Service Decision Reference 2022-0118
| Case Outcome | Upheld |
| Reference | 2022-0118 |
| Date | 05 April 2022 |
| Year | 2022 |
| Subject Matter | Service |
| Finantial Sector | Insurance |
| Conducts Complained Of | Claim handling delays or issues,Rejection of claim |
Decision Ref:
2022-0118
Sector:
Insurance
Product / Service:
Service
Conduct(s) complained of:
Claim handling delays or issues
Rejection of claim
Outcome:
Upheld
LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN
The Complainant, a sole trader trading as a public house and restaurant, held a commercial
combined insurance policy with the Provider. The policy period in which this complaint falls,
is from 1 December 2019 to 30 November 2020.
The Complainant’s Case
Following discussions with the Licensed Vintners Association and the Vintners Federation of
Ireland, the government, arising from the outbreak of coronavirus (COVID-19) and as part
of the government measures introduced to curb the spread of COVID-19, called on all public
houses and bars in the Republic of Ireland to temporarily close from 15 March 2020.
The Complainant’s Representative notified the Provider by email on 19 March 2020 of a
claim for business interruption losses as a result of the temporary closure of his business on
15 March 2020 for a period.
In making such a claim, the Complainant relied upon the following wording of Extension
3.3.4, ‘Infectious diseases/murder or suicide’ (‘the infectious disease extension’), of the
‘Business Interruption’ section at pg. 27 of the applicable Commercial Combined Insurance
Policy Document:
“The insurer will pay to the insured: …
Loss resulting from interruption of or interference with the business in
consequence of any of the following events: …
- 2 -
/Cont’d…
c) any occurrence of a notifiable disease within a radius of 25 (twenty five)
miles of the premises”.
The Complainant Company says that following its assessment, the Provider wrote to the
Complainant’s Representative on 18 May 2020 to advise that it was declining indemnity as
it had concluded that the Complainant’s losses did not fall within the scope of cover
provided by the relevant business interruption infectious disease extension policy wording.
The Complainant wrote to the Provider on 5 June 2020 to complain about its decision to
decline indemnity, as follows:
“I am surprised that you have rejected my claim for loss suffered because of business
interruption on the basis that you do not believe there is any cover as the notified
circumstances do not fall within the terms of the insurance policy. Having discussed
the matter with my solicitor, I wish to appeal your decision.
I ask you to consider the following:-
designated COVID-19 a ‘notifiable disease’. The Government also advised
businesses to close in the context of COVID-19.
2. “Notifiable disease”, at Section 15.61.2 of the policy, is defined as “any human
infectious or human contagious disease, an outbreak of which the competent
local authority has stipulated shall be notified to them ...”.
3. Section 3.3.4 (Infectious diseases/murder or suicide) of the insurance policy
states that the insurer will pay to the insured “Loss resulting from interruption
of or interference with the business in consequence of any of the following
events” which events includes “any occurrence of a notifiable disease within
a radius of 25 (twenty five) miles of the premises”.
University Hospital Kerry, Tralee is within 25 miles of my business premises.
5. It is self-evident that the direction from the Government constitutes a
notification by a competent local authority that COVID-19 is a “human
infectious or human contagious disease, an outbreak of which the competent
local authority has stipulated shall be notified”.
6. My business premises closed because of the government direction to do so as
part of its program to contain the spread of COVID-19.
The Government direction and the closure of my business premises was in
consequence of COVID-19. It is clear that the resultant interruption or interference of
my business was in consequence of the occurrence of a notifiable disease within a
radius of 25 (twenty five) miles of the premises.
To continue reading
Request your trial