System You summarize insurance sales and service call transcripts for a quality-assurance team in India.
Transcripts may be in English, Hindi (Devanagari) or Hinglish. Always write the summary in English.
Return only a JSON object with these keys:
- outcome: what was decided, a few words
- need: what the customer wanted
- products: array of strings, each with the plan, cover and premium exactly as said on the call
- disclosures: array of {key, made, at} for each disclosure that applies to this call; key is one of ped, waiting, exclusions, free_look, market_risk, ncb, grievance, benefit_illustration, grace; made is true or false; at is a short exact quote from the transcript (omit when not made)
- medical: array of medical facts the customer gave
- objections: array of objections the customer raised
- flags: array of {key, note, at} for every mis-selling or data-leakage moment; key is one of guaranteed_returns (Guaranteed returns on a market-linked plan), ped_suppressed (Told to hide a medical condition), cover_misstated (Cover or rights misstated), pressure (False urgency), rebating (Off-book cashback or discount), otp_requested (OTP, PIN or card details asked); at is a short exact quote; empty array when the call is clean. A guarantee that is part of a non-linked guaranteed plan is not a flag.
- next: the follow-up the agent promised
- sentiment: positive, neutral or negative
- brief: two or three sentences
Rules: quote only figures said on the call. Never repeat a phone, PAN, Aadhaar, card, CVV, OTP or policy number.
Customer
TRANSCRIPT:
Agent (Nisha): Hello Rohan, this is Nisha from Policybazaar claims support, the call is recorded. How can I help?
Customer (Rohan): My father's hospital claim was filed 18 days ago and nobody tells me anything.
Agent (Nisha): I'm sorry about that. I can see the claim with Arogya Plus: ₹1,86,000 for his heart procedure. The insurer asked for the discharge summary and pharmacy bills on 10 October.
Customer (Rohan): I uploaded them twice! This is ridiculous. If it isn't sorted I'm going to the ombudsman.
Agent (Nisha): I understand. I can see one upload failed. I'm raising an escalation with the insurer's claims desk now; your ticket number is PB-ESC-55102.
Customer (Rohan): How long will this take?
Agent (Nisha): The claims desk will respond within 48 hours. I'll call you on Friday with an update, and you can also escalate to the grievance officer through the app.
Customer (Rohan): Fine. Friday then.
Judged turngoogle/gemini-4-argon
Outcome: Claim escalated to insurer's claims desk; follow-up scheduled for Friday
Need: Status update and resolution on father's hospital claim of ₹1,86,000 filed 18 days ago
Product: Arogya Plus
Disclosures: Ticket or escalation path given (made)
Medical: Father's heart procedure
Objections: Claim filed 18 days ago with no communication; Uploaded requested documents (discharge summary and pharmacy bills) twice already; Threatened to go to the ombudsman if not sorted
Risk flags: none
Next step: Claims desk response within 48 hours; agent will call on Friday with an update
Sentiment: negative
Summary: The customer called regarding a 18-day delay on his father's ₹1,86,000 hospital claim for a heart procedure under Arogya Plus, frustrated that he had already uploaded the requested discharge summary and pharmacy bills twice. The agent noted that one upload had failed, raised an escalation ticket (PB-ESC-55102) with the insurer's claims desk for a response within 48 hours, and informed him about escalating to the grievance officer via the app. The agent promised to call back on Friday with an update.