Other Decision Reference 2023-0263

• Case Outcome: Rejected
• Year: 2023
• Date: 29 November 2023
• Reference: 2023-0263
• Subject Matter: Other
• Finantial Sector: Insurance
• Conducts Complained Of: Claim handling delays or issues

Decision Ref:

2023-0263

Sector:

Insurance

Product / Service:

Other

Conduct(s) complained of:

Claim handling delays or issues

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

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 -

/Cont’d…

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”.