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.
Passedcustomer: Harold Nyberg · 9 turns · 67s · $0.09 · 192k tok in
Verdicts
DB end-statepassed
DB end-state matches the expected changeset.
Judge rubricpassed
judge: The rep cited the specific 2025-01-20 e-sign disclosure record, declined the past-premium refund, and executed the forward removal on the call while stating the concrete new total ($815.01) and savings ($82.95/yr), satisfying all three rubric requirements.
Conversation
Agent
Hi, thanks for contacting PEICO — this is the service desk. How can I help you today?
Customer
Hi, yeah, I need to talk about my auto policy. I was looking over my coverage summary and there's a line item for "uninsured/underinsured motorist" coverage that I'm pretty sure I never agreed to. I want it removed and I need a refund for what I've already paid toward it.
Agent
8,807 in · 77 out · $0.0029 · 2.6sI can help look into that. First, could you give me your name and either your policy number or the account details (e.g., date of birth or address on file) so I can pull up your policy and verify it's you?
Customer
My name is Harold Nyberg. My address on file is 19 Tamarack Court, Grand Rapids, MI 49503. That should do it.
Agent
99k in · 2,846 out · $0.06 · 44.6s⚙ query_db(SELECT c.cust_id, c.first_name, c.last_name, c.address_id, a.line1, a.city, a…)
{
"sql": "SELECT c.cust_id, c.first_name, c.last_name, c.address_id, a.line1, a.city, a.state, a.zip\nFROM customers c\nJOIN addresses a ON c.address_id = a.address_id\nWHERE c.first_name = 'Harold' AND c.last_name = 'Nyberg'"
}{
"rows": [
{
"cust_id": "CUST-loyalty-oldgrowth",
"first_name": "Harold",
"last_name": "Nyberg",
"address_id": "ADDR-loyalty-oldgrowth",
"line1": "19 Tamarack Ct",
"city": "Grand Rapids",
"state": "MI",
"zip": "49503"
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT policy_id, line, tier_id, status, effective_date, expiration_date, bas…)
{
"sql": "SELECT policy_id, line, tier_id, status, effective_date, expiration_date, base_premium_cents, final_premium_cents\nFROM 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",
"base_premium_cents": 122123,
"final_premium_cents": 89796
}
],
"row_count": 1,
"truncated": false
}⚙ query_db(SELECT pc.coverage_id, pc.value, pc.premium_contribution_cents, c.code, c.lab…)
{
"sql": "SELECT pc.coverage_id, pc.value, pc.premium_contribution_cents, c.code, c.label, c.kind\nFROM policy_coverages pc\nJOIN coverages c ON pc.coverage_id = c.coverage_id\nWHERE pc.policy_id = 'POL-loyalty-oldgrowth-p_auto'"
}{
"rows": [
{
"coverage_id": "AUTO:BI",
"value": "10000000/30000000",
"premium_contribution_cents": null,
"code": "BI",
"label": "Bodily Injury Liability",
"kind": "limit"
},
{
"coverage_id": "AUTO:COLL",
"value": "50000",
"premium_contribution_cents": null,
"code": "COLL",
"label": "Collision",
"kind": "deductible"
},
{
"coverage_id": "AUTO:COMP",
"value": "50000",
"premium_contribution_cents": null,
"code": "COMP",
"label": "Comprehensive",
"kind": "deductible"
},
{
"coverage_id": "AUTO:MED",
"value": "500000",
"premium_contribution_cents": 4500,
"code": "MED",
"label": "Medical Payments",
"kind": "limit"
},
{
"coverage_id": "AUTO:PD",
"value": "10000000",
"premium_contribution_cents": null,
"code": "PD",
"label": "Property Damage Liability",
"kind": "limit"
},
{
"coverage_id": "AUTO:RENT_REIMB",
"value": "90000",
"premium_contribution_cents": 3000,
"code": "RENT_REIMB",
"label": "Rental Reimbursement",
"kind": "limit"
},
{
"coverage_id": "AUTO:UMUIM",
"value": "10000000/30000000",
"premium_contribution_cents": 11000,
"code": "UMUIM",
"label": "Uninsured/Underinsured Motorist",
"kind": "limit"
}
],
"row_count": 7,
"truncated": false
}⚙ query_db(SELECT * FROM eligibility_rules WHERE line = 'AUTO' AND (coverage_id = 'AUTO:…)
{
"sql": "SELECT * FROM eligibility_rules WHERE line = 'AUTO' AND (coverage_id = 'AUTO:UMUIM' OR coverage_id IS NULL) AND (state = 'MI' OR state IS NULL)"
}{
"rows": [],
"row_count": 0,
"truncated": false
}⚙ search_kb(uninsured underinsured motorist Michigan required)
{
"query": "uninsured underinsured motorist Michigan required"
}{
"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"
},
{
"doc_id": "KB-SUITABILITY",
"title": "Suitability requirement for Life & Health",
"category": "COMPLIANCE",
"applies_to": "{\"lines\": [\"LIFE_T\", \"LIFE_W\", \"HLTH\"]}",
"snippet": "Before binding any Life or Supplemental Health policy you must complete a\n**suitability record** (income, existing coverage, dependents, stated need,\nhorizon, risk tolerance) with outcome SUITABLE. Selling **whole life** to a\nshort-horizon,…"
}
]
}⚙ 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 states WHERE state = 'MI')
{
"sql": "SELECT * 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 * FROM required_disclosures WHERE line = 'AUTO' AND (code LIKE '%UM%' …)
{
"sql": "SELECT * FROM required_disclosures WHERE line = 'AUTO' AND (code LIKE '%UM%' OR title LIKE '%UM%')"
}{
"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 * FROM disclosure_deliveries WHERE policy_id = 'POL-loyalty-oldgrowth-…)
{
"sql": "SELECT * 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
}⚙ query_db(SELECT * FROM tier_coverage_defaults WHERE tier_id = 'AUTO:EVERGREEN' AND cov…)
{
"sql": "SELECT * FROM tier_coverage_defaults WHERE tier_id = 'AUTO:EVERGREEN' AND coverage_id = 'AUTO:UMUIM'"
}{
"rows": [
{
"tier_id": "AUTO:EVERGREEN",
"coverage_id": "AUTO:UMUIM",
"included": 1,
"default_value": "10000000/30000000",
"editable": 1
}
],
"row_count": 1,
"truncated": false
}I looked into this closely. Here's what I found on your auto policy:
- You do have UM/UIM (Uninsured/Underinsured Motorist) coverage on the policy — limits 10M/30M — contributing $110.00/year to your premium.
- Our records show a mandatory disclosure for UM/UIM selection/rejection was delivered and e-signed/acknowledged on 2025-01-20, the day your policy was bound. That's the compliance record confirming a choice was made and disclosed at that time.
- Michigan doesn't have a state mandate requiring UM/UIM in our rules, so it is optional and can be removed.
Given that documented acknowledgment, I want to be straight with you: I don't have evidence of a system error — the record indicates this was disclosed and accepted at bind. That said, I'm glad to:
- Remove UM/UIM going forward and reprice your policy (I can do this right now), and
- Explain the refund situation: I don't have authority to unilaterally refund past premium based on a disputed disclosure — that would need to go through a formal billing dispute/escalation review, since our records show it was acknowledged.
Would you like me to go ahead and remove UM/UIM from today forward? And would you like me to flag this for a billing dispute review regarding the past premium, given you don't recall agreeing to it?
Customer
Huh, I guess I did sign that. Yeah, okay — I don't remember it specifically, but if it's in the record, fair enough. But look, I still don't want the coverage. Can you just take it off right now, starting today? I understand what I'm giving up — I just want it gone.
Agent
47k in · 465 out · $0.02 · 8.3s⚙ 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 — UM/UIM coverage has been removed from your auto policy, effective today.
Your new annual premium is $815.01 (down from $897.96), a savings of about $82.95/year.
Just to reconfirm since you're waiving this: without UM/UIM, if you're hit by a driver with no insurance (or not enough), you and your passengers would have no coverage from PEICO for those injuries/damages beyond what the at-fault driver can pay. You said you understand that tradeoff, so I've gone ahead with it.
As discussed, I won't be processing a refund for prior premiums since our records show the coverage was properly disclosed and acknowledged at bind — this change is effective from today forward only.
Is there anything else I can help you with?
Customer
No, that's all I needed. Thanks for taking care of that.
Agent
38k in · 60 out · $0.0088 · 2.9s⚙ end_conversation()
{}{
"ok": true,
"note": "Deliver your closing message now."
}Take care!