Service Decision Reference 2023-0261

• Case Outcome: Rejected
• Year: 2023
• Date: 29 November 2023
• Reference: 2023-0261
• Subject Matter: Service
• Finantial Sector: Insurance
• Conducts Complained Of: Claim handling delays or issues,Poor wording/ambiguity of policy, Rejection of claim

Decision Ref:

2023-0261

Sector:

Insurance

Product / Service:

Service

Conduct(s) complained of:

Claim handling delays or issues

Poor wording/ambiguity of policy

Rejection of claim

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

The Complainant is a sole trader delivering training for the utility industry at accredited

sites in the United Kingdom. He held an Insurance Policy with the Provider, and the

complaint concerns the Provider’s decision to decline the Complainant’s business

interruption claim. The policy period in which this complaint falls, is from 1 April 2019 to

31 March 2020.

The Complainant’s Case

The Complainant, by way of its Representative, notified the Provider on 29 April 2020 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, in making such a claim, relied upon the following provision, ‘the

notifiable human disease clause’, in the ‘Property – Business interruption’ section of the

Insurance Policy Wording:

“We will also insure you for your loss of income or loss of gross profit and

additional expenses up to the limit stated in the schedule as applicable resulting

solely and directly from an interruption to your business caused by the following

Public authority d. your inability to use the office due to restrictions

imposed by a public authority following: …

ii. an occurrence of a notifiable human disease”.