Progress on Stage 2 Review with The Society of Lloyds

Feb 1, 2018 we called Joseph because we hadn’t heard anything since our discussion on Jan 26, 2018, when he said he would “get right on it” . He provided us the name and phone number of our case handler, after stating that he was surprised we hadn’t been notified.

We called Annmarie Lyle, a Stage 2 Complaints Executive (Policyholder and Third Party Oversight, Performance Management). We were encouraged to hear that she had already reviewed the file and felt that there were multiple issues. She had prepared a communication to the underwriters which she was about to send. She stated…..

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  • Bill Trenkle report seemed more credible than John Koon’s report because of things that were wrong in his report.
  • ProSight rested on the opinions of the attorney’s but not supported by the facts.
  • The court would not accept the positions of the attorney’s.
  • They couldn’t claim lack of maintenance because of the amount of money spent.

What a relief! We felt like we actually had someone on the phone who was seeing through the crap that had been dished out to us by ProSight. Perhaps there was someone who could actually be an advocate and make this happen.

She said that in these situations where there are two experts with differing views, the approach was to get a third “expert” to break the tie. She readily admitted that she did not have the technical expertise and felt like the underwriters might be willing to get a third opinion. She suggested that she might hear something back from them by the following mid-week (Feb 6-7), and she would let us know what she heard.

We felt guardedly good after getting off the phone. We just can’t get our hopes up. However, we were confident that if they got a qualified person to review the case and all the documentation, we would be successful.

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Still Waiting for The Society of Lloyd’s Stage 2 Review

On December 21st, 2017 we talked with Joseph Dobbins a manager in The Society of Lloyd’s complaint department. He agreed that they would review our complaint and implied that they would move forward aggressively because it had already been in the complaint process for over 8 weeks. It in fact had been in that process at that point it had already been 2+ weeks and 40 weeks since the denial and the complaints process had started. A process which is supposed to be resolved in 8 weeks. At the time we felt that he understood/empathized with our frustration and would take an active part in moving forward. However, we all recognized that nothing would happen quickly around the holidays. The next action would be for the case handler to contact us.

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January 8, 2018 We followed up with Joseph and he told us that ProSight had not provided the files so a case handler had not been assigned. It was decided that we would provide our files to him, so there would be no delay once the person was assigned.

January 11, 2018 prompted by a follow-up email, Joseph responded that he had received our files, but the technical department had to look at them to make sure they were “safe” to open. No update on the status of the ProSight data.

January 18, 2018 we followed up with Joseph and received no response.

January 26th we decided to call Joseph. He told us that he thought everything was moving along and was shocked that we hadn’t received an email introducing the case manager. He apologized profusely and said he would investigate immediately and let us know what he finds out.

It has now been 35 days since the Lloyd’s of London Stage 2 process has officially started and it doesn’t look like we are even to first base or even in the batter order.

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FOS’s Authority to Investigate Complaint

Waiting on Lloyd's againToday is 7 days after the deadline the FOS gave the Society of Lloyd’s to respond and 21 days since the letter was sent by David Northcott of the FOS. David asked if the Society of Lloyd’s agreed that the FOS had the authority to review our complaint. The FOS wants to proceed but they want the SOL to agree so there are no problems after the investigation and decision.

ProSight originally told us to go to the Indiana Department of Insurance  if we disagreed with the denial. However, the IDOI said that they have no authority to investigate this complaint.

LJJ Associates, and ProSight are regulated by the FCA. Therefore, we believe that the FOS should be able to investigate our complaint. Otherwise, no organization is overseeing them.

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One nice thing about putting this blog together has been revisiting documents and websites that you haven’t looked at in a while. We never imagined this specific road block and hadn’t looked at the documents from this perspective. Therefore we were looking at them with a different perspective. Below is what we found.

Lloyd’s Complaint Process

Lloyd's of London Complaint Options (UK or non-UK)The Lloyd’s Complaints page identifies the complaint processing procedures based upon your location and role. Our logical choice is “Lloyd’s policyholders outside the UK. How to make a complaint“.

 

 

 

 

The “outside the UK” page it states “Lloyd’s is currently introducing complaint handling processes for International policyholders and where possible complaints will be handled in line with local regulations.  Where no local regulations exist, complaints will be handled in line with UK principles and standards.”  That’s us! But we need to make sure what that process is!

 

Lloyds US Complaints Handling:

Lloyds US Complains Handling - FCA Authority

On the Lloyd’s US complaints handling page. it states “Lloyd’s arrangements for international complaints are intended to allow for the oversight of complaints handling, consistent with the regulatory expectations of the UK Financial Conduct Authority (FCA), whilst allowing flexibility for managing agents in the way they handle complaints in accordance with local rules.”  So essentially they are giving the agents (ProSight) the latitude to choose. 

However, at the bottom of that page it links to a page Market Bulletin Y5019 (International Complaints Handling: USA). Within the document it states “The new arrangements are being implemented commencing from 1 January 2017 on the renewal of each binding authority or placement.”  Our policy begin April 1 2016. Therefore it appears that we should be processed as a UK policyholder would.

Lloyd’s UK Complaint Process:

The Complaints by Lloyd’s UK Policyholders is described below:

Lloyds Complaints Process for UK policy holders - FOS Authority

If we should be processed in that manner then it appears that the next step is Stage 2. The Society of Lloyd’s should review our complaint.

FOS Authority?

Lloyd’s acknowledges the authority of the FOS to review all complaints in the “Code for Underwriting Agents: UK Personal Lines Claims & Complaints Handling” dated June 2016.

International Complaints

The procedures set out in this Code apply to complaints that arise from UK policies of insurance. Lloyd’s operates separate arrangements for non-UK policyholder complaints. While managing agents must comply with the local rules of any territory where a policy is written, the jurisdiction of the Financial Ombudsman Service is wide and covers firms for all activities carried on from an establishment maintained by it in the United Kingdom (see DISP 1.1.3 & DISP 2.6.1R).

The Financial Ombudsman Service may therefore have jurisdiction over complaints made by eligible complainants in all territories where Lloyd’s underwriters write business. However, the Financial Ombudsman Service has the discretion to dismiss complaints without a consideration of the merits where the complaint is or would be more suitable to be dealt with by a comparable independent complaints scheme or dispute resolution process (DISP 3.3.4(7) & (10)). This would include any equivalent overseas scheme in the jurisdiction where the complainant is based.”

Therefore, since the FOS has the authority and there is not overseas scheme, it would make sense that we proceed.

Conclusion:

  • The new US policy holder procedure didn’t go into effect until policies written starting January 1, 2017. Our policy was written April 1, 2016
  • Lloyd’s acknowledges that when there are no local regulations (which should include the IDOI stating that they have no jurisdiction), it should be reviewed by the FOS.
  • The Lloyd’s underwriting handbook specifically recognizes the FOS’s jurisdiction over all complaints regardless of the territory.

It appears that the only question is whether we should go thru Stage 2 of the UK process or just go right into the FOS process.

Fingers Crossed - AuthorityWe shared our learnings with David Northcott and Daniel Crockford. We don’t want to assume that they are aware of these. We hope that this will move along soon.

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The FOS and Lloyd’s of London Complaint Process

Financial Ombudsman Service

During one of our initial conversations with Daniel Crockford, he explained to us that in the UK there was an independent organization which would investigate unfair practices and denials called Financial Ombudsman Service (FOS). The FOS has a complaint process which is available to everyone with a Lloyd’s of London policy.

Background

The Financial Conduct Authority (FCA) regulates the financial and insurance industry of UK based companies including Lloyd’s of London. If an individual feels they are not treated fairly they can submit a complaint to the FOS and it will be investigated. If the FOS determines that the complainant is correct, the FOS has the authority to force the respondent to pay. Companies do not want cases heard by the FOS because the results are made public. An unfavorable decision reflects poorly on the company and most do not want that exposure.

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This service is also free to the complainant, making it very attractive over seeking expensive legal council. Also in the UK court system the looser pays, significantly increasing the risk of the complainant. This service is intended to equal out the playing field of the large powerful corporation against the individual.

There is also the Lloyd’s of London complaint process. If you have a Lloyd’s of London policy, you can complain to them. In fact, you are supposed to complain to them prior to the FOS. They provide the opportunity for the syndicates internal complaint department to address it. If the result is not satisfactory to the complainants than there is a complaint process within the overseeing Society of Lloyds.

The SOL complaints department will hear the complaint and make a determination. According to the internet, the majority of the cases are overturned. However, if the individual is not satisfied, they still has the ability to go to the FOS.

Recent changes to Lloyd’s complaint process

FOS Complicated Complaint ProcessHere is where it starts to get convoluted.  Effective January 1, 2017, Lloyd’s of London changed their process. If the policyholder is non-UK, and the response from the syndicate’s complaint department is not acceptable, the individual is referred back to the department of insurance in the state where the policy was purchased.

 

Actual Authority

We went to the Indiana Department of Insurance where we live and Florida Department of Insurance where Blue Water Insurance is based. Neither have the authority to address the issues within their complaint process. Therefore, it appears that the Society of Lloyd’s sends us into a black hole and effectively the syndicates have no regulatory oversight. Our only option would be costly arbitration.

Daniel Crockford, our UK solicitor, believes that our case should be heard by the FOS.

Our policy was written in the UK by a FCA regulated company, LJJ. We paid for the policy via Blue Water Insurance, US broker. However, our policy is with LJJ Associates. The policy is underwritten by ProSight Syndicate 1110 which is also regulated by the FCA. The IDOI doesn’t have authority over these organizaitons, therefore it makes sense that our case is investigated by the FOS.

The procedural change is the Lloyd’s of London procedure and not the FOS complaints procedure. So we submitted our complaint to the FOS on July 15, a few days after we had received the final claim denial from ProSight’s complaint department.

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