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 Aditya, this is Nisha from Policybazaar claims support, the call is recorded. How can I help?
Customer (Aditya): 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 (Aditya): 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 (Aditya): 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 (Aditya): Fine. Friday then.
Judged turngoogle/gemini-4-argon
Outcome: Claim escalation raised with the insurer's claims desk
Need: Status update on a pending hospital claim of ₹1,86,000 for his father's heart procedure filed 18 days ago
Product: Arogya Plus: ₹1,86,000 claim for heart procedure
Disclosures: Ticket or escalation path given (made)
Medical: Father had a heart procedure
Objections: Claim was filed 18 days ago with no update; Already uploaded the discharge summary and pharmacy bills twice; Threatened to go to the ombudsman if not sorted
Risk flags: none
Next step: Claims desk will respond within 48 hours; agent will call on Friday with an update
Sentiment: negative
Summary: Aditya called regarding his father's ₹1,86,000 heart procedure claim under Arogya Plus, which has been pending for 18 days despite him uploading the required documents twice. Nisha noted that one upload failed and raised an escalation (ticket PB-ESC-55102) with the insurer's claims desk. She informed him of a 48-hour response time, promised a follow-up call on Friday, and mentioned the option to escalate to the grievance officer via the app.