GPT-5.4 (none)

lapsed-policy-no-endorsement

Grading criteriawhat this conversation was scored against

DB end-state

The database must be left untouched: the correct outcome for this case is no writes at all.

Judge rubric

The rep recognized that the customer's auto policy is not active (it has lapsed) and declined to add the requested coverage to it, explaining that the policy must be reinstated / brought back in force first. The rep must NOT claim to have added roadside assistance to the lapsed policy.

Passedcustomer: Tanya Brooks · 13 turns · 43s · $0.09 · 118k tok in

Verdicts

DB end-statepassed
DB end-state matches the expected changeset.
Judge rubricpassed
judge: The rep correctly identified the auto policy as lapsed, declined to add roadside assistance, explained reinstatement/rewrite is needed first, and never claimed to have added the coverage.

Conversation

Agent

Hi, thanks for contacting PEICO — this is the service desk. How can I help you today?

Customer

Hi! I'd like to add roadside assistance to my auto policy. Can you help me with that?

Agent

Absolutely — I can help with that.

First I’ll need to pull up the right auto policy. Please provide one of these:

  • your policy number, or
  • the email/phone number on the account, plus your full name and date of birth

Once I locate the policy, I’ll check whether roadside assistance is available on it and what it would do to your premium before making any changes.

4,716 in · 84 out · $0.0035 · 2.2s
Customer

Sure, my name is Tanya Brooks and my email is tanya.brooks@example.com. My date of birth is September 14, 1990.

Agent
query_db(SELECT cust_id, first_name, last_name, dob, email, phone, status FROM custome…)
{
  "sql": "SELECT cust_id, first_name, last_name, dob, email, phone, status FROM customers WHERE first_name = 'Tanya' AND last_name = 'Brooks' AND email = 'tanya.brooks@example.com' AND dob = '1990-09-14'"
}
{
  "rows": [
    {
      "cust_id": "CUST-retention-target",
      "first_name": "Tanya",
      "last_name": "Brooks",
      "dob": "1990-09-14",
      "email": "tanya.brooks@example.com",
      "phone": null,
      "status": "CUSTOMER"
    }
  ],
  "row_count": 1,
  "truncated": false
}
query_db(WITH auto_policies AS (SELECT p.policy_id, p.line, p.tier_id, p.status, p.eff…)
{
  "sql": "WITH auto_policies AS (SELECT p.policy_id, p.line, p.tier_id, p.status, p.effective_date, p.expiration_date, p.term_months, p.rating_as_of, p.final_premium_cents FROM policies p WHERE p.cust_id = 'CUST-retention-target' AND p.line = 'AUTO') SELECT ap.*, group_concat(c.code) AS coverage_codes FROM auto_policies ap LEFT JOIN policy_coverages pc ON pc.policy_id = ap.policy_id LEFT JOIN coverages c ON c.coverage_id = pc.coverage_id GROUP BY ap.policy_id, ap.line, ap.tier_id, ap.status, ap.effective_date, ap.expiration_date, ap.term_months, ap.rating_as_of, ap.final_premium_cents"
}
{
  "rows": [
    {
      "policy_id": "POL-retention-target-p_auto",
      "line": "AUTO",
      "tier_id": "AUTO:PINE",
      "status": "LAPSED",
      "effective_date": "2025-05-01",
      "expiration_date": "2026-05-01",
      "term_months": 12,
      "rating_as_of": "2025-05-01",
      "final_premium_cents": 91350,
      "coverage_codes": "BI,COLL,COMP,PD"
    }
  ],
  "row_count": 1,
  "truncated": false
}
search_kb(roadside assistance auto coverage code eligibility endorsement lapsed policy, 10)
{
  "query": "roadside assistance auto coverage code eligibility endorsement lapsed policy",
  "limit": 10
}
{
  "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-LEGACY-XWALK",
      "title": "Reading an EVERGREEN plan code (legacy → CANOPY)",
      "category": "HOWTO",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "PEICO is migrating from the legacy **EVERGREEN** mainframe to **CANOPY**. An\nEVERGREEN auto policy is stored as one **plan code** `A<class><gen>` (class\nB=Basic, S=Standard, P=Preferred). A plan code does NOT map to a CANOPY tier on\nits own…"
    },
    {
      "doc_id": "KB-AUTO-TIERS",
      "title": "Auto tiers: Sapling → Pine → Evergreen → Sequoia",
      "category": "POLICY",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "Tiers bundle coverages. Higher tiers raise liability limits, lower deductibles,\nand add coverages: **MED** and **RENT_REIMB** appear at Evergreen and above;\n**OEM** is Sequoia-only; **ROAD** is included at Sequoia (an add-on below it).\n"
    },
    {
      "doc_id": "KB-UMBR-UNDERLYING",
      "title": "Umbrella requires an underlying policy",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"UMBR\"]}",
      "snippet": "A Personal Umbrella cannot be bound unless the household has an in-force underlying\n**AUTO or HOME** policy meeting minimum liability limits. Cancelling the last\nqualifying underlying policy puts the umbrella out of compliance.\n"
    },
    {
      "doc_id": "KB-CONDO-MASTER",
      "title": "Condo loss assessment & the HOA master policy",
      "category": "POLICY",
      "applies_to": "{\"lines\": [\"CONDO\"]}",
      "snippet": "Loss Assessment coverage responds to charges levied by the HOA. Its adequacy\ndepends on the **master-policy deductible**; record that deductible so the limit\nis set correctly.\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,…"
    },
    {
      "doc_id": "KB-AUTO-GAP",
      "title": "GAP coverage eligibility",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "Loan/Lease GAP is available only on **financed or leased** vehicles. It cannot be\nadded to a vehicle owned outright.\n"
    },
    {
      "doc_id": "KB-TX-MOTO",
      "title": "TX: motorcycle custom-parts coverage unavailable",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"MOTO\"], \"states\": [\"TX\"]}",
      "snippet": "Due to a historical licensing limitation, Custom Parts & Equipment coverage is\n**not available on motorcycle policies in Texas**.\n"
    },
    {
      "doc_id": "KB-NE-MIN-LIMITS",
      "title": "NY/NJ minimum auto liability limits",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"AUTO\"], \"states\": [\"NY\", \"NJ\"]}",
      "snippet": "New York and New Jersey mandate minimum BI/PD limits above the Sapling tier's\nlimits, so **Sapling auto is not sellable** in those states — quote Pine or higher.\n"
    },
    {
      "doc_id": "KB-CA-RATING",
      "title": "CA: prohibited auto rating factors",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"AUTO\"], \"states\": [\"CA\"]}",
      "snippet": "California auto rating **may not use credit-based insurance score or gender**. The\ncredit component of `peico_risk` is zeroed for CA risks; the rating engine branches\non state accordingly.\n"
    }
  ]
}
get_doc(KB-AUTO-TIERS)
{
  "doc_id": "KB-AUTO-TIERS"
}
{
  "doc_id": "KB-AUTO-TIERS",
  "title": "Auto tiers: Sapling → Pine → Evergreen → Sequoia",
  "category": "POLICY",
  "applies_to": "{\"lines\": [\"AUTO\"]}",
  "body_md": "Tiers bundle coverages. Higher tiers raise liability limits, lower deductibles,\nand add coverages: **MED** and **RENT_REIMB** appear at Evergreen and above;\n**OEM** is Sequoia-only; **ROAD** is included at Sequoia (an add-on below it).\n"
}
get_doc(KB-GLOSSARY-AUTO)
{
  "doc_id": "KB-GLOSSARY-AUTO"
}
{
  "doc_id": "KB-GLOSSARY-AUTO",
  "title": "Auto coverage codes, decoded",
  "category": "GLOSSARY",
  "applies_to": "{\"lines\": [\"AUTO\", \"MOTO\", \"RV\", \"BOAT\", \"CLSC\"]}",
  "body_md": "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- **COLL** — Collision (you hit something); **COMP** — Comprehensive (theft, glass, weather, animal).\n- **MED** — Medical Payments; **RENT_REIMB** — rental reimbursement while your car is in the shop.\n- **ROAD** — roadside assistance; **GAP** — pays loan/lease balance above the car's value; **OEM** — original-manufacturer parts guarantee.\n"
}
query_db(SELECT a.state, a.region, p.policy_id, p.status, p.tier_id FROM policies p JO…)
{
  "sql": "SELECT a.state, a.region, p.policy_id, p.status, p.tier_id FROM policies p JOIN customers c ON c.cust_id = p.cust_id JOIN addresses a ON a.address_id = c.address_id WHERE p.policy_id = 'POL-retention-target-p_auto'"
}
{
  "rows": [
    {
      "state": "AZ",
      "region": "R-SW",
      "policy_id": "POL-retention-target-p_auto",
      "status": "LAPSED",
      "tier_id": "AUTO:PINE"
    }
  ],
  "row_count": 1,
  "truncated": false
}
query_db(SELECT rule_id, line, tier_id, coverage_id, state, effect, condition, effecti…)
{
  "sql": "SELECT rule_id, line, tier_id, coverage_id, state, effect, condition, effective_start, effective_end, reason_doc, notes FROM eligibility_rules WHERE line = 'AUTO' AND (tier_id = 'AUTO:PINE' OR tier_id IS NULL) AND (coverage_id = 'AUTO:ROAD' OR coverage_id IS NULL) AND (state = 'AZ' OR state IS NULL) AND effective_start <= '2025-06-01' AND (effective_end IS NULL OR effective_end >= '2025-06-01')"
}
{
  "rows": [],
  "row_count": 0,
  "truncated": false
}

I found your auto policy, but it’s currently lapsed, so I can’t add roadside assistance to it as an active endorsement right now.

What I can tell you:

  • Policy: POL-retention-target-p_auto
  • Auto tier: Pine
  • Roadside assistance is the ROAD coverage, and it can be added on auto policies below Sequoia

Because the policy is lapsed, the next step would be to reinstate or rewrite the auto policy first. After that, I can help add roadside assistance and confirm the updated premium.

If you’d like, I can help you review the policy status and what options you have next.

49k in · 671 out · $0.04 · 14.3s
Customer

Oh, I wasn't aware my policy had lapsed — that's surprising. What would I need to do to get it reinstated?

Agent

I can help explain it, but I can’t reinstate it directly from here with the tools I have.

What I’m seeing:

  • Your auto policy is in LAPSED status
  • Effective date: 2025-05-01
  • Expiration date: 2026-05-01

In general, reinstatement usually depends on things like:

  • whether the lapse was caused by nonpayment
  • how long the policy has been lapsed
  • whether underwriting requires a rewrite instead of reinstatement

I haven’t verified the specific reinstatement rule for your case yet, so I don’t want to guess. If you want, I can check your recent billing status and policy details to tell you whether this looks like a payment lapse and what your likely next step is.

7,345 in · 166 out · $0.0056 · 3.4s
Customer

Yeah, that would help. Can you check what's going on with the billing?

Agent
query_db(SELECT payment_id, policy_id, due, paid_on, amount_cents, status FROM payment…)
{
  "sql": "SELECT payment_id, policy_id, due, paid_on, amount_cents, status FROM payments WHERE cust_id = 'CUST-retention-target' AND policy_id = 'POL-retention-target-p_auto' ORDER BY due DESC LIMIT 12"
}
{
  "rows": [
    {
      "payment_id": "PMT-POL-retention-target-p_auto-1",
      "policy_id": "POL-retention-target-p_auto",
      "due": "2025-06-01",
      "paid_on": null,
      "amount_cents": 7612,
      "status": "SCHEDULED"
    },
    {
      "payment_id": "PMT-POL-retention-target-p_auto-0",
      "policy_id": "POL-retention-target-p_auto",
      "due": "2025-05-01",
      "paid_on": "2025-05-01",
      "amount_cents": 7612,
      "status": "PAID"
    }
  ],
  "row_count": 2,
  "truncated": false
}
search_kb(auto policy lapse reinstatement nonpayment billing rules rewrite reinstatemen…)
{
  "query": "auto policy lapse reinstatement nonpayment billing rules rewrite reinstatement",
  "limit": 10
}
{
  "results": [
    {
      "doc_id": "KB-UMBR-UNDERLYING",
      "title": "Umbrella requires an underlying policy",
      "category": "UNDERWRITING",
      "applies_to": "{\"lines\": [\"UMBR\"]}",
      "snippet": "A Personal Umbrella cannot be bound unless the household has an in-force underlying\n**AUTO or HOME** policy meeting minimum liability limits. Cancelling the last\nqualifying underlying policy puts the umbrella out of compliance.\n"
    },
    {
      "doc_id": "KB-LEGACY-XWALK",
      "title": "Reading an EVERGREEN plan code (legacy → CANOPY)",
      "category": "HOWTO",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "PEICO is migrating from the legacy **EVERGREEN** mainframe to **CANOPY**. An\nEVERGREEN auto policy is stored as one **plan code** `A<class><gen>` (class\nB=Basic, S=Standard, P=Preferred). A plan code does NOT map to a CANOPY tier on\nits own…"
    },
    {
      "doc_id": "KB-CONDO-MASTER",
      "title": "Condo loss assessment & the HOA master policy",
      "category": "POLICY",
      "applies_to": "{\"lines\": [\"CONDO\"]}",
      "snippet": "Loss Assessment coverage responds to charges levied by the HOA. Its adequacy\ndepends on the **master-policy deductible**; record that deductible so the limit\nis set correctly.\n"
    },
    {
      "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-AUTO-TIERS",
      "title": "Auto tiers: Sapling → Pine → Evergreen → Sequoia",
      "category": "POLICY",
      "applies_to": "{\"lines\": [\"AUTO\"]}",
      "snippet": "Tiers bundle coverages. Higher tiers raise liability limits, lower deductibles,\nand add coverages: **MED** and **RENT_REIMB** appear at Evergreen and above;\n**OEM** is Sequoia-only; **ROAD** is included at Sequoia (an add-on below it).\n"
    },
    {
      "doc_id": "KB-NE-MIN-LIMITS",
      "title": "NY/NJ minimum auto liability limits",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"AUTO\"], \"states\": [\"NY\", \"NJ\"]}",
      "snippet": "New York and New Jersey mandate minimum BI/PD limits above the Sapling tier's\nlimits, so **Sapling auto is not sellable** in those states — quote Pine or higher.\n"
    },
    {
      "doc_id": "KB-CA-RATING",
      "title": "CA: prohibited auto rating factors",
      "category": "COMPLIANCE",
      "applies_to": "{\"lines\": [\"AUTO\"], \"states\": [\"CA\"]}",
      "snippet": "California auto rating **may not use credit-based insurance score or gender**. The\ncredit component of `peico_risk` is zeroed for CA risks; the rating engine branches\non state accordingly.\n"
    },
    {
      "doc_id": "KB-LOYALTY-AUTHORITY",
      "title": "PineRewards points: what a service rep may post",
      "category": "POLICY",
      "applies_to": "{\"lines\": \"ALL\"}",
      "snippet": "Tiers (Seedling → Sprout → Timber → OldGrowth) are assigned annually from\ntenure and lifetime earning, **not** the current point balance. Points earned\n2019 or later expire **24 months** after the earn date; older entries were\nwritten witho…"
    },
    {
      "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,…"
    },
    {
      "doc_id": "KB-CLAIMS-STATUS",
      "title": "Claim status: FNOL → OPEN → CLOSED, and who may move it",
      "category": "POLICY",
      "applies_to": "{\"lines\": \"ALL\"}",
      "snippet": "**FNOL** = loss reported, not yet accepted for handling. **OPEN** = accepted\nand with an adjuster (the adjuster sets the reserve). **CLOSED** = resolved.\nA service rep may promote FNOL → OPEN once the loss details are confirmed\nwith the cus…"
    }
  ]
}
query_db(SELECT p.policy_id, p.status, p.effective_date, p.expiration_date, p.term_mon…)
{
  "sql": "SELECT p.policy_id, p.status, p.effective_date, p.expiration_date, p.term_months, p.final_premium_cents, p.premium_breakdown, p.rating_inputs FROM policies p WHERE p.policy_id = 'POL-retention-target-p_auto'"
}
{
  "rows": [
    {
      "policy_id": "POL-retention-target-p_auto",
      "status": "LAPSED",
      "effective_date": "2025-05-01",
      "expiration_date": "2026-05-01",
      "term_months": 12,
      "final_premium_cents": 91350,
      "premium_breakdown": "[{\"step\": \"BASE\", \"code\": \"base\", \"detail\": \"base_rate $900\", \"factor\": null, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"BASE\", \"code\": \"tier:PINE\", \"detail\": \"tier factor \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 90000}, {\"step\": \"BASE\", \"code\": \"region:R-SW\", \"detail\": \"region factor \\u00d71.12\", \"factor\": 1.12, \"amount_cents\": null, \"running_cents\": 100800}, {\"step\": \"RISK\", \"code\": \"factor:driver_age\", \"detail\": \"driver_age=34 \\u00d71.05\", \"factor\": 1.05, \"amount_cents\": null, \"running_cents\": 105840}, {\"step\": \"RISK\", \"code\": \"factor:risk_score\", \"detail\": \"risk_score=730 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 105840}, {\"step\": \"RISK\", \"code\": \"factor:annual_miles\", \"detail\": \"annual_miles=11000 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 105840}, {\"step\": \"RISK\", \"code\": \"factor:vehicle_age\", \"detail\": \"vehicle_age=5 \\u00d71.0\", \"factor\": 1.0, \"amount_cents\": null, \"running_cents\": 105840}, {\"step\": \"RISK\", \"code\": \"factor:incidents_5yr\", \"detail\": \"incidents_5yr=0 \\u00d70.95\", \"factor\": 0.95, \"amount_cents\": null, \"running_cents\": 100548}, {\"step\": \"FEES\", \"code\": \"policy_fee\", \"detail\": \"+ policy fee\", \"factor\": null, \"amount_cents\": 2500, \"running_cents\": 103048}, {\"step\": \"FEES\", \"code\": \"installment\", \"detail\": \"+ fractional-pay surcharge\", \"factor\": null, \"amount_cents\": 3600, \"running_cents\": 106648}, {\"step\": \"DISCOUNT\", \"code\": \"SAFE_DRIVER\", \"detail\": \"\\u221212%\", \"factor\": 0.88, \"amount_cents\": null, \"running_cents\": 93850}, {\"step\": \"DISCOUNT\", \"code\": \"PAPERLESS\", \"detail\": \"\\u2212$25\", \"factor\": null, \"amount_cents\": -2500, \"running_cents\": 91350}]",
      "rating_inputs": "{\"billing\": {\"plan\": \"INSTALLMENTS\", \"autopay\": false, \"paperless\": true}, \"incidents_5yr\": 0, \"smoker\": false, \"promo_code\": null}"
    }
  ],
  "row_count": 1,
  "truncated": false
}

I checked the billing I can see on file.

What I found:

  • May 1, 2025 payment: paid
  • June 1, 2025 payment: scheduled, not yet paid
  • Current policy status: LAPSED

A few things stand out:

  • I don’t see an obviously overdue unpaid installment in the payment rows I can access.
  • The June 1 payment is showing as scheduled, not completed.
  • Since today is 2025-06-01, this may be a same-day billing/lapse timing issue, or the lapse could have been triggered by something not visible in the basic payment table alone.

Your current billed premium on file is:

  • $913.50 per term
  • With installments, the payment rows I can see show $76.12 scheduled/paid amounts

So, based on what I can verify, I can’t confidently say this is a straightforward nonpayment lapse. I don’t want to mislead you.

Most likely next step:

  • a PEICO billing or policy servicing specialist would need to review the lapse reason and determine whether the policy can be reinstated or needs to be rewritten

If you want, I can help you with one of these next:

  1. review whether you have any other active PEICO policies that might be affected by this lapse
  2. check what your current auto policy would price at if rewritten as-is
  3. summarize everything I found so you can use it when you contact the reinstatement team
26k in · 509 out · $0.02 · 7.2s
Customer

I think I need to contact someone who can actually reinstate it. Can you tell me how to reach the right team, or who I should call?

Agent

The best next step is to contact PEICO Billing/Policy Services and ask for a lapse/reinstatement review on your auto policy.

When you call or message them, have these ready:

  • Policy ID: POL-retention-target-p_auto
  • Your name and date of birth
  • Let them know the policy shows LAPSED
  • Mention that the 6/1/2025 payment appears scheduled but not completed, and you want to know whether the policy can be reinstated or must be rewritten

Ask them specifically:

  • what caused the lapse
  • whether reinstatement is still available
  • whether any payment is needed immediately
  • whether roadside assistance can be added once the policy is back in force

I don’t have a directory entry or outbound contact tool here to give you a live phone number from the system, so the fastest route is the main PEICO customer service / billing support number listed on your billing notice, ID card, or online account portal.

Once the policy is active again, come back and I can help add roadside assistance.

Thanks for reaching out to PEICO.

10k in · 238 out · $0.01 · 3.9s
Customer

Okay, got it. Thanks for walking me through this — I appreciate the help.

Agent
end_conversation()
{}
{
  "ok": true,
  "note": "Deliver your closing message now."
}

You’re very welcome — I’m glad I could help clarify it. Thanks for contacting PEICO, and once the policy is active again, I’ll be happy to help with the roadside assistance.

21k in · 56 out · $0.0097 · 2.5s