Service Decision Reference 2022-0243

Case OutcomeRejected
Date25 July 2022
Subject MatterService
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 public house (“the Complainant
Company”) held a ‘Hospitality 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
The Complainant Company’s Broker (“the Broker”) notified the Provider on 9 April 2020 of
a claim for business interruption losses because of the closure of the Complainant
Company’s business, as follows:
“Business forced to close to COVID 19
Business forced to close due to COVID 19 outbreak”
Acknowledging notification of the Complainant Company’s claim, the Provider wrote to the
Broker on 16 April 2020, as follows:
“The cover, provided under the Notifiable Diseases Section 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
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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 or when it was first brought to your attention;
" The date on which the restrictions 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.”
By letter dated 26 May 2020, the Provider wrote to the Broker advising the Broker to provide
the relevant claim information in order to proceed with the claim.
The Complainant Company wrote to its Broker on 1 June 2020, as follows:
“The closure and hence disruption to business claim which we are making is not due
to an outbreak of a virus on the premises, but due to the closure by law of an outbreak
of the COVID 19 virus in the country. So we cannot supply you with documentation.
By letter dated 23 June 2020, the Provider wrote to the Broker advising the Broker to
provide the relevant claim information in order to proceed with the claim. The letter further
advised that if the Provider did not hear from the Broker within four weeks, it would close
the Complainant Company’s file. The Provider wrote to the Broker on 4 August 2020 to
advise that it had closed the file.
On 25 January 2021, the Complainant Company emailed its Broker in respect of renewing
the claim, as follows:
“we would like to renew our claim for disruption to business for the business
being closed in the last policy. I would like to know what all we can claim for and
what we have to do to restart our claim. We are aware that there is a court case on
the 4th Feb which will set a president (sic) for this.”

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