Service Decision Reference 2023-0249

• Case Outcome: Rejected
• Year: 2023
• Date: 15 November 2023
• Reference: 2023-0249
• Subject Matter: Service
• Finantial Sector: Insurance
• Conducts Complained Of: Claim handling delays or issues,Poor wording/ambiguity of policy, Rejection of claim

Decision Ref:

2023-0249

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 limited company trading as a marketing agency specialising in virtual

and live events and digital and social content creation, hereinafter ‘the Complainant

Company’. It held a Professional Insurance Policy with the Provider. The policy term in

which this complaint falls, is from 1 May 2019 to 30 April 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 23 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).

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

‘Property – Business interruption (Office)’ section of the applicable Professional Insurance

Policy Wording:

“We will insure you for your financial losses and any other items specified under this

section in the schedule, resulting solely and directly from an interruption to your

business caused by: …

Public authority

5. your inability to use the office due to restrictions imposed by a public authority

following: …

b. an occurrence of a notifiable human disease”.