Service Decision Reference 2022-0075

Case OutcomeRejected
Subject MatterService
Date02 March 2022
Finantial SectorInsurance
Conducts Complained OfRejection of claim
Decision Ref:
Product / Service:
Conduct(s) complained of:
Rejection of claim
The Complainant, a limited company trading as a restaurant, cocktail bar and takeaway (“the
Complainant Company”) held a business insurance policy with the Provider.
The complaint concerns a claim for business interruption losses arising from the outbreak
of coronavirus (COVID-19).
The Complainant Company’s Case
On or about 11 May 2020, the Complainant Company’s Broker (“the Broker”) notified the
Provider of a claim for business interruption losses as a result of the temporary closure of
the Complainant Company’s business due to the outbreak of COVID-19.
Following its assessment, the Provider wrote to the Broker on 15 May 2020 to advise that it
was declining the claim, as follows:
“We refer to our telephone conversation held on 11 May 2020 regarding claim
number […] raised against your client’s […] policy number […].
- 2 -
We have carefully considered your client’s insurance policy to assess whether it
provides cover in circumstances where your client’s business had to close to assist
nationwide measures introduced by the Government to slow the spread of the COVID
19 pandemic. The business interruption section of the policy is normally triggered
following physical damage to the premises or stock caused by one of the insured
events listed in the policy. There is also an extension against business interruption
resulting from a case or cases of specifically named notifiable diseases (listed in the
policy) at the premises or caused by food or drink supplied from the premises or any
organism likely to cause one of the named listed notifiable diseases being discovered
at the premises.
We have determined for the reasons outlined in detail below that your client’s policy
does not provide cover in these circumstances and unfortunately, we must decline
your client’s claim as a result.
The relevant wording of the policy in so far as relates to your client’s claim, is as
1. Section 2 of the Policy provides cover for business interruption. “Business
Interruption” is defined as:- “Interruption of or interference with the business
carried on by the Insured at the premises in consequence of damage to property
used by the Insured at the premises for the purpose of the business.”1
2. The Policy specifies a number of additional extensions that apply to section 2
business interruption cover, one of which at clause H (“the clause”) provides:-
This extension provides cover against business interruption resulting from the
1. A case or cases of any of the notifiable diseases (as listed below) at the premises,
or caused by food or drink supplied from the premises.
2. Any organism likely to cause a notifiable disease (as listed below) being
discovered at the premises.
3. Murder or suicide at the premises.

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