Heartbroken- PerfectCircle Outcome

[susan498]

So true. The drama is just a little over the top.

 

[heididdl]

there are no words for what you are in the midst of. I worry that your state of mind is greatly affecting your health. With your dad and husband handling this you must stay strong and fight so you can be reunited with your husband and eventually you will have a beautiful new ring one way or the other......

 

[MrsWhitney]

Thank you Heididdl- it is, so I just, have to let my father, husband, and God handle it. Your ring is beautiful!

 

[MrsWhitney]

I agree. But I guess the amount does not add up (hence the drama). I assumed I was paying for a certain amount, and just was not I guess.

What is the point of an appraisal from the jeweler who makes it though?

 

[denverappraiser]

It's absurd to claim that it's a like kind and quality replacement to swap a genuine Tiffany item with another of similar gemological specs without the branding and from a generic source. They know better. I get asked about Jewelers Mutual a couple of times a week but something tells me my answers are going to change. I even have some of their brochures on my counter. Correction: I used to. No longer.

 

[MollyMalone]

Neil, let me say once more that under the terms of the policy-rider issued for name brand jewelry, the "like kind" MO does not come into play; rather, the insured is expected to first purchase the name brand replacement & then submit the sales receipt to PC for reimbursement.

This is noted on PC's FAQ page & Mrs.Whitney has previously said -- in her preceding thread -- this special condition is set forth in her policy paperwork, but unfortunately, she didn't notice that until recent events prompted her to review it.

 

[ame]

It's absurd to claim that it's a like kind and quality replacement to swap a genuine Tiffany item with another of similar gemological specs without the branding and from a generic source. They know better. I get asked about Jewelers Mutual a couple of times a week but something tells me my answers are going to change. I even have some of their brochures on my counter. Correction: I used to. No longer.

This. Your illness aside, THIS is NOT how you treat a PAYING CUSTOMER.

Chubb needs to start offering policies again for standalone without adding home or cars, because they are THE BEST. There is no comparison.

 

[Niel]

It's absurd to claim that it's a like kind and quality replacement to swap a genuine Tiffany item with another of similar gemological specs without the branding and from a generic source. They know better. I get asked about Jewelers Mutual a couple of times a week but something tells me my answers are going to change. I even have some of their brochures on my counter. Correction: I used to. No longer.

This. Your illness aside, THIS is NOT how you treat a PAYING CUSTOMER.

Chubb needs to start offering policies again for standalone without adding home or cars, because they are THE BEST. There is no comparison.

heres what it says on the perfect circle website under the frequently asked questions page

How do you handle name-brand pieces?
We will replace name-brand pieces with another name-brand piece; however, the claim process is slightly different in that you must repair or replace the item first and then submit your paid receipt to us for reimbursement.

so, and im not on the call with these people, but sounds to me like they are offering her options. You can buy a tiffany and we will reimburse you, or buy a like quality off brand and process the claim the normal way

 

[MrsWhitney]

I had assumed the brand applied to Tiffany......and again, I think that somewhere I should have been made aware that if you cannot pay it all at once, it is only Wholesale plus 16%---because how many jewelers will agree to that? I do understand you though Molly- but have to agree with Neil...and others...it makes me sad that this was their outcome.

With cancer bills and having to have a buffer for further cancer treatment and possible facilities/help, I cannot pay $66,000+.......maybe others can.

*AGAIN since they involved legal teams, I this is my perception of the outcome...

 

[drk14]

MrsW - I am very sorry for what you're going through, and hope that time will bring positive developments on all fronts. The only silver lining here is that it appears that at least the "fraud" investigation was settled in your favor (since the dispute is now about the mechanism and amount of the settlement), is that right? It may not be much if any consolation to you, but there are no doubt many JM/PF policy-holders who following your case on PS and will take action as appropriate (ETA: based on the facts as ultimately established).

Neil, let me say once more that under the terms of the policy-rider issued for name brand jewelry, the "like kind" MO does not come into play; rather, the insured is expected to first purchase the name brand replacement & then submit the sales receipt to PC for reimbursement.

MollyM - Do you have any further info on this name brand policy rider that you've alluded to in several posts? Specifically, where would I find it in my policy if I have it? According to the online FAQ, the same policy (being required to re-purchase and submit receipts for reimbursement) apparently also applies to non-branded jewelry: "If you choose to work with a jeweler that is not on our list of preferred jewelers, the claim process will be slightly different. You will be required to pay for repair or replacement up front and then submit the receipt to us for reimbursement." Thus, it seems that working with a non-preferred jeweler (including T&Co., et al.), and not the name-brand jewelry itself, is what triggers this requirement to submit receipts for reimbursement.

This begs the question: When you submit your receipts, is JM obliged to reimburse the receipts at 100% (up to the coverage amount)? Or will they only reimburse up to the wholesale price + 15%? If anybody can point me to the relevant language in the policy, I would appreciate it.

 

[Niel]

I had assumed the brand applied to Tiffany......and again, I think that somewhere I should have been made aware that if you cannot pay it all at once, it is only Wholesale plus 16%---because how many jewelers will agree to that? I do understand you though Molly- but have to agree with Neil...and others...it makes me sad that this was their outcome.

With cancer bills and having to have a buffer for further cancer treatment and possible facilities/help, I cannot pay $66,000+.......maybe others can.

*AGAIN since they involved legal teams, I this is my perception of the outcome...

MrsW, i hope i dont sound like im belitting your experience or feelings. Its hard when you have an expectation and it isnt met at the most inopportune times. Plus loosing a item worth so much is gut retching. I just want others to see that this isnt a situation of an insurance company trying to screw a paying customer out of an earned claims pay out.

 

[Niel]

MrsW - I am very sorry for what you're going through, and hope that time will bring positive developments on all fronts. The only silver lining here is that it appears that at least the "fraud" investigation was settled in your favor (since the dispute is now about the mechanism and amount of the settlement), is that right? It may not be much if any consolation to you, but there are no doubt many JM/PF policy-holders who following your case on PS and will take action as appropriate (ETA: based on the facts as ultimately established).

Neil, let me say once more that under the terms of the policy-rider issued for name brand jewelry, the "like kind" MO does not come into play; rather, the insured is expected to first purchase the name brand replacement & then submit the sales receipt to PC for reimbursement.

MollyM - Do you have any further info on this name brand policy rider that you've alluded to in several posts? Specifically, where would I find it in my policy if I have it? According to the online FAQ, the same policy (being required to re-purchase and submit receipts for reimbursement) apparently also applies to non-branded jewelry: "If you choose to work with a jeweler that is not on our list of preferred jewelers, the claim process will be slightly different. You will be required to pay for repair or replacement up front and then submit the receipt to us for reimbursement." Thus, it seems that working with a non-preferred jeweler (including T&Co., et al.), and not the name-brand jewelry itself, is what triggers this requirement to submit receipts for reimbursement.

This begs the question: When you submit your receipts, is JM obliged to reimburse the receipts at 100% (up to the coverage amount)? Or will they only reimburse up to the wholesale price + 15%? If anybody can point me to the relevant language in the policy, I would appreciate it.

if you read my above quote you can see where its listed on that FAQ page. I dont know where they list their endorsments vervatim

 

[MrsWhitney]

No Neil, not at all. But I think they need to legally spell out which brands are "branded"; and then clarify that if you are not using a branded item, you only get the wholesale plus 15%.

 

[MrsWhitney]

I may have to wait, if they don't find some middle ground, and hope to get my jewelry replaced after cancer treatment...when I can re-purchase and submit them with the receipts. We are just holding funds like most cancer patients, you know, because you never know what can happen, even with great health insurance.

But at this rate, I may be gone......and it won't matter.....anyway.....

Everyone around me just thought having my jewelry with me, during this time, would be nice. This added hassle, just crushed me.

 

[drk14]

if you read my above quote you can see where its listed on that FAQ page. I dont know where they list their endorsments vervatim

Niel, thanks, I did see that in the FAQ, along with the similar language under "Can I work with my own jeweler or do you specify a jeweler?" that I quoted in my own post. However, because negotiation of a settlement in a real-life situation (like MrsW's) evidently can turn adversarial, what I'm interested in is the legally binding language, which should be found somewhere in the policy document. I'm worried that the FAQ may represent a very loose, best-case-scenario interpretation of the actual contractual obligations. So I would still appreciate a pointer to any relevant policy language that sets out how much JM is required to reimburse in the stipulated scenario, if/when push comes to shove.
(Sorry if this is turning into a threadjack, though!)

 

[Niel]

I may have to wait, if they don't find some middle ground, and hope to get my jewelry replaced after cancer treatment...when I can re-purchase and submit them with the receipts. We are just holding funds like most cancer patients, you know, because you never know what can happen, even with great health insurance.

But at this rate, I may be gone......and it won't matter.....anyway.....

Everyone around me just thought having my jewelry with me, during this time, would be nice. This added hassle, just crushed me.

forgive me if im missing a link in this chain, but couldnt you finance the ring though tiffany, then pay off the financing as soon as the claim is closed?

 

[MrsWhitney]

Neil-I could try, I am not sure I qualify for financing; we used family $ for it. My husband is a MD in residency; I have two BAs from UCLA, a MA from Columbia, a MS from UPenn, and PhD work at the Univ of Cambridge aka our debt/income ratio is a bit high (and I am on medical leave where I work in Academic Affairs at CUMC) at the moment so all credit and incoming money and savings is staying put, for treatment.

 

[Niel]

Neil-I could try, I am not sure I qualify for financing; we used family $ for it. My husband is a MD in residency; I have two BAs from UCLA, a MA from Columbia, a MS from UPenn, and PhD work at the Univ of Cambridge aka our debt/income ratio is a bit high (and I am on medical leave where I work in Academic Affairs at CUMC) at the moment so all credit and incoming money and savings is staying put, for treatment.

thats completely understandable, but wouldnt hurt to have your husband just check with them? I mean, i think i saw on their website it doesnt have interest, and depending on how fast their claims are closed it might not be too much an issue....

lots of ifs, but i know its important to you, so maybe something a loved one can inquire about

 

[MrsWhitney]

Niel- I def will have him check in the am.

 

[MollyMalone]

I had assumed the brand applied to Tiffany......and again, I think that somewhere I should have been made aware that if you cannot pay it all at once, it is only Wholesale plus 16%---because how many jewelers will agree to that? I do understand you though Molly- but have to agree with Neil...and others...it makes me sad that this was their outcome. * * *

I understand this has greatly upset you, but the offer of wholesale + 16% is not per the terms of your contract with them for coverage of the Tiffany pieces. They are now proposing a compromise they are not legally obliged to offer. So they were surely under no obligation to advise you of an outside-the-contract alternative when the insurance agreement was entered into. If this were something they were willing to offer to everyone holding a policy for name brand jewelry, the terms would be different than what you received at the outset.

p.s. It's certainly not just bottom-feeder jewelers who partner with PC; e.g., as you saw in your previous thread, Wink (High Performance Diamonds) partners with PC. Honestly, I'm thinking Tiffany deserves more ire in this scenario; seems to me they could be giving customers like yourself a break by accepting the PC margin since they exacted such a high retail price the first time around.

 

[MrsWhitney]

Molly- I politely disagree- unless I am misunderstanding you...a long-devoted Tiffany & Co buyer, I can see them not wanting to work with PC. Wink may, and I love Wink....but I also do not see Wink as a brand equal (quality sure, perhaps, but brand recognition, probably not).

My policy is NOT restricted to Tiffany, either. So, I am supposed to have the option to replace with "like-brand" or any jeweler of my choice- just no where does it say that jeweler has to 1) provide the wholesale for the item they received it for and then only add 15% markup.

Anyway, I am giving up on it. And letting my family work it out...

 

[MrsWhitney]

Molly- I do appreciate all your help though... did not want to seem ungrateful.

 

[tmorrow]

Molly- I do appreciate all your help though... did not want to seem ungrateful.

I am not exactly following your problem.
Cash flow? Risk of them denying a claim or paying less if you were to purchase and then submit a claim?

Why can you not replace one item at a time(minimizing risk) and when they reimburse you proceed with the next and use short term credit(LOC, CC, Tiffany etc) to do so. Start with a lower priced item.

I also must advise if they are alleging libel or will make things difficult for you as result of you publicly airing your complaint on pricescope, you might want to consider ceasing your participation in this thread and ask the mods to close it while you seek appropriate legal counsel.

It does sound like the possibility of "shaming" them publicly and on pricescope may not be enough to produce a positive outcome for you in this case and this thread may not be helping you.

 

[MollyMalone]

if you read my above quote you can see where its listed on that FAQ page. I dont know where they list their endorsments vervatim

Niel, thanks, I did see that in the FAQ, along with the similar language under "Can I work with my own jeweler or do you specify a jeweler?" that I quoted in my own post. However, because negotiation of a settlement in a real-life situation (like MrsW's) evidently can turn adversarial, what I'm interested in is the legally binding language, which should be found somewhere in the policy document. I'm worried that the FAQ may represent a very loose, best-case-scenario interpretation of the actual contractual obligations. So I would still appreciate a pointer to any relevant policy language that sets out how much JM is required to reimburse in the stipulated scenario, if/when push comes to shove.
(Sorry if this is turning into a threadjack, though!)

The name brand proviso would be triggered by the supporting documents (e.g., recent sales receipt and/or appraisal) submitted in application for insurance on, say, a Cartier ring. I don't own any name jewelry pieces (my Tiffany sterling flatware is on a special rider to my home insurance policy) & PC doesn't seem to have any samples of its name brand provisions posted on its web site. Until her most recent posts, I thought, based on posts in her first thread re the investigation, that what MrsW initially received from PC/JM had spelled out what the drill is, e.g.

*** The Tiffany thing did bother me, I guess that was my fault for not reading the fine print (you purchase it from them, submit the receipt o to JM, and then they reimburse you). *** .

So I am now confused as to what she received when the policy took effect. But I think the take-away for all of us is
* press for details before applying to any insurer (I thought PC routinely spoke with those applying for coverage of $50 Gs or more to make sure people had a good grasp of the terms but maybe I've mixed up PC with another insurer), and
* scrutinize the documents as soon as you receive them, and ask additional questions if need be -- and there is then the option of canceling the policy & get your money back.

I am not sure if Chubb is heads and shoulders above PC for everyone to whom it is available; I'm not seeing any reports of any PSer who has submitted a claim, for any kind of jewelry, in the past 5 years, so Chubb too may now be more difficult when "push comes to shove." And isn't PC the only insurer who covers loose stones while being set (and sent for setting)?

I'm wondering if there is a way, acceptable to the administrators, to collect PSer claims experiences (including contributions from Trade members) going forward?

 

[tmorrow]

I am not sure if Chubb is heads and shoulders above PC for everyone to whom it is available; I'm not seeing any reports of any PSer who has submitted a claim, for any kind of jewelry, in the past 5 years, so Chubb too may now be more difficult when "push comes to shove." And isn't PC the only insurer who covers loose stones while being set (and sent for setting)?

From my experience Chubb is very expensive for "very similar" coverage and usually only available to those who own their own high value home upon which jewelry can be included as part of the coverage. I can't help with claims experience as I don't have any I wouldn't use them as my insurer as they are way overpriced in Canada.

 

[Karl_K]

I am sorry to hear this.
If I said what I thought of PC/JM in the language I am thinking it right now I would get a PS time out for a week.

 

[proto]

@msop

you pay your premium for an insurance policy

what you get is what is stated in your policy

read your policy, preferably before you purchase it

+1

I understand that. I read the policy, and spoke with a representative. I specifically asked what would happen if my ring was lost or stolen... I asked if they would pay for another to be made by Christopher Designs, since it was custom. The representative say, "...of course... it can even be something different, as long as it's of like value..."

This was me asking for specifics as it related to my policy, and that was the answer I received. Would this be a different than the OP's (since mine is GIA certed)?

your policy and OP's policy are unrelated. your policy is your policy.

what your rep told you is almost irrelevant sadly. It should not be, but if it wasnt in writing or recorded, and is contrary to the wording of your policy, your policy issuer may (and is likely to) hold you to the wording on the policy unless you want to go to court and litigate a misrepresentation claim.

read and understand your policy

thats not necessarily correct, i do not work for that company, but the company i work for works like this; we record every call, if on a recorded line we guarenteed coverage, we have to provide that, even if that rep was wrong.

look the bold part.

will post longer tmr when missus not sleeping

yes i read what you said, but what i am saying is most insurance companies record your call and should be noting calls on your policy. so starting off your post by saying that call is irrelevant is misleading

I'm a litigation attorney by background in the UK and I have seen the nitty gritty of insurance claims - not for jewellery but for banks, and the circumstances are basically the same.

You are correct in that, insurance providers should record the call, they should note the call, and they should keep a recording of the call for many years. but in practice:

calls dont get recorded for whatever technical reason
the call gets given the wrong reference numbers so it can never be found when searched
the call gets deleted for technical reasons
the insurance company gets bought out/restructured between the time of the call and when you want to make your claim and records get lost/deleted
no note of the call is actually made by the insurance rep and there is no recording because the company relied only on the note
the note of the call does not match the call
the insurance rep has no memory of the call when asked about it later
the insurance rep has left the company years ago and cannot be traced
the insurance rep says "I do not recall the call, but I would have said [insert policy wording/training speech]" which is not necessarily what you were told on the phone

None of these things is within your control. The only thing you control is the policy wording, which you can read for yourself - carefully. Nobody really reads contracts properly before they buy them, compared to how carefully they are reviewed when something goes wrong. Then they find to their horror that what they signed up for is not what they thought they signed up for, that there are exclusion clauses, limitations, various hoops they should have done by certain date to keep their claim live etcs. Insurance contracts are built to pay out the absolute minimum and to weed out the most potential claims. Not what they advertise, but this is how insurance works. And when the policy holder gets upset, you point to the documentation. Not to say all insurance companies are shady or trying to rip off customers, and I am sure there are good ones, but this is my experience of dealing with insurance companies (admittedly I only see where there is a dispute and never where the claim gets processed smoothly).

Now, lets say the insurance rep told you XYZ on the call which is different to your policy.
You are again correct that generally they should honour the XYZ (depending on further variables/exceptions outside of your control and whether they feel bound to do so), but will the insurance company believe you? See above for all the reasons why they may not be able to find any evidence of what you were told on the call. Thats even assuming they bother to look in the first place, and you will probably need to go through the hassle of escalating internally to get this looked at by someone you would trust to be competent.

Now the insurance rep who sold you the contract is not necessary a bad guy/gal, they may have misunderstood the insurance contract innocently. They may also have stretched the truth or outright lied to you in order to hit their commission targets, or just to keep their job. In some circumstances, they may have been trained incorrectly (deliberately or innocently) to tell you XYZ on the phone when it does not match the policy documentation. On the flipside, you may have misunderstood what the insurance rep said. In other circumstances, in the context of the documentation, what the insurance rep said may have been correct, but you interpreted what they said very differently.

Now lets say there is a real dispute because you were told XYZ but the policy states ABC so you seek legal recourse - a huge escalation. This is so prohibitively expensive that most people dont bother pursuing further because of the time and expense. Litigating in the UK is expensive enough, its even more so in the US. At this stage, the insurer (in the UK at least) will transfer how the dispute is handled to their legal department/their insurer and they will assess whether it is worth defending. It is not the 50% threshold you may expect. It is much much lower, and this is because of relative size and bargaining power. One insurance policy and the cost of litigating it, while high and disproportionate to the value of the claim, is nothing to the insurance company - its the cost of doing business. To the policy holder, this may require mortgaging their house to fund the litigation, so they are much more inclined to settle the claim or not litigate. The insurance companies know this and this is why they will defend claim. Also to prevent spurious claims by try-ons (not saying OP's claim is not legit, there is not enough info to assess either way) and to get a market reputation for being tough to sue, to discourage litigation. Occasionally the legal dept will take the view that they were in the wrong and they should pay out (conduct risk as a regulatory issue/reputation al risk/they think they will lose in litigation), but generally the legal dept is there to kill these claims as fast and cost effectively as possible.

Litigating is one of the most stressful things on earth for individuals, more so than weddings, divorce etcs. You never want to get that far if at all possible.

@Niel - This is why I say what the insurance rep says on the phone is almost irrelevant (although it should not be). Its too hard and cumbersome and time consuming and sometimes impossible to prove what they said to you on the phone.

You read the policy, make sure you understand the policy, and then decide if thats the one you want. If you have queries, you get responses in writing and keep the records yourself.

@MSOP - when you say the following
I read the policy, and spoke with a representative. I specifically asked what would happen if my ring was lost or stolen... I asked if they would pay for another to be made by Christopher Designs, since it was custom. The representative say, "...of course... it can even be something different, as long as it's of like value..."

There is enough wiggleroom in this for the item not to be replaced, they may only replace it to the "like value" of the item, to be defined in the policy wording. On the other hand, they may just replace it.

As to what the appraisal value is for, it is simply for the appraisal value itself and to get a description of the item. The value that your insurance covers is almost certainly NOT the value of the appraisal and your policy will explain how much is insured. You likely have deductions, and discounts applied to this.

Hope this has been helpful.

 

[Harpertoo]

I just want to say I hope the OP has a healthy recovery.

Proto - thank you for the thoughtful & informative post.
I was a commodity broker and my calls were recorded in case of problèmes...and the only time I ever needed recorded evidence it was unavailable due to some technical glitch....
I appreciate the information. Many get insurance as a matter of course with new aquisitions and think we'll never need it - and certainly never press the details. This is a sad reminder.

 

[ame]

I had assumed the brand applied to Tiffany......and again, I think that somewhere I should have been made aware that if you cannot pay it all at once, it is only Wholesale plus 16%---because how many jewelers will agree to that? I do understand you though Molly- but have to agree with Neil...and others...it makes me sad that this was their outcome.

With cancer bills and having to have a buffer for further cancer treatment and possible facilities/help, I cannot pay $66,000+.......maybe others can.

*AGAIN since they involved legal teams, I this is my perception of the outcome...

MrsW, i hope i dont sound like im belitting your experience or feelings. Its hard when you have an expectation and it isnt met at the most inopportune times. Plus loosing a item worth so much is gut retching. I just want others to see that this isnt a situation of an insurance company trying to screw a paying customer out of an earned claims pay out.

That's exactly what it looks like. You rebuy it at your cost, submit it and MAYBE we will reimburse you.

 

[ame]

I am not sure if Chubb is heads and shoulders above PC for everyone to whom it is available; I'm not seeing any reports of any PSer who has submitted a claim, for any kind of jewelry, in the past 5 years, so Chubb too may now be more difficult when "push comes to shove." And isn't PC the only insurer who covers loose stones while being set (and sent for setting)?

From my experience Chubb is very expensive for "very similar" coverage and usually only available to those who own their own high value home upon which jewelry can be included as part of the coverage. I can't help with claims experience as I don't have any I wouldn't use them as my insurer as they are way overpriced in Canada.

I have chubb and do not have my home or cars with them. It's standalone jewelry. And I have had Chubb claims without any issues. One when my rings and purse were stolen at the gym, which i had a police report for, and the other when my rings were damaged in my recent car accident, where they paid out for my eng ring setting only and I replaced that alone bec my stone was fine and I paid out of pocket to repair my wedding band at Tiffany bec the repair cost was incredibly reasonable.