Mr Blake passed away after suffering a heart attack on holiday in Lanzarote in 2018
A travel insurer that refused to repatriate a 72-year-old holidaymaker following a heart attack in Lanzarote has been ordered to pay £7000 compensation to his estate, following an ombudsman (FOS) dispute which lasted 18 months.
An interim FOS report last year, which we reported on here, and a provisional decision seen by COVER in January was challenged by insurance provider Union Reiseversicherung (URV) and its claims handler Travel Insurance Facilities (tifgroup), who as a result submitted additional supporting information for the ombudsman to consider.
tifgroup operates a range of travel insurance brands including Flexicover, Holidaysafe, Alpha and Boots travel insurance, among others, via insurance company URV.
In its response, URV and tifgroup argued that it is not for the FOS to dispute the clinical decisions of its medical team; that the quality of medical care Mr Blake received was not their responsibility and that the FOS had overlooked the contractual obligations of the insurer.
However, after reviewing the evidence, ombudsman Anna Wilshaw decided to uphold the complaint against the travel insurer, ordering URV to pay £7000 to the estate of Mr Blake for the "distress and inconvenience" caused.
The decision hits home a travel insurer's obligation to take responsibility for the medical needs of policyholders while abroad.
Last month, The Times issued an apology to tifgroup and agreed to pay damages and costs to the travel insurance operator as it chose to settle a libel case. The newspaper had accused it of ‘a pattern of fraudulent practice' related to Mr Blake and two other policyholders - an allegation it has since admitted is ‘untrue'.
As reported by COVER previously, formal allegations against Dr Miguel Nadal, director of emergency assistance for tifgroup, have been passed by the General Medical Council (GMC) to a Medical Practitioners Tribunal to assess his fitness to practice. The complaints relate to three cases in which families of those who died accuse Dr Nadal and tifgroup of refusing to arrange a medical evacuation - two of these cases featured in The Times libel case, one of them involved Mr Blake.
Mr Blake's daughter, Michelle Sullivan, told COVER she was "delighted" by the final FOS decision, while URV and tifgroup said it has the "deepest sympathy" for the Blake family and agreed to pay the compensation immediately.
URV and tifgroup said: "The resolution of this matter has, unfortunately, taken 18 months, which we appreciate has been difficult for the family. URV disputed the complaint, submitting its representations in February of this year, because this case gave rise to difficult issues concerning the way in which insurers deal with medical advice, which issues needed to be fully considered by the ombudsman. The ombudsman has now made a decision on the very special facts of this case."
‘Unreasonable delays'
While FOS is not in a position to award compensation for the service the Blake family received, as they were not policyholders, the decision does take into account "unreasonable delays in repatriating" Mr Blake and "the service he received" during the six weeks he waited in a hospital in Lanzarote, Wilshaw said.
Despite evidence suggesting that treating hospital doctors in Lanzarote believed that Mr Blake was fit to fly, URV and tifgroup maintain that repatriating him to the UK or moving him to a hospital on a nearby island where he could get alternative treatment was not within his best interests.
The FOS also questioned whether URV and tifgroup's assertion that hospital waiting times in Spain were shorter than in the UK could be applied to a public hospital in Lanzarote.
According to a transcript, the treating doctor told the travel insurer at the time: "One month to have catheterisation done. 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."
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."
tifgroup said: "URV's position is that it acted throughout on the basis of the advice of experienced medical professionals. URV's medical team considered that a flight to the UK was dangerous for Mr Blake. The team believed that Mr Blake would not be able to cope with the stress of the flight, and that he was likely to die on the flight or a few days afterwards.
"The FOS has previously accepted that this type of medical advice could not properly have been ignored by URV. In this case that advice was that repatriating Mr Blake at the time requested by his family or transferring him to another hospital was against his best interests."
In her final decision, Wilshaw said: "I remain satisfied that the discretion to repatriate or move Mr B, set out within the insurance contract, has not been exercised properly in accordance with the regulatory obligations that I have identified and, generally, in line with what I consider to be fair and reasonable in all the circumstances."
She added that she didn't think URV and tifgroup "adequately explained or justified" why they thought the risk of leaving Mr Blake at the hospital in Lanzarote was more acceptable than the risk of bringing him home or sourcing an alternative hospital.
European health card
Another area of focus in this case involved the relationship between the travel insurer and surrounding local private facilities.
According to the FOS report, URV and tifgroup cited a "lack of facilities" and "inappropriate" practices on offer privately as a reason not to move him. However, in light of this, Wilshaw argued that it was not sufficient to leave policyholders, such as Mr Blake, in a position where they would need to rely on the same amount of medical care already available under the reciprocal health agreement in place with the EU.
Wilshaw said: "In line with the FCA's guidance, I'd have expected URV to have taken such issues into account when deciding whether to offer policyholders, such as Mr B, cover in tourist destinations where these issues are apparent, such as the islands Mr B was visiting.
"I remain persuaded that, at the very least, URV ought to make it clear in their policy documentation so that their customers can make an informed choice about this when travelling to destinations that are likely to be affected by issues of this nature."
URV and tifgroup concluded: "We will review our policies and procedures in the light of the FOS decision to identify improvements we can make. At the heart of all of our decision making is the desire to do what is in the best interest of our customers. Regrettably, in a very small number of cases, difficult issues arise and there is sometimes a breakdown in communications. These type of communication issues were identified in Mr Blake's case and we have taken steps to ensure that they do not occur again."
