HELP!!! Diamond cracked vs feather? Cushion cut 1.78

[Ericaannehamilton]

Please help! I've had my engagement ring for 3 years. Last week, I had an accident which caused me to fall into a cement doorway. My hand took the brunt of it and it hit my ring directly. Afterwards, this is what my ring looked like. It had a raised donut shape issue with what looks like a hole. We have insurance for accidents, so we sent it in. They are now claiming that it is not damaged or cracked, but wear and tear. This literally can't be true since it happened from a fall.

This is what insurance said:
I have reviewed the gemologist report. They found there was wear and tear including pitting and scratching on the surface of the diamond. It also appears the posts are loosened due to wear and tear. There is no crack in the diamond it is a feather in the diamond that reaches the surface. This is a natural characteristic of the diamond and is noted on the GIA report for the diamond.
The policy excludes damage caused by wear and tear, deterioration, inherent vice or defect and any repairing, adjusting, servicing or maintenance. There will be no payment under the policy.

Any advice on how to fight them on this?? Thank you so much!

 

[anangel]

wow- that’s quite a wack!
Do you have any before pictures? I feel like that would help your case of the Imperfection being a result of the accident, and not an inclusion in the diamond. Who is your insurance company?

 

[Ericaannehamilton]

It really was!!! There is even a dent in that side of the prong. Here are some before pictures!

I have USAA. I just can't understand how someone can look at that diamond and tell us that it's a "character" of the stone.

 

[anangel]

Your before and after pictures really speak for themselves. I don’t see how anybody could see that as normal wear and tear. Have you sent them your before pictures? Your pictures are from similar angles- If the flaw was there before, it certainly would’ve shown up in those photos.

 

[hnhn]

I think what they could mean was without those inclusions, reimburse for cracked stone by accident is fine. But, because of those clouds, feathers, needles, crystal, any hit can make it cracks. That kind of crack is not covered.

That is why I was away from any thing like that even clarity of vvs1 ones.

 

[meesmom]

Wow! I cant believe USAA would do this. I have USAA as well and I have a lot of jewelry on my policy. My mom has lost jewelry and never had an issue with a claim. I guess damage is different. And they are so wrong to put you thru this. I would consider opening a claim against them with the BBB? I won a case against a contractor that screwed us over with the BBB.

 

[JulieN]

I hope you are ok from the fall. You can ask the adjuster for a different gemologist? The easiest way to deal with denied claims is to get a lawyer.

 

[Ericaannehamilton]

I think what they could mean was without those inclusions, reimburse for cracked stone by accident is fine. But, because of those clouds, feathers, needles, crystal, any hit can make it cracks. That kind of crack is not covered.

That is why I was away from any thing like that even clarity of vvs1 ones.

The interesting part is though, is that they're saying the coverage is denied because there is no crack or damage

 

[anangel]

I think what they could mean was without those inclusions, reimburse for cracked stone by accident is fine. But, because of those clouds, feathers, needles, crystal, any hit can make it cracks. That kind of crack is not covered.

That is why I was away from any thing like that even clarity of vvs1 ones.

That is flipping absurd! When so many people on jewelry from chain jewelers were most larger diamonds are of I clarity, I don’t see how they can deny your claim. There is nothing about your diamond, that I can see from the pictures, which would suggest it was one whack away from falling apart.

 

[lovedogs]

That is beyond odd. Your stone is clearly damaged, and didnt look like that before (from what I can see). Can you escalate it somehow?

 

[Mreader]

They are just trying to get away with not paying. I would be furious. You will have to go up the chain of command. What jerks. So sorry you are going through this.

 

[Lookinagain]

Are they trying to say that the "donut hole" that is obvious from your photos is a result of wear and tear because of the inclusions that previously existed, and therefore this is just the result of those being there, and then the fall? That's not what they are saying in what you posted. They are saying this is normal wear and tear and I don't buy that at all. What was the clarity grade on your stone on the certificate? Can you post a photo of the entire certificate?

 

[Crazie4Cuts]

Oh dear! I am so sorry this happened to you and hope USAA would have provided a better outcome than what I just read!

It would be good just as @Mreader stated to go to the next level of management, BUT consider that it was already denied by USAA you may want to get an independent certified gemologist appraiser like Neil Beaty https://americangemregistry.com/neil-beaty/ to review your information, pictures and GIA report to help make a solid claim that it was damage in an accident and not due to normal wear and tear.

You should ask the appraiser regarding your situation and if they had experience in situations such as this where they have documented and ‘won’ such a case as yours. I do know you will want to call first and vet which one is best for your situation, if needed then go in person.

Appraisers in your state/City can be found in the Resources tab above and then select Appraisers.

Also ask USAA the timeframe to keep your case open as you do not want this closed until all options have been exhausted.

I have not used an independent certified appraiser, but would want to in your case since you have been denied already and hope an experienced appraiser can help make a case for insurance payment. Although you will have to pay out of pocket for this, it may make a stronger case for your claim.

BTW, Normal wear and tear on your ring should not look like a damage diamond which we can all see from your photos above.

Beware too if USAA does rule in your favor (may take months on their end so be diligent and document every communication with every person and the runaround you may get! But don’t give up!) you may receive a low ball amount. Be sure to show your appraiser what was paid if you have receipts for the ring and diamond separately and ask that the appraiser if they can value what it the ring replacement cost would be for a new ring/diamond and noted in the appraisal.

I know, more work for you. I want you to be made whole again and receive $ so you can use towards a new diamond/ring. You paid for insurance and USAA should not dismiss your claim so easily. I hope this helps.

Always the best,
-C4C

 

[Karl_K]

You need a very very good appraiser to take a look at it where are you located? Not specific.. just state and city or a nearby city.

 

[DejaWiz]

Perhaps get no less than three local jewelers that are certified gemologists to inspect it and give written testimony as to the cause of the current condition, along with a evaluation from a certified jewelry appraiser.

Upload all of the documents along with the before and after photos to the USAA claims communication center (website or app).

 

[Mreader]

OhBeware too if USAA does rule in your favor (may take months on their end so be diligent and document every communication with every person and the runaround you may get! But don’t give up!) you may receive a low ball amount. Be sure to show your appraiser what was paid if you have receipts for the ring and diamond separately and ask that the appraiser if they can value what it the ring replacement cost would be for a new ring/diamond and noted in the appraisal.

I know, more work for you. I want you to be made whole again and receive $ so you can use towards a new diamond/ring. You paid for insurance and USAA should not dismiss your claim so easily. I hope this helps.

Always the best,
-C4C

just a comment on the “lowballing” an FYI that when it comes to ensuring jewelry, if it gets lost or stolen or damaged and they cover it what they will do often is offer to replace the stone with one of the jewelers that they have contracts with. If you don’t go that route and you choose cash payout so you can shop and buy for your own stone you don’t necessarily get what it was appraised for or what you paid for it because they get wholesale prices with the jewelers they contract with. This is one reason I really get frustrated with insurance agencies. It makes it seem like they will just cut you a check for the appraisal amount but often that’s not the case.

 

[tinatark]

just a comment on the “lowballing” an FYI that when it comes to ensuring jewelry, if it gets lost or stolen or damaged and they cover it what they will do often is offer to replace the stone with one of the jewelers that they have contracts with. If you don’t go that route and you choose cash payout so you can shop and buy for your own stone you don’t necessarily get what it was appraised for or what you paid for it because they get wholesale prices with the jewelers they contract with. This is one reason I really get frustrated with insurance agencies. It makes it seem like they will just cut you a check for the appraisal amount but often that’s not the case.

I had an insurance claim... it worked out for me, but I learned, you should pay a little more for "agreed value" coverage for jewelry. With that coverage, they do just cut you a check.

 

[Mreader]

I had an insurance claim... it worked out for me, but I learned, you should pay a little more for "agreed value" coverage for jewelry. With that coverage, they do just cut you a check.

Can you tell me more? There is something called "agreed value" where they just cut you a check? My husband and I were held up at gunpoint and our rings were taken from us - this was many years ago. I had State Farm and it was a fight to get enough $ from them to cover the loss; they didn't just look at my paperwork and cut me a check. They said "ok we can replace it and here's our jewelers etc". I didn't want to do that bc I wanted to buy my stone from a specific vendor and they only wanted to make the check for what they could get it for. It was a horrible experience. By going up the chain, we got what we wanted but it wasn't easy. Anyway perhaps things have changed as that was many years ago. Hopefully the theory won't have to be tested again!

 

[meesmom]

Can you tell me more? There is something called "agreed value" where they just cut you a check? My husband and I were held up at gunpoint and our rings were taken from us - this was many years ago. I had State Farm and it was a fight to get enough $ from them to cover the loss; they didn't just look at my paperwork and cut me a check. They said "ok we can replace it and here's our jewelers etc". I didn't want to do that bc I wanted to buy my stone from a specific vendor and they only wanted to make the check for what they could get it for. It was a horrible experience. By going up the chain, we got what we wanted but it wasn't easy. Anyway perhaps things have changed as that was many years ago. Hopefully the theory won't have to be tested again!

This is the way i think it goes most of the time. My mother lost her diamond earrings (uncertified but purchased from a top diamond dealer in Boston, so they were very good quality) and USAA was all too happy to "replace" them. Thank goodness i talked to her before she actually got the wheels moving on it. I saw the specs. of the stones to be used and that was it, i made her ask for a check instead. After much back and forth, I think she got like 80% of the appraisal value, which was better than the replacements for sure.
I hope OP is able to escalate this matter and win. Its crazy what insurance companies will do not to pay out.

 

[kenny]

I'm very sorry this happened.

But, how in the world could an impact (or anything else, including wear and tear) cause a perfectly round doughnut shape to emerge onto the table of the diamond

Are you sure that doughnut shaped material isn't something ON the diamond?

Did you send the diamond in so the insurance company's gemologist could inspect it?
Did they take those pictures in your opening post?

 

[gm89uk]

What clarity is the diamond?

It's absolutely absurd

They are saying it was pre-existing, then normal wear and tear, of which it is obviously neither. The 'feather' on the diamond couldn't be pre-existing because of your photos, and because it would certainly not be the clarity on the diamond certificate from GIA.

Again you need an appraiser with some authority to state the obvious...

 

[MillieLou]

I'm very sorry this happened.

But, how in the world could an impact (or anything else, including wear and tear) cause a perfectly round doughnut shape to emerge onto the table of the diamond

Are you sure that doughnut shaped material isn't something ON the diamond?

Did you send the diamond in so the insurance company's gemologist could inspect it?
Did they take those pictures in your opening post?

I was wondering the same. Diamond material doesn't crater up like that with an impact... does it?

I would get it to a good appraiser, asap. I'd be inclined to use a trusted PS appraiser.

 

[tinatark]

Can you tell me more? There is something called "agreed value" where they just cut you a check? My husband and I were held up at gunpoint and our rings were taken from us - this was many years ago. I had State Farm and it was a fight to get enough $ from them to cover the loss; they didn't just look at my paperwork and cut me a check. They said "ok we can replace it and here's our jewelers etc". I didn't want to do that bc I wanted to buy my stone from a specific vendor and they only wanted to make the check for what they could get it for. It was a horrible experience. By going up the chain, we got what we wanted but it wasn't easy. Anyway perhaps things have changed as that was many years ago. Hopefully the theory won't have to be tested again!

Agreed value coverage is a little more expensive than regular scheduled coverage - but yes, they write you a check for the "agreed value" upon a total loss - my husband lost my wedding ring, I fought with my company to be made whole - after that transaction was complete, I learned about agreed value - from then on any scheduled items are added as "agreed value" coverage.

 

[Dancing Fire]

But, how in the world could an impact (or anything else, including wear and tear) cause a perfectly round doughnut shape to emerge onto the table of the diamond

Yeah really strange! ..

 

[m-cubed]

Is there any chance this is a fracture filled diamond and the filling agent got pushed to the surface by the impact?

 

[Mreader]

Oh yeah for some reason I didn’t see the first couple of photographs and the later ones look like chipping. What is that ? What does it feel like when you touch it? That is so strange looking!

 

[blingmeupscotty]

My first question would be-is this a rider on a standard homeowners policy? or is this a stand alone jewelry policy covering the diamond itself? Also, were you required to have it independently appraised before it was insured? Or are you paying for blanket coverage?

In either case-the damage done to the item is certainly *not* common and could not easily have been done by you simply knocking it into a wall or scraping it. Remember the first initial claims adjusters denial to approve your claim is just that, a first denial. They are not the end all be all. This is USAA. There are many ways to skin that cat. Work your way up the chain and document everything in this timeline, especially with before and after photos and your appraisal. More emails, more phone calls, more going up the chain of command needs to happen here. Because this is "usaa" and not a regular insurance company the regular dispute channels such as the BBB may not apply because of who we're dealing with. I wish you luck!

 

[yssie]

Is there any chance this is a fracture filled diamond and the filling agent got pushed to the surface by the impact?

GIA will not grade fracture filled or coated diamonds.

 

[Karl_K]

I dont get the images either that's why I am trying to get a rough location so a top end appraiser can be recommended.

 

[monipod]

GIA will not grade fracture filled or coated diamonds.

But what if it was filled/treated after grading? Not suggesting that this was the case with OP's stone, but does it happen?