AccountId: 011433970860
ContactId: c45e75c7-09fa-4673-8305-8a902fbe6d7f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246279 ms
Total Talk Time (AGENT): 154869 ms
Total Talk Time (CUSTOMER): 52487 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/c45e75c7-09fa-4673-8305-8a902fbe6d7f_20250513T15:00_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], this is [PII] in the care team. I've got a broker's office again on the line, um, checking on a claim status, um, if you can help me with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the policy?
[CUSTOMER][NEUTRAL] Uh, policy is.
[CUSTOMER][NEUTRAL] 244-97006
[AGENT][NEUTRAL] OK, and which claim are we looking at?
[CUSTOMER][NEUTRAL] Uh, we're looking at the 359279-3.
[CUSTOMER][NEUTRAL] He states he got his right thumb amputated, but when I look at the notes it says tip of right thumb, so I'm thinking that's why he's not getting.
[CUSTOMER][NEUTRAL] The accident benefit? I wasn't quite sure.
[AGENT][NEUTRAL] Probably let me see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, let me pull up the policy because I'm pretty sure that this policy states that um,
[AGENT][NEUTRAL] To be considered a full dismemberment, the joint, it has to be taken at the joint closest to the hand. So if you're just having that first.
[CUSTOMER][NEUTRAL] Well, I tried
[AGENT][NEUTRAL] Like
[AGENT][NEGATIVE] From the tip to that first joint, it's not gonna qualify.
[CUSTOMER][NEUTRAL] OK, we will play the that's dislocation. OK, I didn't know what to, I looked up amputation, but I couldn't find anything on that.
[AGENT][NEUTRAL] OK, so single dismemberment, it's on page 10 if you're looking at on base.
[CUSTOMER][NEUTRAL] And that's why I was
[AGENT][NEUTRAL] Um, we will pay the single dismemberment benefit amount and the schedule benefits covered sustains the single dismemberment as a result, must occur within 90 days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then when you look at finger and toe, um, it still says that it has to occur within 90 days, but it doesn't actually define the dismemberment. So you have to go to the definitions to kind of see what qualifies.
[AGENT][NEUTRAL] And that is going to be under.
[AGENT][NEUTRAL] Definitions which start on page 26.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] When you look at dismemberment.
[AGENT][NEUTRAL] Um, it's gonna be under single dismemberment because it looks like it has double and single.
[AGENT][NEUTRAL] Defined separately. So.
[AGENT][NEGATIVE] QRF OK, loss of hand, loss of foot or loss of sight. Oh my gosh, now we have to go to those destinations. I hate when they do that. I just put it all up under one.
[CUSTOMER][NEUTRAL] Just the same
[AGENT][NEUTRAL] OK, so let's see, loss of both hands, that's at the joint, feet, foot.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, it's not.
[AGENT][NEGATIVE] Defining, oh there it is, finger and toe dismemberment. It is on there. It's on page 30, uh, close to the top. One or more finger, fingers or toe toes is removed or above the joint where it is attached to the hand or foot. So it has to be that joint closest. So if he is, it just had that tip, just had a bunch of, bunch of black hots like flop by my house. It was weird. Um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] But if it was like basically just at that first joint and not at the joint closest to the hand, which I believe, you know, it's gonna be real, real, like it's gonna be essentially the entire thumb um or finger, whichever one it is, then it's not gonna qualify for the dismemberment benefit.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK perfect OK that's what I was needing perfect I'll let her know thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][NEUTRAL] Bye.