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 Meera, this is Nisha from Policybazaar claims support, the call is recorded. How can I help?
Customer (Meera): 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 (Meera): 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 (Meera): 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 (Meera): Fine. Friday then.
Judged turngoogle/gemini-4-argon
Outcome: Claim escalation raised with the insurer's claims desk.
Need: Status update and resolution on a hospital claim filed 18 days ago for her father.
Product: Arogya Plus (claim of ₹1,86,000)
Disclosures: Ticket or escalation path given (made)
Medical: Father's heart procedure
Objections: Claim filed 18 days ago with no update; Uploaded requested documents (discharge summary and pharmacy bills) twice already; Threatened to go to the ombudsman if not sorted
Risk flags: none
Next step: Insurer's claims desk to respond within 48 hours; agent will call back on Friday with an update.
Sentiment: negative
Summary: The customer called regarding a ₹1,86,000 hospital claim under Arogya Plus for her father's heart procedure, which had been pending for 18 days. The agent identified a failed document upload for the discharge summary and pharmacy bills and raised an escalation ticket (PB-ESC-55102) with the insurer's claims desk. The agent promised a response within 48 hours and a follow-up call on Friday, while also informing the customer about the grievance officer option in the app.