSTOMER][POSITIVE] Thanks bye bye.
[AGENT][NEUTRAL] Mm Bye-bye.