AccountId: 011433970860 ContactId: 6f51b7e0-f8f0-4ac6-bf66-5d76745518dc Channel: VOICE LanguageCode: en-US Total Conversation Duration: 1326430 ms Total Talk Time (AGENT): 333688 ms Total Talk Time (CUSTOMER): 868854 ms Interruptions: 7 Overall Sentiment: AGENT=0.7, CUSTOMER=-1.2 Redaction Types: PII Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/6f51b7e0-f8f0-4ac6-bf66-5d76745518dc_20250429T15:08_UTC.wav -------------------------------------------- [AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you? [CUSTOMER][NEGATIVE] Yes, can I speak with a manager. I need to speak to somebody that's over the insurance department cause I don't need to talk to Miss [PII] cause me and her, I need to talk to somebody how down a supervisor cause we got, we got a problem here. [CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. [AGENT][NEUTRAL] OK, I'm so sorry, Mr. [PII]. What, what, what, can you tell me your last name again, please? I'm sorry, I didn't catch that. [CUSTOMER][NEUTRAL] I don't know what's going on in that. [CUSTOMER][NEUTRAL] She [CUSTOMER][NEUTRAL] [PII]. [CUSTOMER][NEGATIVE] I need to speak to somebody, a manager or somebody that's over. I don't need to speak to no supervisor. I need to speak to somebody that's over, over y'all. [CUSTOMER][NEUTRAL] Because uh I don't know where they got to where they don't want to pay the claims or what, but I know right now we got a problem here and we need to solve this problem because the person I talked with yesterday named Miss [PII], I don't know what she got going on, but the plane specifically say what they said, I ain't got to be physically hurt for the accident. If you fall, ma'am, that's an accident. [CUSTOMER][NEGATIVE] You ain't got to be in a hurt some or fall accident. See, for some reason, I don't know where she getting her information on where she coming from. Now I understood last time when she did this, it said no. They said well this business due to injury, it said no, I understood, but this time it said yes and she still talking about it got it coming you can fall. [CUSTOMER][POSITIVE] And don't have asked. What do you, have you ever failed and you didn't get hurt when you fail? How can you fall and don't get hurt? [CUSTOMER][NEUTRAL] That's why I sent you off the chart. That's why you talk to somebody that's higher than a supervisor. [AGENT][NEUTRAL] OK, Mr. [PII], so you're wanting to speak to someone who is above [PII]. Is that correct? [CUSTOMER][NEUTRAL] Above, yes ma'am, because like said this lady that vote to be uh supervisor over the uh accident claim, she ain't right cause what like I I explained to her yesterday, I said what do the papers that do it it said those things that fall. What do you do? She said you can fall and don't get hurt. [CUSTOMER][NEUTRAL] But they took X-rays though. So why would they, why would the doctor she's trying to say the doctor don't know what he talking about. [CUSTOMER][NEGATIVE] Now what kind of stuff is that now I pay up before and they paid the claim and they ain't said nothing about it wasn't no bother on. You need to read the whole thing. [AGENT][NEUTRAL] OK, so [CUSTOMER][NEGATIVE] But you gonna tell me that I can fall. [CUSTOMER][NEUTRAL] And don't get hurt. I got a feel to break something. That ain't what that party say. It's the accident. He said nothing about you got to be, you got to break some or do something. It's the accident. That's what that's what the part about. [CUSTOMER][NEGATIVE] I don't know where she get the definition of whatever rock you don't come off nothing. She needs to go back there. [AGENT][NEUTRAL] OK, Mr. [PII], so first off, before I can help you further get you connected with someone else, what is a good callback number for you, please? [CUSTOMER][NEUTRAL] It's [PII]. [AGENT][NEUTRAL] Yes, sir. [AGENT][NEUTRAL] OK, did you say [PII]? [CUSTOMER][NEUTRAL] Yes ma'am. [PII]. [AGENT][NEUTRAL] OK, thank you. All right. Thank you. And what is your policy number, please? [CUSTOMER][NEUTRAL] It's 968-817. [AGENT][NEUTRAL] 968-817. Is that correct? [CUSTOMER][NEUTRAL] 968-817. I sent y'all. [CUSTOMER][NEUTRAL] Some pictures. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] 000. [CUSTOMER][NEGATIVE] I sent some pictures show my leg is still swollen. I'm gonna have to end up going back out here to this hospital cause my leg is still swollen. [AGENT][NEUTRAL] OK, Mr. [CUSTOMER][NEUTRAL] That's why I'm trying to explain to this warming up. [CUSTOMER][NEGATIVE] And she gonna tell me about it's bothering her. I ain't got no I ain't gotta be no broke nothing for to be no accident. [AGENT][NEUTRAL] OK, so Mr. [CUSTOMER][NEUTRAL] That ain't what they say. It's that. [AGENT][NEUTRAL] So what I need to do first, as I mentioned to you before I, before I can further assist you or get you connected with someone different, I will need to verify some information with you first for security and also any information, Mr. [PII] that I'm able to provide would be a verification of benefits and not a guarantee of payment. So first off, if you could please verify your date of birth for me? [CUSTOMER][NEUTRAL] It's [PII]. [AGENT][NEUTRAL] OK, thank you. Also your home mailing address. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] Thank you. The phone number we show for you is the same as the one you gave me, so that is your best phone number, is that correct? [CUSTOMER][NEUTRAL] Yeah. [AGENT][POSITIVE] Thank you and lastly your email address please? [CUSTOMER][NEUTRAL] It's [PII] [CUSTOMER][NEUTRAL] 18. [CUSTOMER][NEUTRAL] [PII]. [AGENT][NEUTRAL] OK, thank you. So, Mr. [PII], do you mind giving me a moment to look at uh just some information, please? [CUSTOMER][NEUTRAL] OK. [AGENT][POSITIVE] Thank you. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Mm. [CUSTOMER][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] [PII]. [CUSTOMER][NEUTRAL] I [CUSTOMER][NEUTRAL] I. [CUSTOMER][NEUTRAL] You do wrong. [CUSTOMER][NEUTRAL] Oh [CUSTOMER][POSITIVE] They do the right [CUSTOMER][NEUTRAL] that. [AGENT][NEUTRAL] OK, so Mr. [PII], I do, um, I was looking just through some information now on this claim, and this is for the most recent claim that was processed on yesterday, is that correct? For [PII]? OK. And [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yeah. [CUSTOMER][NEGATIVE] Mhm, they got, they got 4 things on there. They got fall. [CUSTOMER][POSITIVE] Ain't complain. [CUSTOMER][NEUTRAL] Knee pain? [CUSTOMER][NEUTRAL] And most of the thing got 4 things on it. Oh, OK, what is the phone? [AGENT][NEUTRAL] Now, I can see that, you know, I can see that she did go over your policy information with you and she did explain the appeals process that you can file an appeal, Mr. [PII]. [CUSTOMER][NEUTRAL] Explain that to me. [CUSTOMER][NEGATIVE] OK, well, well, what I'm saying, you talking about filing a ell, OK, filing a pill, man, what I'm saying the thing on there said was this bitch, the last time she did this. [AGENT][NEUTRAL] I have [AGENT][NEUTRAL] Yes, sir. [CUSTOMER][NEUTRAL] He said that uh when it got on here this visit wasn't due to injury. He said no. OK, this time it asked for this visit due to an injury, it said yes. OK, she gonna say the doctor don't know what he or she saying. [CUSTOMER][NEGATIVE] Because on there I had to, I said how can you fall and not get hurt? I me my leg right now swollen. I sent y'all some pictures that show my leg. I got to go back out here to this hospital because of what happened. [CUSTOMER][NEGATIVE] My legs swollen right now. I can't hardly walk on this right leg right now. [CUSTOMER][NEUTRAL] And I'm trying to explain to her, I don't have to necessarily be nothing broke it's a, it's an accident. Accident means if you fall, that's an accident. It ain't no, it ain't, you ain't got to be a broken leg, broke your arm. It's an accident. [CUSTOMER][NEGATIVE] I just filed a claim back in about two months ago. It, it was on my, uh, I had failed uh doing found washing my toy. [CUSTOMER][NEGATIVE] OK, what is the difference? Did you go to what we what really act down when it said I was, I was cutting, I was in a dish cutting the dish with the weed is, and I climbed out there and I fell on my knee. I said, my knee swole. I sent y'all some pictures that show the knee swollen. I can't even have to walk on the knee. I got to go back out here to the hospital. [CUSTOMER][NEUTRAL] And find out [CUSTOMER][NEUTRAL] Why his leg is still swollen? [CUSTOMER][NEGATIVE] Now do I need to send y'all some pictures, some more pictures to show you that my leg is swollen? That's why I said that's why the doctor said accident. She trying to talk about where it gotta be bodily injury. It ain't gotta be no body where I gotta have no broke leg for in order for that ain't what that policy state. [CUSTOMER][NEGATIVE] If that was so, they never pay me for none of my problem. [CUSTOMER][NEUTRAL] So I know better than that. [CUSTOMER][NEGATIVE] It said fall, and anytime you fall, you gonna get hurt. [CUSTOMER][NEUTRAL] It's just something like I told you. It's just self-explanatory. It's in black and white. It says what this business, I'm gonna repeat it again, due to an injury, it said yes. [CUSTOMER][NEUTRAL] So, she gonna tell me the doctor don't know what he's talking about, but she don't know what you're talking about. [CUSTOMER][NEUTRAL] That they didn't stay well over here it got on there, but it said it said she only focused on knee pain. [CUSTOMER][NEGATIVE] Ankle pain, muscle, that's all she focused on. She ain't even looking at the phone part. But now like I said I gotta go back out here now. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEGATIVE] And find out what the heck is going on with my leg, but my, my, my, my ankle right now is swollen up. [CUSTOMER][NEUTRAL] Right now. [CUSTOMER][NEUTRAL] And she just talking about uh I it got to be like it gotta be broke man that ain't what accident is. [CUSTOMER][NEUTRAL] I'm still showing myself now. I know what this is about. [CUSTOMER][NEUTRAL] You ever heard of security national life down in [PII]? [AGENT][NEUTRAL] Mm, no, sir. I personally haven't, but, but, you know, no, sir. [CUSTOMER][NEUTRAL] Well. [CUSTOMER][NEUTRAL] Well, they, they got one down in [PII] named Security Life. Security National. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] So I tell insurance so I know. So the thing about from where I'm living at, y'all don't want to pay the claim now. [CUSTOMER][NEUTRAL] But it sounds like [CUSTOMER][NEUTRAL] Because she done did this 2 times, 7 times she did it. [CUSTOMER][NEUTRAL] For the same reason. Now I understood, like I said, I understood me on the first week. It said, well this business due to an injury said no. [CUSTOMER][NEUTRAL] I understood that clearly cause it said no. [AGENT][NEUTRAL] Yes, sir. [CUSTOMER][POSITIVE] With no problem with that. [CUSTOMER][NEUTRAL] But, but this time. [CUSTOMER][NEUTRAL] It said [CUSTOMER][NEGATIVE] With this business due to injury and she said she's trying to tell me you gotta be both at home. I got to be the hurt broke something or something in order for, no, that ain't what that, that ain't what they say. That ain't what that positive state. It's if you get it just like if I walk out this door right now and fall off, I got porch and I fall off this porch, that's an accident. [CUSTOMER][NEUTRAL] Will I break my leg or not? It's still an accident, man. [CUSTOMER][NEGATIVE] You just self expla I'm telling you can't, you can't get it no clear. [CUSTOMER][NEUTRAL] Yeah, if I, if I go out there on the road. [CUSTOMER][NEUTRAL] And I some his father. They walking down the road. [CUSTOMER][NEUTRAL] That's an accident. My trip over something. That's an accident. [CUSTOMER][NEUTRAL] It's just self explaining. So I don't, I don't know, like I said, I don't know where she's coming from. [CUSTOMER][NEGATIVE] It's like you don't wanna pay the point. [CUSTOMER][NEUTRAL] But they wouldn't feel it because if you ask anybody that that's why they go when you go to the hospital if you're a person that fall, they give you a a a a a tag put on you for fall. [CUSTOMER][NEUTRAL] That's why they give you that. [CUSTOMER][NEUTRAL] OK, I'm cutting, I'm cutting down the dish with a weed. The dish deep. [CUSTOMER][NEGATIVE] I'm just ready to come up out of there. I fell on my knee trying to come up out of there and I hurt the knee and like I said, my, my, my right leg right now is still swollen. My ankle swollen up right now. I got to go back out here, like I said to the hospital to find out what's going on here because the doctor told me. [CUSTOMER][NEGATIVE] To put some ice on it. OK, ma'am, I don't put ice on it. I'm elevating. When I stand on this leg now, my ankle sweat. It's, it's swollen. It's swollen right now. [CUSTOMER][NEGATIVE] I sent you two pictures that show you that the leg is swollen. [CUSTOMER][NEUTRAL] What else do you need to do for to to to to show you that it was accident? [CUSTOMER][NEUTRAL] That's why I'm trying to see what, that's why I said I need to talk to somebody. That's how, because that right there is self-sam recovery. Why would the doctor put on there? [CUSTOMER][NEUTRAL] Accident if it wasn't an accident. [CUSTOMER][NEGATIVE] That don't, that don't make sense, man. [CUSTOMER][NEGATIVE] They would put on that note, feel like they did last time, no. This was not due to a note. This business was not due to no interest. [CUSTOMER][NEGATIVE] But now they don't put it on and she still want hard again and the doctor don't know what they talking about. [CUSTOMER][NEUTRAL] Well, all I see a, you, you don't see the fall? [CUSTOMER][NEUTRAL] Why do you think to put the fall, go down in the deeper part where they tell you about what I was doing. [CUSTOMER][NEUTRAL] In order to further anchor this way. [CUSTOMER][NEUTRAL] In order for the knee pain, for the ankle pain, muscle pain. It tells you why come from a what? from a fall. [CUSTOMER][NEUTRAL] Selfna. [CUSTOMER][NEUTRAL] In black and white. [CUSTOMER][NEUTRAL] Now how you gonna argue with it? [CUSTOMER][POSITIVE] But she tells me that you can fall and don't, I like to see you fall, ma'am, and don't get hurt. You'll be the first one I know to do it. [CUSTOMER][NEGATIVE] And like I say, I failed coming up out the ditch is deep, and I was, I was cutting down in a ditch and I failed. [CUSTOMER][NEGATIVE] So you need to tell me I had to break my leg in order for not to clean. I don't sound, that ain't what that is, man. [CUSTOMER][NEGATIVE] that don't sound right. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] Right. [CUSTOMER][NEUTRAL] That's why I say I need to talk to somebody that's above a supervisor. [CUSTOMER][NEUTRAL] But we don't went through this before. Last time about a cold. It was talking about a cold. I said, man, what about? I said, I was calling the hospital and all they said a cold is a cold we gave. What you mean? Then they call me back later on and apologize. [CUSTOMER][NEUTRAL] But the moment was out. [CUSTOMER][POSITIVE] Yeah, they call me back and I apologize. [AGENT][NEUTRAL] OK. So if you want, Mr. [PII], uh, again, the appeals process is what I would recommend for you to file an appeal asking, you know, and include, you may include any addition. [CUSTOMER][NEUTRAL] Yeah [CUSTOMER][NEUTRAL] Man [AGENT][NEUTRAL] Now, it's in regards to speaking to. [CUSTOMER][NEUTRAL] The appeal, OK, who I'm appealing to what I'm trying to say, man, is the people that, oh, that just like going to the uh the people that go to make the decision. OK. These are the same people that you come out with the appeal and the same people, the one that's doing from the from the beginning. [CUSTOMER][NEUTRAL] It ain't like somebody different. Y'all the one doing the feeling. You're the one making the decision, so. [AGENT][NEUTRAL] No, so there's a separate appeal. Yes, sir, but there's a separate appeals department. [CUSTOMER][NEUTRAL] Yeah, yeah, the same people that's working for y'all. [AGENT][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] That that's the thing. [AGENT][NEUTRAL] OK, so [CUSTOMER][NEGATIVE] The thing that just like when I went there went there one time and they told me well we gonna let the doctor something. OK, you gonna let the doctor, OK, just the same doctor that work for y'all. So how you think that this same doctor that's working for y'all gonna go against what y'all saying. [CUSTOMER][NEGATIVE] OK, disappeal. Who, how you think that one that OK, I'm appealing disagreeing with what they were when they all working together. So yeah, they, they. [AGENT][NEUTRAL] Yes, so all insurance [PII]es, you know, insurance companies have the appeals process in place for a reason, so that if you, you know, disagree with the decision that has been made, you have the right to file an appeal within 180 days from the date of the decision that was made. [CUSTOMER][NEUTRAL] OK, and it takes. [CUSTOMER][NEUTRAL] OK, it takes 6 months to a year? [AGENT][NEUTRAL] No, you have that long, you have, you have the right to file an appeal within 180 days. [CUSTOMER][NEUTRAL] I understand that. I said how long do it. [AGENT][NEUTRAL] From the, from the decision was made. [AGENT][NEUTRAL] How long does the appeal take to review? No, sir. It would take approximately, um, [CUSTOMER][NEUTRAL] Take from 6 months. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] Um, um, let's see. I would say a couple of weeks on average. No, sir. That's just the time frame that you have to file the appeal. [CUSTOMER][NEUTRAL] 6 months to [AGENT][NEUTRAL] You have, from the day, OK, if you're wanting to speak to someone above [PII] because she is a supervisor, I'm very sorry, but that person is not in the office today. [CUSTOMER][NEGATIVE] Well, why I can't talk to somebody? [CUSTOMER][NEUTRAL] But I'm saying what [CUSTOMER][NEGATIVE] No, I'm talking about a man, it's somebody over y'all, well, it's somebody over y'all. [AGENT][NEUTRAL] Yes, sir, but that she's not available. She's not at work today. So I would have to, no, sir, I would have to send an email. [CUSTOMER][NEUTRAL] Oh yeah, she's not available today. [AGENT][NEUTRAL] I can see she's out of the office completely today. [CUSTOMER][NEUTRAL] Well, I need to talk to her. [AGENT][NEUTRAL] I can send [CUSTOMER][NEUTRAL] And then when I talk to her, then I think about what I need to file appeal. [AGENT][POSITIVE] OK, well, I'll be happy. [CUSTOMER][NEUTRAL] But I need to talk to her though. [AGENT][NEUTRAL] So this phone number that you gave me that is also on file for you, Mr. [PII], the [PII] is your best contact number that she could reach you at, is that correct? Now, I will send the email right now. It typically takes approximately 24 hours to receive a call back, and again, I can only tell that she's not in the office today. I don't know if she will be out tomorrow or not, but I will send. [CUSTOMER][NEUTRAL] Mhm. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] Uh, the email in just a moment. [CUSTOMER][NEUTRAL] Well, I got that. [CUSTOMER][NEUTRAL] I got time cause like I said, I'm gonna go back out here and find out what's going on because putting ice on it. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] Yes, sir. [CUSTOMER][NEUTRAL] Eating. [AGENT][NEUTRAL] Sure [CUSTOMER][NEUTRAL] I said I sent you 2 pictures. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] So this, uh this leg, two of them, y'all should all y'all don't get them today, y'all get them sometime the day out of the month. I said two pictures show this leg is full. [CUSTOMER][NEUTRAL] And right now I gotta find out why my leg is still swimming. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] Yes, sir. I do understand that. [CUSTOMER][NEGATIVE] And it ain't buy no food. [AGENT][NEUTRAL] So, um, what I will do is I will send this email now, um. [CUSTOMER][NEUTRAL] Yeah. [AGENT][NEUTRAL] And someone will be back in touch with you. But again, that will, it will most definitely not be today because they're not at work today. And that's the only thing that I can do. [CUSTOMER][NEUTRAL] Well I said I, I, I got time. I got, I got time why I was telling you that uh uh. [AGENT][NEUTRAL] So [CUSTOMER][NEUTRAL] For with the then I, I decide then what I want to file cause see I know I said man I said insurance I know how this stuff works and see you said 2 weeks, OK, the same people be like a doctor and I'm gonna leave this alone. [CUSTOMER][NEUTRAL] OK, the doctor gonna sit there and agree. [CUSTOMER][NEUTRAL] Well what? Cause I don't went through that before too. [CUSTOMER][POSITIVE] Agree with what this is. [AGENT][NEUTRAL] Well, I can't [AGENT][NEUTRAL] Yes, Mr. [PII], I can't say that. [CUSTOMER][NEUTRAL] Well, I, I'm, I'm already know cause see then then what I'm gonna do then I'm gonna call the board of insurance. [CUSTOMER][NEUTRAL] Then we gonna find out what's really going on and let them know, well, for some reason they don't want to pay the w. [CUSTOMER][NEGATIVE] Because it's self-explanatory what is what and then they don't, you don't act like the doctor don't know what they talk about talking about you gotta be acting this this hurt. That ain't what that that said cause I call the boy and she. I know who to talk to. [AGENT][NEUTRAL] OK. [CUSTOMER][NEUTRAL] So, that's why I say I'm, I'm gonna go through the steps. [AGENT][NEUTRAL] Well [CUSTOMER][NEUTRAL] I'm gonna talk to this lady who, and then if she. [CUSTOMER][NEGATIVE] Saying something different. Now I said if I'm wrong, I'm I'm I'm willing to admit when I'm wrong, but I'm not on this, this now like yeah I can't, I can't stand on it, man. I, I just cannot. [AGENT][NEUTRAL] OK. [AGENT][NEUTRAL] OK, Mr. [PII], I unders yes, sir, I understand your frustration, but the best that I can do for you at the moment is to send a request. OK. [CUSTOMER][NEUTRAL] Yeah. [CUSTOMER][NEUTRAL] OK [CUSTOMER][POSITIVE] It ain't got no frustration about it's just the way she come out. [CUSTOMER][NEGATIVE] It's just the way how how Miss [PII] came out. I'm dealing with other folk, and we had this, every time I deal we got this constipation. It's like some, I don't know, like I told her she didn't get that chip off her show. [AGENT][NEUTRAL] But I'm [CUSTOMER][NEUTRAL] For some reason she got some like I told him I said, well, they're not gonna be no browning point if you think you being top notch, what you call top notch. [CUSTOMER][NEUTRAL] Yeah, cause she never been there before. She come, she left there and come back for some reason. [CUSTOMER][NEGATIVE] I'm deal with her. That's why I know right now, she's not right. [CUSTOMER][NEUTRAL] And I'm gonna leave it at that. [CUSTOMER][POSITIVE] Ma'am, you have a blessed day. [AGENT][POSITIVE] Mr. [PII], I did, I hope you have a nice day as well. Um, and again, I will send this email to have someone call you. Is there anything else that I could possibly help you with today? [CUSTOMER][POSITIVE] And uh actually I'll use it. [CUSTOMER][NEUTRAL] No, that'd be all. [AGENT][POSITIVE] OK, Mr. [PII], well, thank you so much ma'am for calling APL and I hope I do hope that you have a nice day today. [CUSTOMER][NEUTRAL] Yeah, you too. [AGENT][POSITIVE] Yes, sir. Thank you so much. I appreciate that. [AGENT][NEUTRAL] Uh-huh. OK. Bye-bye now. [CUSTOMER][NEUTRAL] All right. [CUSTOMER][NEUTRAL] Uh.