Travel Insurance Facilities (TIF) 'strongly disagrees' with Ombudsman's interim interpretation of case
Waiting times
Another area of dispute between the insurer and Mr Blake's estate is the assertion by URV agents that the wait for cardiac procedures was much shorter in Spain than in the UK, which it relied on in part to justify its decision not to repatriate Blake, as his family wished.
TIF told COVER: ‘It is also worth noting that the Spanish healthcare system is excellent. It is rated 7th best worldwide for healthcare by the World Health Organisation (WHO) and 2nd in the world for emergency health care, as opposed to the United Kingdom which is ranked 18th.'
However, according to the FOS letter, waiting times in Spain are not necessarily reflective of those in the Canary Islands for this specific procedure, and URV did not provide any specific evidence to support its position, it said.
The FOS report includes a passage from one of the transcripts from the treating doctor explaining how long Blake would have to wait to receive the catheterisation he needed.
‘One month to have catheterisation done,' the treating doctor is quoted telling URV in the report. ‘It is impossible to do through the public system, as they take a month to do so. We are going to ask you to go private, as I am unable to do it through the public health system.'
In a later tape it is reported he said: ‘Look. This man requires you to come with an ambulance, pick him up and take him to either his country or a place where they can do catheterisation.'
The FOS also found that four days later he said: ‘Look, the air ambulance is so much better than here. He is not even being monitored here, as I do not have a monitor for him. Not even his saturation levels are being monitored; I don't know if you are understanding what I am saying. We live next to Africa! We live next to Africa, we do not have catheterisation.'
The FOS document also points to a statement from Blake's GP which the family supplied in support of its complaint. He contacted the UK hospital and suggests he could have received angiography surgery within 48 to 72 hours if he had been admitted to the local district general hospital in Wrexham via the local cardiac catheterisation lab in Glan Clwyd Hospital.
‘I'm therefore not persuaded that waiting times in the UK were an adequate reason not to bring Mr Blake home,' concluded FOS' Chris Woolaway in the report, who considered that TIF should have made more enquiries into other possible options.
‘We believe that the initial view, expressed in the letter, fundamentally misinterprets the role a travel insurer can take in the clinical management of someone who is sick and injured overseas,' TIF told COVER. ‘Mr Blake was being cared for by doctors in Spain who we had no doubt could and would have treated him appropriately, as was their duty.'
Alternative treatment
The FOS also found that while Blake's insurance policy is not for private treatment, flexibility was available because alternative treatment could have been approved by URV - despite the exclusion - where necessary.
According to the FOS initial findings report: ‘In circumstances where a policyholder can't receive treatment at a public facility, and can't be repatriated, we would expect the insurer to consider private treatment.'
It added: ‘Given the warnings of the treating doctors, I'm persuaded that Mr Blake's situation was one where public treatment was unavailable within a reasonable timescale. URV also said that Mr Blake couldn't be repatriated.'
While there was a private hospital on Lanzarote which did not have the facilities to perform the treatment, a hospital on Tenerife did, the FOS report claimed, yet it is stated that this suggestion was dismissed by URV because it was deemed not appropriate.
‘Given the urgency of the situation and Mr Blake's deteriorating health, the hospital on Tenerife ‘should have been considered as a viable alternative', said the FOS report. It also suggested there were also options available in destinations such as Gibraltar, Seville and Lisbon, however the FOS did not see any proof that these alternatives had been explored by URV. FOS considered that not exploring other alternatives was unsatisfactory.
TIF told COVER that the FOS ‘has misunderstood our position on private clinics'. ‘We only recommend transfer to private clinics if they are better able to deal with serious cases like this one,' it said. ‘In this instance there was no clinic in Lanzarote that could have done more for Mr Blake than where he was being treated.'
Emergency service
The FOS also described various conversations between Mrs Sullivan and doctors engaged by the insurer during the ordeal.
Referring to one discussion, the report said: ‘Mrs Sullivan was clearly upset and frustrated. But URV's doctor did little to help put Mrs Sullivan's mind at ease or answer her questions.' The report stated that when private treatment was not being made available: ‘Mrs Sullivan asked for URV's stance in writing, but URV's doctor said he's under no obligation to provide this and directed her to the complaints department. Mrs Sullivan asked about other private hospitals but URV's doctor didn't answer.'
The FOS report also mentions more than one occasion in which Mrs Sullivan was promised to be called back by URV as she awaited an update but to no avail. In FOS's conclusions, it was only after Blake's case was taken over by the head of URV's assistance team that service provided improved.
Despite not being able to personally award compensation to Mrs Sullivan and Ms Blake, his other daughter, due to them not being ‘eligible complainants' - because they were not policyholders themselves - the FOS recognised the ‘clearly personal distress they've suffered'.
Following their complaint to URV in 2018, the Blakes received £350 for ‘poor service' from URV in a letter on 4 June 2018 but no air ambulance reimbursement until six months after, when URV reimbursed them the full cost of Blake's repatriation
Mrs Sullivan has told COVER that she was not informed of the full pay-out of £23,000 (which included 8% of the payment as additional payment) until two days after The Times called TIF on 15 October.
The FOS concluded in its report: ‘I think URV failed to fulfil their obligations under Mr Blake's insurance policy, and I think the service they provided was exceptionally poor overall,' it said. ‘But the Financial Ombudsman Service can't act beyond the powers we've been given by the regulator.'
TIF told COVER: ‘The letter dated 17 May 2019, is, at this point, an interim 'view', and not the final decision of the FOS. It is an investigator's provisional interpretation of the facts and was not intended for publication.
‘We are disappointed it has found its way prematurely into the public domain while the family's complaint is still being considered by the FOS,' it added.
‘It is far too early to draw any conclusions about this case until the FOS delivers its final decision. That decision won't be taken until we've had a chance to challenge specific points that are misunderstood about Mr Blake's case,' said TIF.
‘We strongly disagree with the initial view of the FOS investigator,' it concluded. ‘We will be submitting information to the FOS in order to challenge the interim view and to seek the final determination of a senior ombudsman.'
COVER intends to publish an update regarding any further FOS findings related to this case in due course.
Travel insurance policies underwritten by TIF on behalf of URV are available via the Boots Travel Insurance website and various other outlets including Holidaysafe, Alpha, Puffin, World-first and Flexicover.
