Service Decision Reference 2022-0093

Case OutcomeRejected
Subject MatterService
Date14 March 2022
Finantial SectorInsurance
Conducts Complained OfRejection of claim,Failure to process instructions
Decision Ref:
Product / Service:
Conduct(s) complained of:
Rejection of claim
Failure to process instructions
The Complainant, a limited company trading as a golf and country club (“the Complainant
Company”) holds a ‘Combined Property Policy’ of insurance 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
By email dated 16 March 2020, the Complainant Company’s Broker (“the Broker”) advised
the Provider of the closure of the Complainant Company’s business due to the outbreak of
COVID-19, as follows:
“We wish to advise that [the Complainant Company’s business] will close this evening
until further notice due to the outbreak of Coronavirus. The hotel staff have been laid
off from 6.00pm today.
In light of the above can you confirm if there is any cover under the Business
Interruption section for loss of revenue while the premises is closed?”
- 2 -
Responding the same day, the Provider advised the Broker, as follows:
“Unfortunately, for the Notifiable Diseases extension on the Policy to become
operative a Notifiable Disease must occur at the Premises and then the Premises
must be subsequently closed by the authorities. As this is not the current scenario the
extension does not apply.”
It appears the Broker notified the Provider on 16 April 2020 of a claim for business
interruption losses as a result of the temporary closure of the Complainant Company’s
business in March 2020 due to the outbreak of COVID-19.
Acknowledging the notification of the claim, the Provider wrote to the Broker on 20 April
2020, as follows:
“The cover, provided under the Notifiable Disease Extension of your Policy, operates
only where there is loss resulting from interruption or interference with the business
as a result of any occurrence of a Notifiable Disease at the Premises, which causes
restrictions on the use of the Premises on the order or advice of the competent
authority. The Indemnity Period is from the date on which the restrictions on the
Premises are applied for a maximum period up to three months, and is subject to a
limit as noted in your Policy.
To enable us to investigate and consider your claim please let us have details of the
occurrence of COVID-19 at your Premises. This should include the following:
- The date of the occurrence of the Notifiable Disease at your Premises or when it
was first brought [to] your attention;
- The date on which the restrictions by the competent authority were put in place;
- The period of the restrictions; and
- Copies of any notices or relevant documents in support of your claim.
Once we have the required information, we will come back to you as quickly as
possible with a decision on cover.”
In response to the Provider’s request for information, the Broker wrote to the Provider on
18 May 2020, as follows:

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