Perfect Circle Jewelry Insurance Frustration

[missy]

Sending you healing vibes and good thoughts for a full recovery. And big (((HUGS))).

 

[denverappraiser]

It sounds like Graff is an acceptable alternative for both you and them as 'like kind and quality', and they actually want your money. This sounds like a fine solution. As a side benefit, when your finances improve and you want something else, you'll know where to go.

Note to self. Sell. https://www.google.com/finance?q=NYSE:TIF

 

[MrsWhitney]

@denverappraiser- you are 100% right, from this day forward, if I make it, I will be a Graff customer for life. Thank you for your advice.

FOR ALL OF YOU (so many to name), THANK YOU for your kind words, thoughts and prayers. I was born with a major heart defect, have had 5 surgeries, and an updated appointment and blood work found what is now determined as cancer. I do hear Thyroid is the "best" of the cancers- so I am hoping for that; they did find additional tumors though---

Ironically once the jewelry is settled, and all, I may move home- because my husband's hours are long and my mom will be able to care for me during all this. I guess, I just got mad, that because I had an EKG, had to remove all jewelry, and then when I got some preliminary results and my husband I were disheveled, I lost my prized materialistic goods. Obviously, did not plan the course of events that day. At all- had I predicted, I would not have brought anything, but Kleenex.

Again, I CANNOT THANK my PS family enough- those of you may remember me as UCLABelle or Dani- but I stopped coming on as often...used to be more active. I have more time now that I will be in treatment, so I will be on more often Hopefully, with some jewelry

 

[diamondseeker2006]

Please check in and let us know how you are doing and how the jewelry claim goes as well, Dani! We are going to believe that both will work out for your good!!!

 

[MrsWhitney]

@Diamondseeker I miss talking to you; now that I have "ample" time- I will def keep everyone posted. I am sad because I had to cut back hours at my church where I "should" be, but bed, and rest, and hospital/doc visits is just where I will be for a while.

I guess that is why the claim sounded so crazy at first----who takes off all jewelry at once????? I am happy my inherited jewelry was not there- and at my parents home, insured. That (and my life) are priceless...and you are right, I am sure Perfect Circle and Jewelers Mutual will settle it so I can move on.

 

[Karl_K]

I am sorry to hear of your problems.
Thoughts and prayers outgoing for a quick recovery and successful treatment.
Keep in mind that insurance investigators are not police as much as they would like you to think otherwise.
You are under no legal requirement to talk to them and they have no powers beyond any other non-law enforcement person.
If they make you uncomfortable or distressed in any way leave and contact an attorney and the state insurance commission.
Anything beyond a basic what happened interview I would tell them to pound sand.

 

[Karl_K]

I have to do a videos and taped recording for 2 hours; they pulled all cameras around us; my husband has a separate interview for the same amount of time (so he is asking for time off his surgery rotation that day). When asked about how long this could last- I was told MANY months.

You don't "have" to do anything, an insurance investigator is not law enforcement.
They can request that you do an interview but can not compel you to do so and can not legally deny your claim just for refusing.

 

[MrsWhitney]

Dear Karl_K- Thanks for the information; the man just seems annoyed I had to move my appointments around treatment at the doctors and said if I cannot meet him Monday- he is out of town for a few more weeks. An interview is required, in person, taped. My husband, and myself are to be separated. His name is Peter Montalbano I guess, who they contract with; I googled him and he works for Asero Woldwide as well apparently.

I guess it was just bad timing.

It just feels like while I am sure fraud goes on, I never thought I would be the "subject" of it. Especially given the fact it is a massive headache when I DO NOT NEED MORE STRESS....

 

[MollyMalone]

You don't "have" to do anything, an insurance investigator is not law enforcement.
They can request that you do an interview but can not compel you to do so and can not legally deny your claim just for refusing.

Well, they can indeed deny a claim for refusing to participate in the investigational interview or otherwise cooperate with, e.g., a request for the names of other possibly useful witnesses & to produce paperwork relating to the purchase/acquisition of the insured property. Those are among the insured's obligations under the policy.

Which makes sense, and is certainly not unique to Perfect Circle -- or jewelry insurance in general. Otherwise, non-cooperating fraudsters (including, e.g., arsonists who torch their house or business premises in the hope of collecting a fire insurance pay-out) would reap windfalls, to the detriment of us all.

Consequently, this well-intended advice

If they make you uncomfortable or distressed in any way leave and contact an attorney and the state insurance commission.

is a misguided effort to be helpful. Of course, sexual advances, for example, should not be tolerated, but it is not unreasonable for them to ask repeated questions, seeking information from various angles & for the interview to be conducted under oath and recorded; as related in the 2008 PS post I linked previously, having the interview transcribed, and then asking you to review the transcript for accuracy, wouldn't be out of the ordinary either. Such does not give rise to any grounded basis for complaint or legal action.

Again, although this seems unnecessary, probably insulting to most every honest person called upon to do likewise - and is even more distressing for you because of everything else happening to you -- it's a par-for-the-course, business routine for them. And although it was a huge hassle to reschedule your medical appointments in order to be able to do the interview on Monday, there is a bright side to that: it gets the ball rolling towards completion.

So please take deep breaths and be good to yourself this weekend, OK?

 

[Karl_K]

under oath

As much as they like to think otherwise they have no standing to put any one under oath they are not law enforcement nor agents of the court involved in a legal proceeding.
The have no powers other than any other person has when talking to another person.

 

[Karl_K]

You don't "have" to do anything, an insurance investigator is not law enforcement.
They can request that you do an interview but can not compel you to do so and can not legally deny your claim just for refusing.

Well, they can indeed deny a claim for refusing to participate in the investigational interview or otherwise cooperate with, e.g., a request for the names of other possibly useful witnesses & to produce paperwork relating to the purchase/acquisition of the insured property. Those are among the insured's obligations under the policy.

They would really hate to try and defend that in court that a 2 hour interrogation is a reasonable obligation to a policy holder.
My point is they pretend to be something they are not by telling people things are mandatory and under oath so people think it is legal proceeding when legally it is not. They are not law enforcement nor agents of the courts.
If it was then someone even the most innocent person would be crazy not to bring an attorney which would not be a bad idea anyway.
ianl and this is not legal advise consult an attorney licensed in your state for specific legal advise.

 

[MollyMalone]

As much as they like to think otherwise they have no standing to put any one under oath they are not law enforcement nor agents of the court involved in a legal proceeding.
The have no powers other than any other person has when talking to another person.

A bank to whom you apply for a mortgage is neither law enforcement nor an agent of a court involved in a legal proceeding, but what happens if you refuse to subscribe, under penalty of perjury, your mortgage application? The bank won"t accept it for processing.

Let me put this another way: if someone were come to me (a lawyer) and tell me they want to sue their insurance company because it declined to pay out on a claimed loss, and in the course of our consultation, I learn that they refused to participate in the standard, initial investigation & that they want me to "take their case" on a contingency fee basis, I would decline (and kindly explain why),

I honestly don't see what there is to be meaningfully gained by an insured indignantly getting up on their high horse at this juncture; it may feel good in the moment but it doesn't advance you towards recoupment.

P.S. I imagine the 2-hour estimate is-- like the caution that resolution may take a couple of months -- a worst case scenario advisory so the person doesn't make plans to be elsewhere shortly after the scheduled start time. Similar to Citibank telling me last summer, after I was the victim of identity theft, that it could be 2+ months before they would finish their investigation & decide whether to restore the purloined funds to my account. As it turned out, I was "made whole" in a matter of days.

 

[Karl_K]

As much as they like to think otherwise they have no standing to put any one under oath they are not law enforcement nor agents of the court involved in a legal proceeding.
The have no powers other than any other person has when talking to another person.

A bank to whom you apply for a mortgage is neither law enforcement nor an agent of a court involved in a legal proceeding, but what happens if you refuse to subscribe, under penalty of perjury, your mortgage application? The bank won"t accept it for processing.

That would be a Unsworn declaration would it not?
Very different from being under oath in the legal sense.
https://www.law.cornell.edu/uscode/text/28/1746

 

[Karl_K]

Let me put this another way: if someone were come to me (a lawyer) and tell me they want to sue their insurance company because it declined to pay out on a claimed loss, and in the course of our consultation, I learn that they refused to participate in the standard, initial investigation & that they want me to "take their case" on a contingency fee basis, I would decline (and kindly explain why),

Which is why I did not say to not do it and within reason to go along with it and give a voluntary statement.
However there is no excuse for them making someone uncomfortable or fearful and if they cross the line or even if they are not feeling well then the person has every right to walk out.
They are not law enforcement nor agents of the court so they can not compel someone to be there.

 

[MollyMalone]

Karl, here is a sample Perfect Circle policy; you will find "an examination under oath" (what's been called "an interview" here) is among
the obligations on page 3 under the What Must Be Done In Case Of Loss header:
https://www.perfectcircleinsurance....-Personal-Jewelry-Insurance-Policy-SAMPLE.pdf
Because refusing to participate in at least an initial examination under oath (what some may call a deposition) is a material breech of the insured's contractual duty to cooperate, the insurance company can consequently disavow paying out the coverage contemplated by the agreement.

fyi: whether the insured himself/herself feels discomfited, apprehensivd or fearful by the questions asked is not the appropriate yardstick; after all, guilty scammers are likely to be ill at ease in the face of a legitimate course of questions exploring the circumstances surrounding the loss, one's financial history, etc. At the same time, investigators realize that legitimate claimants are going to be nervous for it is indeed a weird position to be in.

I am not saying this will be a casual, brief & breezy "walk in the park"; it isn't intended to be (understandably enough, from an objective perspective) social chit-chat. That's why I linked the 2008 thread with its summary description of being asked, politely, the same kinds of questions "many times", "using a barrage of different tactics", so that Mrs.Whitney wouldn't be thrown for a loop, could have some idea of what to expect from someone with first-hand, similar experience.

Mts.Whitney, here's the counsel I give any witness: you will want to listen and respond to the questions, but "be in the moment", I.e., don't try to second-guess the questiion and therefore give the answer you think they are fishing for; that kind of speculation distracts you from really "hearing" the question and responding accordingly & you can end up inadvertently tripping over yourself. And although you'll conscientiously strive to answer the questions, if you honestly don't know the answer, can't remember, aren't certain, or are drawing a momentary blank, don't be shy about saying so! It's not uncommon for people to "fill in the blanks" because they feel foolish (or some pressure to please), but resist the temptation; there's no good reason to do so. You're only human, not a robot programmed to have perfect total recall.

Take good care, there's lots of positive energy winging your way from behind PSer keyboards ~ Molly

 

[MrsWhitney]

Molly_Malone- I do see where you are coming from; however I do have a sense that I am going into this meeting already presumed guilty; when in fact, jewelry that was lost- some of equally high value was not yet insured (I know, tsk tsk on me). I wish Jewelers Mutual and Perfect Circle had more than 1 claims investigator for NYC.

I like that my husband will be home with me- although in a separate room.

Let the apartment cleaning commence

 

[ame]

Did the police get Video from the hospital that shows you handing your rings to your husband and him putting them in his pocket? Surely they can do so.

 

[MollyMalone]

Molly_Malone- I do see where you are coming from; however I do have a sense that I am going into this meeting already presumed guilty; when in fact, jewelry that was lost- some of equally high value was not yet insured (I know, tsk tsk on me). I wish Jewelers Mutual and Perfect Circle had more than 1 claims investigator for NYC.
I like that my husband will be home with me- although in a separate room.
Let the apartment cleaning commence

Oh, I burst out laughing upon seeing your "Let the apartment cleaning commence" & wink 'cause I too would feel the need to get my apartment ready to receive strangers (or my mother, were she still alive; I did not inherit her enthusiastic zeal for all matters of housework!)

Not sure why you sense you've already been judged, but let me assure you that they have asked you and your husband to be examined under oath does not mean they have jumped to an unfavorable conclusion. And the fact that the investigator has been all-business is sound professionalism on his part; in fact, I'd be raising my eyebrows if he were coming across as your new best friend.

Scooting off to bed, who knows, maybe I'll wake up raring to dust bookshelves and wax floors.

 

[MrsWhitney]

Thank you so much Molly-

I do feel guilty- I mean, I did lose it, I suppose. And you are right, I will stress that the events were so traumatic health wise, I honestly will do my BEST to answer exactly how everything happened (to help when we met with the policy, we went over a timeline) and my husband and I even realized we were off on when bloodwork was done versus the EKG for example. But it was just a traumatic experience. I am fairly healthy- with the congenital heart defect. So, we just, it felt like a death sentence even though it was not.

All I can be is honest. I just initially was caught off guard with the strict interview rules I was given within 24 hours of realizing, there is a 25% chance I will not live to see the ring and jewel replacement anyway-

I have no idea how long they typpically take...

 

[MrsWhitney]

Hi!

It is NYC; so it is a small private practice with no cameras. ESP in patient rooms.

 

[rocks]

The police in NYC (upper east side) will not get involved. The do not consider this to be their responsibility. As for the doctors office, they would be hesitant....hippa violations.....

Just try to go with the flow. Cooperate to the extent that you are able. Get it behind you....you have more important things to focus on.

 

[MrsWhitney]

Dear Rocks- I agree, health is 1, and I put it first, hence why I obviously lost the jewelry- too focused on the "C" word and the notion of tumors. I guess I just, being a LONG time member of pricescope under UCLABelle- would hope to have my jewelry with me. Sometimes a small flash of light of a diamond makes you forget life for a split moment; and I miss that and could really use it now

 

[MissGotRocks]

Oh, so sorry for your troubles! Don't know why life sometimes puts too much on us at one time but it usually all ravels out to be fine. I wish you all the best with the thyroid procedure but there are many, many successful stories about this out there and I'm sure all will be well in time.

I had a car stolen from me at a gas station while I was pumping gas many years ago. I so understand the feeling of you being the criminal instead of the other way around. I was so outraged that this thing had happened to me and couldn't understand why anyone would question me over and over while seeming to be non-sympathetic to my plight. In hindsight, I realize that I too was bringing forward my own feelings of victimization and guilt about what happened. They were just doing their job but at that time I was just shaken to the core. The good thing about investigations is that they will get to the heart of what happened and make it right. I wanted instant replacement; the insurance company said the car had to be gone 30 days before they would consider paying. On the 28th day, the car was found in terrible shape. Because it was a new car, they ripped out all the interior and replaced it with brand new. I wanted a new car and basically got one - just not the way I wanted it to happen. Insurance is good but not perfect so again I understand the Tiffany dilemma. In the end, it was all good though and it will be for you as well. You might even end up with a ring that you love more! I know some of the sentiment is lost but it can still be a good outcome.

Hugs to you and best wishes as you sort through all of these situations. A year from now, you will be whole and good again and this won't seem nearly as traumatizing as it is today. Probably not a lot of comfort right now but I promise you it will be so!

 

[MrsWhitney]

@MissGotRocks- thank you so much; this means a lot- and I am sorry about your car! How horrible. I agree, insurance I guess- I just assumed it would be easy; I appreciate them doing there job- just a tad surprised only 1 adjustment and claims investigator for ALL of NYC. He seems to be a famous security expert, specializing in fraud. I can see how they may view it is odd from the outside- but I am sure if they were there when it occurred, they may have seen how it easily could have happened.

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). They told me to just take out a $60,000+ credit card. Not happening.

They said this is the case for nearly all brands, but I did stop by Graff on the way home, which is 2-3 blocks away, and the Manager will work with the insurance company, so that was nice. I personally prefer Tiffany, but a this point I just want my jewelers replaced at some point. Graff was shockingly very nice- and they actually work on pricing; something I did not know. Good for future purchases.

I have my insurance appointment IN BETWEEN my scan and then an oncology appointment. Then Tuesday a cardiologist. BIG DAYS AHEAD.

 

[MissGotRocks]

I think we all make broad assumptions about a lot of things. You don't get all the facts until you have to put some of this into play. I am really sorry about the Tiffany jewelry; I too would have assumed they would have replaced it. I am stunned by their wanting you to pay out of pocket and then be reimbursed. Many people would have to float a loan to do that - how is that helpful? I'm just sorry that you have this layered upon the health issues but I do really believe it will all work out in the end. Your well being of course is the most important thing right now so see about your appts and the jewelry will work itself out.

Please keep us posted - PS has so many caring members. It's a good place to be when you need nurturing and info!!

 

[MrsWhitney]

MissGotRocks- thank you again- I agree- and if it has to be of similar brand, Graff would be more than fine, and they have been kind- just with my phone call- to see if they deal with insurance companies.

I used to be on PS all the time, I love the community (I was UCLABelle), but then I got busy with my PhD at Cambridge, jobs, marriage, and suddenly stopped. I wish I didn't. I made so many friends- and I even met some in real life for PS get-togethers. This whole cancer bit- and the tumors does put life into perspective; I got caught up in work so much so I forgot to enjoy the little things that once made me happy, such as PriceScope.

Hopefully I will have jewelry to show someday again but in the interim, I will enjoy the beauty of sharing my health journey in the other forum, and use this for any Perfect Circle and/or Jewelers Mutual updates.

 

[MrsWhitney]

Quick related question- is it typical for people to receive multiple documents expressing "fraud"? For example, I just received this evening the mail (I live 4 flights up, so it is hard to get up and down and I waited for my husband to be done from work), and I received my 3rd notice of the "Severity of Committing Fraud" from Perfect Circle?

Again, with my thyroid it could be I am being overly sensitive, but it does seem a bit odd? Three letters within a few days? All including return business reply envelopes for me acknowledging this? Do I keep signing and sending them back?????

 

[MollyMalone]

It's either a computerized mailing snafu or JM/PC sends 'em out until they receive the return mailing from the insured; the first 1 you acknowledged & mailed could take several days to travel from NYC to their headquarters out in Wisconsin. Since you don't have to pay for the return mailing, might as well sign and send off the 2 you have since received; if it makes you feel better, you could attach a note saying you received multiple mailings & that you previously acknowledged & returned the first one received.

2 quick questions for you:
* On the very remote chance you've not already done so, have you searched the handbag you were carrying that day; I know you-your husband recall he put the jewelry in a coat pocket, but maybe it was transferred to your bag for safekeeping
* In addition to filing the lost property report at the local NYPD precinct station, did you also submit a report to the Taxi & Llimosine Commission (since you took a cab from the doctor's office); I know of a couple of people who were pleasantly surprised to learn that their lost property had been turned in by cab drivers. It's possible that jewelry in a pocket fell could fall out in the cab, and wouldn't be great if you could be reunited with it!
https://www1.nyc.gov/apps/311universalintake/form.htm?serviceName=TLC+Lost+Property

 

[MrsWhitney]

Hi Molly-I did check the purse; thank you for the suggestion. I even checked the whole even though I knew "better" hahaha. I cut the lining of my Max Mara $1,000 cashmere coat to see if it was there....it just is not.


In addition to Cancer, my husband's surgery program closed, so we are being relocated to...Knoxville TN. IN 4 WEEKS. We just found out the official word an hour ago. Luckily, they have a good cancer center- and my insurance is even better than mine at Columbia and his at Lincoln Hospital/Cornell. So I will have all treatments covered....

I think I am focusing on my jewelry to 1) take my mind off cancer 2) I love jewelry

Because the only "comparable" store is Graff that will take insurance payment without me fronting the money- does anyone have an idea of how long it takes to process large claims like this???? Once the interview, police report and all other documentation has been given?

I have this miracle that I get to fly to Knoxville with my ring (or one like it), headed towards great cancer treatment. My Mom will be moving with us, to help care for me.

 

[diamondseeker2006]

Oh, that is wonderful you can stay with your husband AND have your mom there to care for you! Talk about major life stresses all at once, though!!! Knoxville is a pretty area..horse country, I think. Been a long time since I have been through that area.

I want to tell you, I totally "get" the jewelry distraction in times of trouble. I have had some difficult periods of time in the past and PS was my wonderful escape into a happy place! So it is good you are back! Have you posted elsewhere...like Family, Home, and Health? I didn't see anything in Hangout.