Stage 2 Review Dilemma

Dec 6th, 2017 we were told that we would be going thru a Lloyd’s Stage 2 review.  The Society of Lloyd’s complaint department will review the complaint and determine if they agree or disagree with the denial. We were told that Lloyd’s would contact us with a case handlers name.

Dec 13 we hadn’t heard from Lloyd’s complaint department, so we called. We were immediately passed off to the international complaints team. Pierre told us that we were to go to our local governmental agency. (Groan…. not again!) We explained that we had been thru that process and the local agency had no jurisdiction. He put us on hold. When he returned he said that his colleague, two desks away had been assigned the case and he would contact us “straight away”.

”More”

Decision Reversed

Dec 15 we still hadn’t received an email or call. So we called again and were transferred to Pierre again. He told us that it had been decided that a Stage 2 would NOT be done and our complaint would go directly to the FOS for their review. We asked him who decided this and when. He said that David Northcott an adjudicator at the FOS had been involved.  We were clearly being passed around like a hot potato that no one wanted.

We immediately sent an email off to David Northcott, explaining what we had been told and asked for an explanation. He replied that he would need to consult the Society of Lloyd’s and would respond to us when he had additional information.

Dec 19 we received an email from David Northcott in which it included the following excerpt from the Lloyd’s complaint department’s response to his inquiry:

“As the case has no doubt already been converted by yourselves, Lloyd’s would not be undertaking a full review and upon receipt of the file, we will be passing this directly to yourself for review”.

What does that mean?

Dec 20 we decided that our best course of action was to call and talk with the individual at Lloyd’s who has been conversing with David. The people on the phone within the Lloyd’s complaint department are so courteous and appearing to want to help. We were finally able to determine that Joseph Dobbins was the person and they put us thru to him.

Finally – An Answer

Joseph was very informative and helpful. He explained that the phrase referred to a technical part of their process and was not relevant to us. He said that they would review the complaint. However, we had the right to bypass their review if we desired. It’s interesting that he referred to us bypassing it rather than not being allowed to go thru it, which is the perception we have gotten from the website and others we talked with.

We explained our concern regarding the settlement limit powers of the FOS, which he acknowledged. But he made it perfectly clear that The Society of Lloyd’s could not force ProSight to pay anything if their findings were different. They could explain their reasons and try to influence them. But it was still up to ProSight to actually change their position and make the payment. We asked how often do they not pay the claim as advised by the SOL. He didn’t have a specific number, but he said it is not infrequent.

We asked how long this would take. He said it is supposed to take less than 8 weeks, but could take months depending on the complexity. He acknowledged that it had already taken longer than 8 weeks and it was thought that we might prefer to move on to the FOS. We told him that we would make a decision and let him know but probably wanted to have the Stage 2 review. We suggested that we could come to London. However, he did not think that a face-to-face meeting would be needed and the case handler could acquire answers over the phone.

Dilemma

So do we go thru the Stage 2 Review process with a decision that can’t be enforced? Yes. Because if they do disagree with ProSight’s denial. Then perhaps influence ProSight to pay so that it does not go to the FOS and become a public record. If they agree with ProSight then it is another set of eyes to review the data and identify weak areas in our complaint that need to be addressed prior to presenting it to the FOS.

But will they be motivated to pay now that they are going thru a run-off? Now there is a new twist!

”Less”

Tell us what you think.