AccountId: 011433970860
ContactId: 9b965ae9-e2b2-4958-99a3-bcf587bbfecb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1044368 ms
Total Talk Time (AGENT): 363970 ms
Total Talk Time (CUSTOMER): 289380 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/9b965ae9-e2b2-4958-99a3-bcf587bbfecb_20250117T21:51_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII], and I'm returning a phone call from, uh, [PII], I believe was her name.
[AGENT][NEUTRAL] All right, thank you. Do you happen to have your policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, yes, I do.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] It is 024.
[CUSTOMER][NEUTRAL] 891
[CUSTOMER][NEUTRAL] 91.
[AGENT][NEUTRAL] Thank you. And what is your date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] I'm checking on that, bear with me just one moment please sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] While I'm waiting to see if she's available, Mr. [PII]. Can you go ahead and verify your current mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and I don't have an email on file list. Can I add an email for you?
[CUSTOMER][NEUTRAL] Sure, it's [PII]?
[CUSTOMER][NEUTRAL] At
[CUSTOMER][NEUTRAL] Local L O C A L 1014 all one word.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK hang on just a quick minute if you don't mind.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Were you needing assistance completing your disability claim form?
[CUSTOMER][NEUTRAL] That's what what I'm calling about, yeah, because, uh, uh, but I had another question too. The, um, last thing that I got, I got a $900 payment on [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And in the remarks it says uh payment completes your claim for this occurrence and benefits have been paid to the date you were released to return to work.
[CUSTOMER][NEUTRAL] And I haven't gone back to work. I had shoulder surgery uh in December.
[AGENT][NEUTRAL] OK, so it looks like we had on file the return to work date was [PII].
[CUSTOMER][NEUTRAL] That was my next doctor appointment.
[AGENT][NEUTRAL] OK. So have you had the doctor to complete his physician statement showing that you will be on extended disability?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I did and I just submitted that um I'm I'm not the greatest at paperwork but um.
[CUSTOMER][NEGATIVE] Because you, you guys paid me, um, and it was like 6 months later from when I went off and then it's been probably 2 or 3 months.
[CUSTOMER][NEUTRAL] Since I had a payment and then I got this $900.01 and I just submitted um actually just the other day um the employer statement and the position statement.
[CUSTOMER][NEUTRAL] I upload those were sent to you guys already.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] This should be under my account.
[AGENT][NEUTRAL] OK, so it looks like when we received your portion it was not completed, so hang on just a second, let me take a quick look.
[AGENT][POSITIVE] Let me just get that pulled up for you and let's let's see what's going on for you.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] OK, that's the employer portion. Let me check this other one.
[AGENT][NEUTRAL] I apologize my system is moving a little slow this afternoon.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] That's physician's portion. Let me check your.
[AGENT][NEUTRAL] Do we have your portion?
[AGENT][NEUTRAL] You're the employee, the
[AGENT][NEUTRAL] Uh, and the claimant statement.
[CUSTOMER][NEGATIVE] From the original, you should have it from the original one, yeah. It's the same injury.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No you you needed me to fill one out each each time I submit?
[AGENT][NEUTRAL] Well, I was looking at the um notes of the examiner, the adjuster put on here and it said we needed the complete portion for the employee.
[AGENT][NEUTRAL] The statement of insured.
[AGENT][NEUTRAL] I was checking to see if we have.
[CUSTOMER][NEUTRAL] Yeah, and, and I know I filled that out originally because, I mean, you have, uh, like I said, they did pay me already from the same injury for a few months, right? For 6 months or whatever it was.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And I think that's where we're we're probably there's a miscommunication because.
[CUSTOMER][NEUTRAL] Like I said, I got this that says they were I was released back to work when I wasn't that was just the doctor's appointment, my next doctor's appointment, so that's what they put on the paperwork.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I think that that's what it is because the the return to work date was 10-10-24.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And so
[CUSTOMER][NEUTRAL] Yeah, because even if you look at the, you look at the next ones.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It has in my next appointment date from the physician. It'll say that on it.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, and I think that because
[CUSTOMER][NEUTRAL] But like I said,
[CUSTOMER][NEUTRAL] I just had surgery in December, so.
[CUSTOMER][NEUTRAL] And this is taking me through.
[CUSTOMER][NEUTRAL] Who knows when.
[AGENT][MIXED] Bless your heart. That surgery should, shoulder, uh, did you say it was your shoulder? I can't say that. That is hard surgery.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] It is, it is, it's horrible.
[AGENT][NEUTRAL] It is so hard. So I'll tell you what, let me get you to an examiner and see or if you don't mind holding just one moment, let me just check and see if that is needed since it is the same disability claim.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] But I think that for now I do know that for continuation you will need to submit that insured statement monthly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A monthly, OK.
[CUSTOMER][NEUTRAL] And so,
[CUSTOMER][NEUTRAL] Well, I don't go to the doctor every month. It's every 6 weeks.
[AGENT][NEUTRAL] Right, so for the insured statement, that is your information, not the doctor's.
[CUSTOMER][NEUTRAL] OK, and then you send me something every month or where do I find that?
[AGENT][NEUTRAL] So when you received, let's see, are you set up for direct deposit or check mailing? Let's see.
[CUSTOMER][NEUTRAL] Direct deposit, yeah.
[AGENT][NEUTRAL] Yeah, you should get an EOB in the mail, an explanation of benefits with the form.
[CUSTOMER][NEUTRAL] Mm, yeah, see that and the the form that I'm looking at that I was telling you it was like released back to work.
[CUSTOMER][NEUTRAL] There's nothing there to fill out.
[CUSTOMER][NEUTRAL] That's why I'm confused I guess.
[AGENT][NEUTRAL] Hang on just a second.
[CUSTOMER][NEUTRAL] And I also just for your knowledge, I don't know if you guys are this I, I got an email from.
[CUSTOMER][NEUTRAL] Uh, an employee retention benefits, is that you guys too?
[AGENT][NEGATIVE] It is not.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] But they sent me a form to fill out.
[CUSTOMER][NEUTRAL] But I don't have, I, I don't even know who that is, to be honest with you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I thought it was you guys.
[AGENT][NEUTRAL] It's not us.
[AGENT][NEUTRAL] OK, so I, I see that you have the online portal account correct?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, if you go to the claim forms section and look up the disability claim form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On the front page there's a section that says for continuing disability benefits.
[AGENT][NEUTRAL] And the instructions, that is the portion that you will need to complete monthly.
[AGENT][NEUTRAL] Now, your physician, yeah, just complete that portion and upload it monthly. And we
[CUSTOMER][NEUTRAL] And just upload that.
[CUSTOMER][NEUTRAL] OK, yeah, because I won't have a physician statement every month.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right, if they've extended that return to work time, then we should have that on that position statement for the new date, the expected return to work date.
[AGENT][NEUTRAL] But monthly we do need that form from you.
[CUSTOMER][NEGATIVE] Hm, OK. Nobody, thank you for telling me that. Nobody's ever told me that.
[AGENT][NEUTRAL] Do you see the instructions where it says uh are you looking at it now?
[CUSTOMER][NEUTRAL] I, I'm gonna pull it up, yeah, here.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] So I kind of have to have the one arm.
[AGENT][NEUTRAL] That's true bless your heart isn't it the hardest thing I had a friend that had rotator cuff surgery and she said that it was the hardest thing trying to do things one handed.
[CUSTOMER][NEGATIVE] It's horrible, yeah, it really is.
[AGENT][NEUTRAL] Kind of have to learn how to do everything. OK, so if you got the form pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] On the instructions page.
[CUSTOMER][NEUTRAL] Claim forms.
[AGENT][NEUTRAL] It is under that first bold bullet which says complete the statement of insured. The 2nd.
[CUSTOMER][NEUTRAL] Oh well I, I just, I clicked on claims and forms and it took me to a different.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Because now it says sign in again.
[CUSTOMER][NEUTRAL] Yeah this is
[AGENT][NEUTRAL] Just tell me when you get there, you're fine.
[CUSTOMER][NEUTRAL] It says the sign it, is it supposed to, so when I go to APL, it's APL secured that has all my.
[CUSTOMER][NEUTRAL] My um claim.
[AGENT][NEUTRAL] That's your personal information. Yes, sir.
[CUSTOMER][NEUTRAL] Like my claim on it, right? And then I click on claims forms.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah it may take you just to the [PII] website.
[CUSTOMER][NEUTRAL] And that takes me to
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It does, yeah, so sign in again.
[CUSTOMER][NEUTRAL] Mm, it takes me back to my clients.
[AGENT][NEUTRAL] OK, just go to the [PII].
[AGENT][NEUTRAL] Just a regular, just our website.
[AGENT][NEUTRAL] You do
[CUSTOMER][NEUTRAL] Yeah, that's where it's on me in [PII].
[AGENT][POSITIVE] Mhm. That's right.
[CUSTOMER][NEUTRAL] But doesn't bring up any forms.
[AGENT][NEUTRAL] When you go to the a.m. public, did you go to the and you went to the claims and forms section?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then it should take you to a page where it's got a man and a young boy and it says claims and forms under APL.
[CUSTOMER][POSITIVE] Correct and I it would make me sign in again.
[AGENT][NEGATIVE] That shouldn't make you sign in, hm.
[CUSTOMER][NEUTRAL] Yeah, because it says sign in.
[AGENT][NEUTRAL] Did you click the sign in? Yeah, don't click the sign in.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] I see what you're looking at.
[AGENT][NEUTRAL] Uh this is just our public website.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you go down to the disability claim form.
[AGENT][NEUTRAL] Let's see, I'm gonna tell you exactly where that is. Let me scroll.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Going down
[AGENT][NEUTRAL] It's gonna be on page 2.
[CUSTOMER][NEUTRAL] Direct deposit.
[AGENT][NEUTRAL] Under short term disability claim form.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] It's gonna be right after the request change of ownership form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see it.
[AGENT][NEUTRAL] OK, so if you download that form.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on the first page under the these are the instructions. Under that first bold dot your bullet, you're gonna see two of those under there. It says for a continuing disability claim form, complete sections A through E and sections G through H.
[AGENT][NEUTRAL] And that's what we're needing.
[AGENT][NEUTRAL] Because we've got the physician and the employee's statement.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But that is going to be required monthly for your continuing disability benefits.
[CUSTOMER][NEUTRAL] A 3 E and G. 2 H.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so, um, this should cover the balance of October I'm assuming up to to this month to January.
[AGENT][NEUTRAL] Yes sir, it it very well could, and I can't guarantee payment until they process the claim, but it looks like we have everything that's needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because I haven't and and like I said I've, I've been off since so.
[CUSTOMER][NEUTRAL] Well, like I said, I had surgery and, but I got that thing saying that that I had returned to work, which I haven't, so.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I will fill this out and upload this.
[AGENT][NEUTRAL] All right. Is there anything else I can help you with, Mr. [PII]?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, I appreciate you.
[AGENT][POSITIVE] No, it's been my pleasure to assist you with the claim form, and I hope you have a wonderful day. Hope that shoulder gets better for you soon.
[CUSTOMER][POSITIVE] I hope so.
[AGENT][POSITIVE] Yeah and thank you for calling APL. Take care.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] Bye bye.