Other Decision Reference 2023-0263

Case OutcomeRejected
Date29 November 2023
Subject MatterOther
Finantial SectorInsurance
Conducts Complained OfClaim handling delays or issues
Decision Ref:
Product / Service:
Conduct(s) complained of:
Claim handling delays or issues
The Complainant is a limited company trading as an events and marketing solutions
company, hereinafter ‘the Complainant Company’. It held an Insurance Policy with the
Provider, and this complaint concerns the Provider’s decision to decline the Complainant
Company’s business interruption claim.
The Complainant Company’s Case
The Complainant Company, says that by way of its Representative, it notified the Provider
by email on 12 February 2021 of a claim for business interruption losses sustained due to
measures imposed by the Government to help curb the spread of coronavirus (COVID-19).
The Complainant Company, in making its claim, relied upon the following provision, ‘the
notifiable human disease clause’, in the ‘Property Business interruption (Office)’ section
of the Policy Wording:
We will insure you for your financial losses and any other items specified in the
schedule resulting solely and directly from an interruption to your business caused
by the following: …
Public authority 5. your inability to use the office due to restrictions
imposed by a public authority during the period of
insurance following …
b. an occurrence of a notifiable human disease”.
- 2 -
The Complainant Company notes that the Provider wrote to its Representative on 5 March
2021 to advise that it was declining the claim because it had determined that the
Complainant Company’s business was not subject to mandatory closure as a result of the
relevant Government restrictions and that the Complainant Company was not reliant on its
premises in order to operate the business.
The Complainant Company says that its Representative emailed the Provider on 22 March
2021 regarding its declinature of the claim, as follows:
“…[Complainant Company’s] business provides and undertakes event and
marketing solutions primarily to Retail, Shopping Centres, Department Stores and
the like.
A key factor and integral part to the Business operating, is access to [its] plant,
equipment and props stored at the premises which is used to build and kit out the
set at the location for the marketing events. This could be set for a children’s event,
a cooking demo or a fashion show.
The lockdown included a mandatory closure of all commercial premises, unless they
were providing an essential service (which [Complainant Company] was not), or
travel, which included to work, unless you were an essential worker (which
[Complainant Company] is not)
Obviously with the premises shut due to the Government Order, working remotely
was not an option that would allow the business to operate. Even if [Complainant
Company] were able to continue to use the premises the lockdown order also
prevented any possibility of transporting the props plant and materials from the
premises to locations, as all travel was restricted to essential services and all
construction was specifically stopped along the provision of the people to manage
and undertake the show.
Under the circumstances the claim for [business interruption] must fall within the
cover and we would therefore ask [Provider] for confirmation of this position in
light of the comments above”.
The Complainant Company notes that the Provider responded to its Representative by
email on 29 April 2021, confirming that it was declining indemnity for the reasons
previously stated in its email of 5 March 2021.
The Complainant Company says that its Representative subsequently made a complaint to
the Provider by email on 18 May 2021, as follows:
[Provider’s] assumptions and basis for declinature are inaccurate and unfounded
for the reasons as outlined in my previous email to you on this matter dated 22
March 2021”.

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