Travel Insurance Facilities (TIF) 'strongly disagrees' with Ombudsman's interim interpretation of case
In November last year, we reported on concerns about the insurer behind Boots travel insurance and a number of other brands.
Travel Insurance Facilities (TIF) at the time ‘wholly' denied the ‘very serious' allegations against it and, as a result of articles in The Times last year, has taken legal proceedings against The Times. The court proceedings are still in progress.
However, TIF is the subject of a complaint to the Financial Ombudsman Service (FOS) related to Martin Blake, one of the policyholders mentioned in The Times story.
Blake suffered a heart attack on 11 February 2018 while on holiday in Lanzarote before passing away around six weeks later shortly after his family decided to fly him back to the UK for treatment.
COVER can today reveal that the Financial Ombudsman Service (FOS), as part of an initial findings letter written to the estate of Mr Blake, has said that Union Reiseversicherung AG (URV), the insurer behind TIF, ‘failed to explore all the available options' to ensure that Blake ‘received the surgery he needed'.
Blake took out his policy through Flexicover; insured by URV, with claims handled by TIF and support provided by Emergency Assistance Facilities (EAF). His estate made a complaint to FOS about how TIF, acting on behalf of URV, had handled Blake's claim and the service they had received. FOS refers to ‘URV' as including ‘all their agents' within the findings.
The FOS letter - which records the initial findings of an FOS case handler - outlines that Mr Blake's estate argues that URV should have repatriated Blake sooner and not doing so ultimately led to his death, while URV argues that it was within his best interests to stay in Lanzarote - as he awaited transferal to a hospital in Gran Canaria - because he was not well enough to travel by air and safe under the care of the Spanish health service.
The 12-page document (re 2083-7045) takes into consideration correspondence between URV and Blake's daughters, as well as conversations involving his treating doctors.
FOS does not consider whether an insurer contributed to anyone's death, it is concerned with the insurer's conduct. In Blake's case, FOS's preliminary finding is that TIF did not meet industry standards in its handling of the claim or the standard of service provided. However, FOS rejected the estate's claim for travel expenses incurred by family members in visiting Blake in hospital in Lanzarote because they fell outside the terms of the policy. It also rejected a claim for compensation.
FOS's findings were sent to the complainants and URV last month and any of them can seek a review from the Ombudsman. In an email to Blake's daughter Michelle Sullivan, the FOS investigator Chris Woolaway, who wrote the report, explained that, following his initial findings, ‘TIF's directors' have asked for ‘more time to respond' and the FOS has asked for their response by mid-June.
TIF has told COVER that it rejected the interim findings and intends to have the conclusions reviewed by the Ombudsman.
‘We have the deepest sympathy for Mrs Sullivan and Ms Blake for the loss of their father,' said TIF. ‘However, we strongly disagree with the Ombudsman's interpretation of the case, and plan to challenge this ‘interim view'.
‘tifgroup's decisions throughout this difficult situation were taken purely on clinical grounds, based on medical advice given to us by experienced doctors with specific medical aviation knowledge, and always in Mr Blake's best interests,' it said.
Fit to fly
TIF's position is that Mr Blake was never fit to fly home, a claim backed by clinical information from its medical officer suggesting that his damaged heart, combined with other conditions, made it unsafe to move him even by air ambulance.
It argues that despite specific clinical reasons as to why it was not suitable to transfer Blake, his family arranged their own air ambulance against its recommendations.
TIF told COVER: ‘Where we consider that repatriation is not in the best medical interests of a patient, should the patient or their family disagree, they are free to make their own arrangements in returning back to the United Kingdom and to submit a claim for costs on their return,' said TIF. ‘This was the case with Mr Blake and his family.
‘We were genuinely saddened that Mr Blake passed away very shortly following the flight that was undertaken against our doctor's recommendations. Mr Blake's family submitted a claim upon their return for the cost of the repatriation and this was paid by us.'
According to the FOS, the insurer also asserted that the treating doctors never actually declared Blake fit to fly or recommended his repatriation, stating that they only said he could be moved due to the wishes of his family.
However, FOS's preliminary conclusion is that this is not consistent with the medical reports. It stated, instead, that URV's emergency assistance team wrote to Blake's daughter Mrs Sullivan on 8 March 2018 saying ‘you are correct in saying that the treating doctors say your father is fit-to-fly', while a note on URV's system dated 23 February specifically states that the treating doctors suggested an air ambulance for catheterisation in the UK.
Translated call recordings do reflect some confusion around Blake's fitness to fly, however the FOS's initial finding is that the evidence supplied does not support URV's point of view.
‘I think URV failed to take several important pieces of information into account, and their decision was based on inaccurate and incomplete information,' said the FOS investigator. ‘I'm not persuaded they've adequately explained why the risks of leaving Mr Blake without adequate monitoring in Lanzarote outweighed the risks of repatriation by air ambulance.'
MS has worked with AHG since 2014
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