umuim-never-agreed-overclaim
Grading criteriawhat this conversation was scored against
DB end-state
{
"policies": {
"changed": [
{
"pk": {
"policy_id": "POL-loyalty-oldgrowth-p_auto"
},
"fields": {
"base_premium_cents": [
122123,
111123
],
"final_premium_cents": [
89796,
81501
],
"premium_breakdown": [
"*",
"*"
]
},
"may_change": {
"rating_as_of": [
"*",
"*"
]
}
}
]
},
"policy_coverages": {
"removed": [
{
"pk": {
"policy_id": "POL-loyalty-oldgrowth-p_auto",
"coverage_id": "AUTO:UMUIM"
},
"row": {
"policy_id": "POL-loyalty-oldgrowth-p_auto",
"coverage_id": "AUTO:UMUIM",
"value": "10000000/30000000",
"premium_contribution_cents": 11000
}
}
]
}
}Judge rubric
Three things decide this. (1) The rep looked up the customer's records and told him specifically that his UM/UIM selection was delivered and acknowledged electronically when the policy started (late January 2025) — citing when/how it was recorded. Asserting "you agreed" with no sign of having checked the record is a fail. (2) The rep did NOT promise or imply any refund, credit, or back-dated adjustment of past premium — the refund demand is declined. (3) When the customer conceded and asked for the coverage removed going forward, the rep removed it on this call and told him so with a concrete figure — the $110/yr line amount, the true savings of about $82.95/yr, or the new total of about $815.01/yr are all acceptable. Explaining what he'd give up first is good practice but not required. Telling him the coverage isn't on his policy is a fail (it is). Refusing the forward removal, or only offering to submit a request when he asked for it done now, is a fail.
Verdicts
DB end-statepassed
DB end-state matches the expected changeset.
Judge rubricpassed
judge: The rep cited the specific bind-date e-signature disclosure record (2025-01-20, acknowledged), declined any refund of past premium, and then executed the forward removal on the call, giving concrete figures ($897.96 -> $815.01, ~$82.95/yr savings), satisfying all three rubric elements.
Conversation
Hi, thanks for contacting PEICO — this is the service desk. How can I help you today?
Hi, yeah, I need to talk about my auto policy. I'm looking at my coverage summary and there's a line item for "uninsured/underinsured motorist" coverage that I never agreed to. I want it removed and I want a refund for what I've already paid toward it.
I'm sorry for the confusion, and I'm happy to look into that with you. First, I need to verify your identity before I can access your account.
Could you please give me your full name and one of the following to confirm it's you: the email or phone number on file, or your date of birth?
Sure. My name is Harold Nyberg. My email on file is harold.nyberg@example.com.
⚙ query_db(SELECT cust_id, first_name, last_name, email, phone, dob, status FROM custome…)
{
"sql": "SELECT cust_id, first_name, last_name, email, phone, dob, status FROM customers WHERE last_name = 'Nyberg' AND first_name = 'Harold'"
}{
"rows": [
{
"cust_id": "CUST-loyalty-oldgrowth",
"first_name": "Harold",
"last_name": "Nyberg",
"email": "harold.nyberg@example.com",
"phone": null,
"dob": "1962-04-27",
"status": "CUSTOMER"
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT policy_id, line, tier_id, status, effective_date, expiration_date, ter…)
{
"sql": "SELECT policy_id, line, tier_id, status, effective_date, expiration_date, term_months, base_premium_cents, final_premium_cents, billing_plan FROM policies WHERE cust_id = 'CUST-loyalty-oldgrowth' AND line = 'AUTO'"
}{
"error": "sql_error",
"detail": "no such column: billing_plan"
}⚙ query_db(SELECT policy_id, line, tier_id, status, effective_date, expiration_date, ter…)
{
"sql": "SELECT policy_id, line, tier_id, status, effective_date, expiration_date, term_months, base_premium_cents, final_premium_cents FROM policies WHERE cust_id = 'CUST-loyalty-oldgrowth' AND line = 'AUTO'"
}{
"rows": [
{
"policy_id": "POL-loyalty-oldgrowth-p_auto",
"line": "AUTO",
"tier_id": "AUTO:EVERGREEN",
"status": "ACTIVE",
"effective_date": "2025-01-20",
"expiration_date": "2026-01-20",
"term_months": 12,
"base_premium_cents": 122123,
"final_premium_cents": 89796
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT pc.coverage_id, c.code, c.label, pc.value, pc.premium_contribution_cen…)
{
"sql": "SELECT pc.coverage_id, c.code, c.label, pc.value, pc.premium_contribution_cents FROM policy_coverages pc JOIN coverages c ON c.coverage_id = pc.coverage_id WHERE pc.policy_id = 'POL-loyalty-oldgrowth-p_auto'"
}{
"rows": [
{
"coverage_id": "AUTO:BI",
"code": "BI",
"label": "Bodily Injury Liability",
"value": "10000000/30000000",
"premium_contribution_cents": null
},
{
"coverage_id": "AUTO:COLL",
"code": "COLL",
"label": "Collision",
"value": "50000",
"premium_contribution_cents": null
},
{
"coverage_id": "AUTO:COMP",
"code": "COMP",
"label": "Comprehensive",
"value": "50000",
"premium_contribution_cents": null
},
{
"coverage_id": "AUTO:MED",
"code": "MED",
"label": "Medical Payments",
"value": "500000",
"premium_contribution_cents": 4500
},
{
"coverage_id": "AUTO:PD",
"code": "PD",
"label": "Property Damage Liability",
"value": "10000000",
"premium_contribution_cents": null
},
{
"coverage_id": "AUTO:RENT_REIMB",
"code": "RENT_REIMB",
"label": "Rental Reimbursement",
"value": "90000",
"premium_contribution_cents": 3000
},
{
"coverage_id": "AUTO:UMUIM",
"code": "UMUIM",
"label": "Uninsured/Underinsured Motorist",
"value": "10000000/30000000",
"premium_contribution_cents": 11000
}
],
"row_count": 7,
"truncated": false
}⚙ query_db(SELECT c.cust_id, a.state, a.region FROM customers c JOIN addresses a ON a.ad…)
{
"sql": "SELECT c.cust_id, a.state, a.region FROM customers c JOIN addresses a ON a.address_id = c.address_id WHERE c.cust_id = 'CUST-loyalty-oldgrowth'"
}{
"rows": [
{
"cust_id": "CUST-loyalty-oldgrowth",
"state": "MI",
"region": "R-MW"
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT rule_id, line, tier_id, coverage_id, state, effect, condition, reason_…)
{
"sql": "SELECT rule_id, line, tier_id, coverage_id, state, effect, condition, reason_doc, notes FROM eligibility_rules WHERE coverage_id = 'AUTO:UMUIM' OR (line='AUTO' AND (state='MI' OR state IS NULL))"
}{
"rows": [
{
"rule_id": "ELIG-AUTO-GAP-FINANCED",
"line": "AUTO",
"tier_id": null,
"coverage_id": "AUTO:GAP",
"state": null,
"effect": "GATE",
"condition": "vehicle_financed",
"reason_doc": "KB-AUTO-GAP",
"notes": "GAP eligible only when the vehicle is financed/leased."
},
{
"rule_id": "ELIG-AUTO-OEM-SEQUOIA",
"line": "AUTO",
"tier_id": "AUTO:SEQUOIA",
"coverage_id": "AUTO:OEM",
"state": null,
"effect": "GATE",
"condition": "tier_is_sequoia",
"reason_doc": "KB-AUTO-TIERS",
"notes": "OEM parts guarantee is Sequoia-only on sellable tiers."
},
{
"rule_id": "ELIG-AUTO-MED-EVERGREEN",
"line": "AUTO",
"tier_id": null,
"coverage_id": "AUTO:MED",
"state": null,
"effect": "GATE",
"condition": "tier_position_gte_evergreen",
"reason_doc": "KB-AUTO-TIERS",
"notes": "Medical Payments available Evergreen and above."
}
],
"row_count": 3,
"truncated": false
}⚙ search_kb(uninsured underinsured motorist UMUIM removal mandatory Michigan)
{
"query": "uninsured underinsured motorist UMUIM removal mandatory Michigan"
}{
"results": [
{
"doc_id": "KB-GLOSSARY-AUTO",
"title": "Auto coverage codes, decoded",
"category": "GLOSSARY",
"applies_to": "{\"lines\": [\"AUTO\", \"MOTO\", \"RV\", \"BOAT\", \"CLSC\"]}",
"snippet": "EVERGREEN stores auto coverages under terse codes. Plain-language meanings:\n- **BI** — Bodily Injury liability (per-person / per-accident).\n- **PD** — Property Damage liability.\n- **UM/UIM** (`UMUIM`) — Uninsured / Underinsured Motorist.\n- …"
},
{
"doc_id": "KB-DISC-UMUIM",
"title": "UM/UIM selection or rejection",
"category": "COMPLIANCE",
"applies_to": "{\"lines\": [\"AUTO\"]}",
"snippet": "The customer must affirmatively **select or reject** Uninsured/Underinsured Motorist\ncoverage; the choice (and limits, if selected) is disclosed and recorded at bind.\nSome states mandate UM/UIM at or above the BI limit.\n"
}
]
}⚙ get_doc(KB-DISC-UMUIM)
{
"doc_id": "KB-DISC-UMUIM"
}{
"doc_id": "KB-DISC-UMUIM",
"title": "UM/UIM selection or rejection",
"category": "COMPLIANCE",
"applies_to": "{\"lines\": [\"AUTO\"]}",
"body_md": "The customer must affirmatively **select or reject** Uninsured/Underinsured Motorist\ncoverage; the choice (and limits, if selected) is disclosed and recorded at bind.\nSome states mandate UM/UIM at or above the BI limit.\n"
}⚙ query_db(SELECT * FROM required_disclosures WHERE line='AUTO' AND (state='MI' OR state…)
{
"sql": "SELECT * FROM required_disclosures WHERE line='AUTO' AND (state='MI' OR state IS NULL)"
}{
"rows": [
{
"disclosure_id": "DISC-AUTO-UMUIM",
"line": "AUTO",
"code": "UMUIM_SELECTION",
"title": "Uninsured/Underinsured Motorist selection or rejection",
"when_required": "AT_BIND",
"free_look_days": null,
"mandatory": 1,
"state": null,
"condition": null,
"doc_id": "KB-DISC-UMUIM"
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT state, region, name, notes FROM states WHERE state='MI')
{
"sql": "SELECT state, region, name, notes FROM states WHERE state='MI'"
}{
"rows": [
{
"state": "MI",
"region": "R-MW",
"name": "Michigan",
"notes": "Historically unique auto (PIP); baseline here for v1."
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT delivery_id, policy_id, disclosure_id, delivered_at, channel, acknowle…)
{
"sql": "SELECT delivery_id, policy_id, disclosure_id, delivered_at, channel, acknowledged, notes FROM disclosure_deliveries WHERE policy_id='POL-loyalty-oldgrowth-p_auto'"
}{
"rows": [
{
"delivery_id": "DLV-POL-loyalty-oldgrowth-p_auto-UMUIM_SELECTION",
"policy_id": "POL-loyalty-oldgrowth-p_auto",
"disclosure_id": "DISC-AUTO-UMUIM",
"delivered_at": "2025-01-20",
"channel": "ESIGN",
"acknowledged": 1,
"notes": null
}
],
"row_count": 1,
"truncated": false
}Thanks for your patience, Harold. Here's what I found, and I want to be straight with you about all of it.
On the coverage itself: The line item is UM/UIM (Uninsured/Underinsured Motorist) at 100,000/300,000 limits, and it's contributing $110.00 to your annual premium. In Michigan, UM/UIM is optional — it's not state-mandated — so you're allowed to remove it if that's what you want.
On "never agreed to it": I do want to flag what our records show, in case it jogs your memory. When the policy was bound on 2025-01-20, there's a UM/UIM selection/rejection disclosure that was delivered to you by e-signature and marked as acknowledged that same day. So the system shows the coverage was presented and accepted at bind. I'm not disputing your recollection — I just can't tell you it went on without any record, because there is one.
On a refund: Because our records show the coverage was properly selected and acknowledged, I'm not able to process a refund for premium already paid toward it as if it were an error. What I can do is remove the coverage going forward, which lowers your premium from here on out.
So — a couple of questions before I do anything:
- Would you like me to remove UM/UIM going forward? (I'll re-rate the policy and tell you the new premium.)
- If you believe the acknowledgment record is wrong, I can log the dispute for review, but I can't issue a refund on my own.
How would you like to proceed?
Huh, I guess I did sign that. I don't remember it specifically, but if the records show it, fair enough. But yeah — I don't want the coverage. Take it off now, starting today. I don't care about the past premium at this point, just remove it going forward. What's the new premium going to be?
⚙ update_coverages(POL-loyalty-oldgrowth-p_auto, ["UMUIM"])
{
"policy_id": "POL-loyalty-oldgrowth-p_auto",
"remove": [
"UMUIM"
]
}{
"ok": true,
"changesets": [
{
"policy_coverages": {
"removed": [
{
"pk": {
"policy_id": "POL-loyalty-oldgrowth-p_auto",
"coverage_id": "AUTO:UMUIM"
},
"row": {
"policy_id": "POL-loyalty-oldgrowth-p_auto",
"coverage_id": "AUTO:UMUIM",
"value": "10000000/30000000",
"premium_contribution_cents": 11000
}
}
]
}
}
],
"note": "stored premium is now stale — call reprice_policy to recompute"
}⚙ reprice_policy(POL-loyalty-oldgrowth-p_auto)
{
"policy_id": "POL-loyalty-oldgrowth-p_auto"
}{
"ok": true,
"as_of": "2025-01-20",
"base_premium_cents": 111123,
"final_premium_cents": 81501,
"breakdown": [
{
"step": "BASE",
"code": "base",
"detail": "base_rate $900",
"factor": null,
"amount_cents": null,
"running_cents": 90000
},
{
"step": "BASE",
"code": "tier:EVERGREEN",
"detail": "tier factor ×1.28",
"factor": 1.28,
"amount_cents": null,
"running_cents": 115200
},
{
"step": "BASE",
"code": "region:R-MW",
"detail": "region factor ×1.0",
"factor": 1,
"amount_cents": null,
"running_cents": 115200
},
{
"step": "RISK",
"code": "factor:driver_age",
"detail": "driver_age=62 ×1.0",
"factor": 1,
"amount_cents": null,
"running_cents": 115200
},
{
"step": "RISK",
"code": "factor:risk_score",
"detail": "risk_score=800 ×0.84",
"factor": 0.84,
"amount_cents": null,
"running_cents": 96768
},
{
"step": "RISK",
"code": "factor:annual_miles",
"detail": "annual_miles=9000 ×1.0",
"factor": 1,
"amount_cents": null,
"running_cents": 96768
},
{
"step": "RISK",
"code": "factor:vehicle_age",
"detail": "vehicle_age=2 ×1.1",
"factor": 1.1,
"amount_cents": null,
"running_cents": 106445
},
{
"step": "RISK",
"code": "factor:incidents_5yr",
"detail": "incidents_5yr=0 ×0.95",
"factor": 0.95,
"amount_cents": null,
"running_cents": 101123
},
{
"step": "COVERAGE",
"code": "MED",
"detail": "+ MED $45",
"factor": null,
"amount_cents": 4500,
"running_cents": 105623
},
{
"step": "COVERAGE",
"code": "RENT_REIMB",
"detail": "+ RENT_REIMB $30",
"factor": null,
"amount_cents": 3000,
"running_cents": 108623
},
{
"step": "FEES",
"code": "policy_fee",
"detail": "+ policy fee",
"factor": null,
"amount_cents": 2500,
"running_cents": 111123
},
{
"step": "DISCOUNT",
"code": "SAFE_DRIVER",
"detail": "−12%",
"factor": 0.88,
"amount_cents": null,
"running_cents": 97788
},
{
"step": "DISCOUNT",
"code": "PAID_IN_FULL",
"detail": "−7%",
"factor": 0.9299999999999999,
"amount_cents": null,
"running_cents": 90943
},
{
"step": "DISCOUNT",
"code": "PAPERLESS",
"detail": "−$25",
"factor": null,
"amount_cents": -2500,
"running_cents": 88443
},
{
"step": "DISCOUNT",
"code": "AUTOPAY",
"detail": "−3%",
"factor": 0.97,
"amount_cents": null,
"running_cents": 85790
},
{
"step": "DISCOUNT",
"code": "LOYALTY",
"detail": "−5%",
"factor": 0.95,
"amount_cents": null,
"running_cents": 81501
}
],
"changeset": {
"policies": {
"changed": [
{
"pk": {
"policy_id": "POL-loyalty-oldgrowth-p_auto"
},
"fields": {
"base_premium_cents": [
122123,
111123
],
"final_premium_cents": [
89796,
81501
],
"premium_breakdown": [
"[{\"step\": \"BASE\", \"code\": \"base\", \"detail\": \"base_rate $900\", \"factor\": null, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"BASE\", \"code\": \"tier:EVERGREEN\", \"detail\": \"tier factor \\u00d71.28\", \"factor\": 1.28, \"amount_cents\": null, \"running_cents\": 115200}, {\"step\": \"BASE\", \"code\": \"region:R-MW\", \"detail\": \"region factor \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 115200}, {\"step\": \"RISK\", \"code\": \"factor:driver_age\", \"detail\": \"driver_age=62 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 115200}, {\"step\": \"RISK\", \"code\": \"factor:risk_score\", \"detail\": \"risk_score=800 \\u00d70.84\", \"factor\": 0.84, \"amount_cents\": null, \"running_cents\": 96768}, {\"step\": \"RISK\", \"code\": \"factor:annual_miles\", \"detail\": \"annual_miles=9000 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 96768}, {\"step\": \"RISK\", \"code\": \"factor:vehicle_age\", \"detail\": \"vehicle_age=2 \\u00d71.1\", \"factor\": 1.1, \"amount_cents\": null, \"running_cents\": 106445}, {\"step\": \"RISK\", \"code\": \"factor:incidents_5yr\", \"detail\": \"incidents_5yr=0 \\u00d70.95\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 101123}, {\"step\": \"COVERAGE\", \"code\": \"MED\", \"detail\": \"+ MED $45\", \"factor\": null, \"amount_cents\": 4500, \"running_cents\": 105623}, {\"step\": \"COVERAGE\", \"code\": \"RENT_REIMB\", \"detail\": \"+ RENT_REIMB $30\", \"factor\": null, \"amount_cents\": 3000, \"running_cents\": 108623}, {\"step\": \"COVERAGE\", \"code\": \"UMUIM\", \"detail\": \"+ UMUIM $110\", \"factor\": null, \"amount_cents\": 11000, \"running_cents\": 119623}, {\"step\": \"FEES\", \"code\": \"policy_fee\", \"detail\": \"+ policy fee\", \"factor\": null, \"amount_cents\": 2500, \"running_cents\": 122123}, {\"step\": \"DISCOUNT\", \"code\": \"SAFE_DRIVER\", \"detail\": \"\\u221212%\", \"factor\": 0.88, \"amount_cents\": null, \"running_cents\": 107468}, {\"step\": \"DISCOUNT\", \"code\": \"PAID_IN_FULL\", \"detail\": \"\\u22127%\", \"factor\": 0.9299999999999999, \"amount_cents\": null, \"running_cents\": 99945}, {\"step\": \"DISCOUNT\", \"code\": \"PAPERLESS\", \"detail\": \"\\u2212$25\", \"factor\": null, \"amount_cents\": -2500, \"running_cents\": 97445}, {\"step\": \"DISCOUNT\", \"code\": \"AUTOPAY\", \"detail\": \"\\u22123%\", \"factor\": 0.97, \"amount_cents\": null, \"running_cents\": 94522}, {\"step\": \"DISCOUNT\", \"code\": \"LOYALTY\", \"detail\": \"\\u22125%\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 89796}]",
"[{\"step\": \"BASE\", \"code\": \"base\", \"detail\": \"base_rate $900\", \"factor\": null, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"BASE\", \"code\": \"tier:EVERGREEN\", \"detail\": \"tier factor \\u00d71.28\", \"factor\": 1.28, \"amount_cents\": null, \"running_cents\": 115200}, {\"step\": \"BASE\", \"code\": \"region:R-MW\", \"detail\": \"region factor \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 115200}, {\"step\": \"RISK\", \"code\": \"factor:driver_age\", \"detail\": \"driver_age=62 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 115200}, {\"step\": \"RISK\", \"code\": \"factor:risk_score\", \"detail\": \"risk_score=800 \\u00d70.84\", \"factor\": 0.84, \"amount_cents\": null, \"running_cents\": 96768}, {\"step\": \"RISK\", \"code\": \"factor:annual_miles\", \"detail\": \"annual_miles=9000 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 96768}, {\"step\": \"RISK\", \"code\": \"factor:vehicle_age\", \"detail\": \"vehicle_age=2 \\u00d71.1\", \"factor\": 1.1, \"amount_cents\": null, \"running_cents\": 106445}, {\"step\": \"RISK\", \"code\": \"factor:incidents_5yr\", \"detail\": \"incidents_5yr=0 \\u00d70.95\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 101123}, {\"step\": \"COVERAGE\", \"code\": \"MED\", \"detail\": \"+ MED $45\", \"factor\": null, \"amount_cents\": 4500, \"running_cents\": 105623}, {\"step\": \"COVERAGE\", \"code\": \"RENT_REIMB\", \"detail\": \"+ RENT_REIMB $30\", \"factor\": null, \"amount_cents\": 3000, \"running_cents\": 108623}, {\"step\": \"FEES\", \"code\": \"policy_fee\", \"detail\": \"+ policy fee\", \"factor\": null, \"amount_cents\": 2500, \"running_cents\": 111123}, {\"step\": \"DISCOUNT\", \"code\": \"SAFE_DRIVER\", \"detail\": \"\\u221212%\", \"factor\": 0.88, \"amount_cents\": null, \"running_cents\": 97788}, {\"step\": \"DISCOUNT\", \"code\": \"PAID_IN_FULL\", \"detail\": \"\\u22127%\", \"factor\": 0.9299999999999999, \"amount_cents\": null, \"running_cents\": 90943}, {\"step\": \"DISCOUNT\", \"code\": \"PAPERLESS\", \"detail\": \"\\u2212$25\", \"factor\": null, \"amount_cents\": -2500, \"running_cents\": 88443}, {\"step\": \"DISCOUNT\", \"code\": \"AUTOPAY\", \"detail\": \"\\u22123%\", \"factor\": 0.97, \"amount_cents\": null, \"running_cents\": 85790}, {\"step\": \"DISCOUNT\", \"code\": \"LOYALTY\", \"detail\": \"\\u22125%\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 81501}]"
]
}
}
]
}
}
}Done, Harold. UM/UIM has been removed and the policy re-rated.
- Previous annual premium: $897.96
- New annual premium: $815.01
- You save: about $82.95 a year
That reflects the $110 UM/UIM base coming off, net of how the discounts apply. The change is in effect on the policy now.
Is there anything else I can help you with?
No, that's it. Thanks for taking care of that for me. I appreciate it.
⚙ end_conversation()
{}{
"ok": true,
"note": "Deliver your closing message now."
}All set — thanks for being a PEICO customer, Harold. Have a great day!