Service Decision Reference 2023-0252

• Case Outcome: Rejected
• Year: 2023
• Date: 15 November 2023
• Reference: 2023-0252
• Subject Matter: Service
• Finantial Sector: Insurance
• Conducts Complained Of: Rejection of claim

Decision Ref:

2023-0252

Sector:

Insurance

Product / Service:

Service

Conduct(s) complained of:

Rejection of claim

Outcome:

Rejected

LEGALLY BINDING DECISION OF THE FINANCIAL SERVICES AND PENSIONS OMBUDSMAN

The Complainant is a limited company trading as an incoming tour operator (hereinafter

‘the Complainant Company) and it held a Professional Insurance Policy with the Provider.

The policy term in which this complaint falls, is from 23 December 2019 to 22 December

2020. This complaint concerns the Provider’s decision to decline the Complainant

Company’s business interruption claim.

The Complainant Company’s Case

The Complainant Company says that by way of its Representative, it notified the Provider

by email on 28 May 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).

In making its claim, the Complainant Company says it relied upon the following wording in

the ‘Property – Business interruption’ section of its Professional 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”.

- 2 -

/Cont’d…

The Complainant Company says that following its assessment, the Provider emailed the

Complainant Company’s Representative on 8 March 2021 to advise that it was declining

the claim, as it had determined that the Complainant Company’s business was not subject

to mandatory closure as a result of the relevant Government restrictions and that the

Complainant Company was not reliant on its premises in order to operate the business.

The Complainant Company set out its response to the Provider’s declinature in its email of

7 April 2021, as follows:

“The initial response from [Provider] indicates that they do not have a clear

understanding of how our business operates and we now take this opportunity to

explain this in some detail …

We are an incoming tour operator, 95% of our guests come from overseas with 80%

coming from North America. We provide an extensive menu of tours, ranging from

day tours up to 11 days in duration. We arrange all the transport and

accommodation, and a host (tour guide) accompanies our customers in order to

ensure the smooth running of the tour.

We bring our customers to areas of natural beauty, taking in attractions of cultural

and historic significance such as Blarney Castle, Shannon Heritage and Folk Park

and the Giants Causeway. We use scheduled Irish Rail services to bring our

customers from Dublin to our tour destinations, and a variety of coach operators in

the locations visited. We have contacts with hotels and the owners of the various

attractions visited.

In March 2020 the Irish Government introduced restrictions which precluded the

running of tours, these restrictions have continued to this day. From time to time

these restrictions were varied as circumstances changed but they are still in force

and have had enduring effects on our business. In August 2020 we created a new 7-

night (a “staycation with a difference”) tour specifically aimed at the domestic

market in the absence of any overseas visitors. This was at a time when the

lockdown temporarily improved to Level 3 restrictions. Although a series of this tour

was planned, it ran only once, was not a success commercially and we incurred

substantial losses.

These restrictions continue to affect us in different ways as follows:

• We had to close our offices to the general public

• We had to close our offices to our staff, some of whom had to be laid off

while others had to work from home. Our office is the epicentre of our highly

complex and logistical operation which is responsible for delivering a

mixture of tours – from one day to eleven day fully inclusive vacations. The

team involved in such delivery, work together in weaving the different

strands necessary (rail, coach, hotel, B&B, visitor attractions, transfers, and

guides) to create an enjoyable and memorable holiday for our guests. This